Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance

Abstract

Despite the increasing popularity of total lumbar disc replacement (TDR) in predominantly young and active patients, no previous study has addressed possibilities, limitations and potential risks regarding athletic performance following TDR. Mechanical concerns remain and the implant's resilience as regards its load-bearing capacity during sporting activities is unknown. Thirty-nine athletic patients fulfilled the inclusion criteria for this study. These patients participated in a large variety of different types of sport. Significant and lasting pain-relief was attained following TDR with a mean follow-up of 26.3 months (range 9-50.7 months; FU rate 97.4%). Sporting activity was resumed within the first 3 months (38.5%) to 6 months (30.7%) with peak performance being reached after 5.2 months. Thirty-seven patients (94.9%) achieved resumption of sporting activity. Athletic performance improved significantly in 33 patients (84.6%). Minor subsidence was observed in 13 patients (30%) within the first 3 months with no further implant migration thereafter in 12 patients. Participation in all types of sport recorded in this study was accessible for a high rate of patients up to the level of professional athletes as well as those participating in extreme sports. Preoperative participation in sport proved to be a strong positive predictor for highly satisfactory postoperative outcome following TDR. In a selected group of patients, however, preoperative inability to participate in sporting activities did not impair postoperative physical activity. Due to the young age of the patients and significant load increase exerted during athletic activities, persisting concerns regarding the future behaviour of the implant remain and will require longer follow-up, modified investigation techniques and larger patient cohorts.

Fig. 1

Comparison pre/postoperative results for a Visual Analogue Scale (VAS) and b Oswestry Disability Index (ODI) for athlete patients from this study in comparison to our overall results

Fig. 2

Frequency and distribution of participation in various athletic activities

Fig. 3

Comparison pre/postoperative results for a VAS and b ODI between patients with preoperative abstinence from sport due to low-back pain and patients still participating in athletic activity until lumbar disc replacement surgery

Fig. 4

Implant subsidence of 4 mm was observed within the first three postoperative months following total lumbar disc replacement at L5/S1. Despite continued physical activity (cycling, mountaineering) no further migration of the implant was noted thereafter