When Do Patients Return to Physical Activities and Athletics After Scoliosis Surgery?: A Validated Patient Questionnaire Based Study

Abstract

Study design: A retrospective chart review with a survey.

Objectives: This study seeks to determine time of return to normal, physical and athletic activities, and delaying factors after all pedicle screw fixation.

Summary of background data: Return to athletic activity after posterior spine fusion (PSF) in adolescent idiopathic scoliosis (AIS) is largely dependent on a surgeon's philosophy. Some allow contact and collision sports by 6 and 12 months, while others avoid contact sports for 1 year and never allow collision sports. We have utilized a patient driven self-directed approach.

Methods: The sports activity questionnaire (SAQ) was developed and activities were categorized into normal (school, gym, and backpack), physical (running, bending, and bicycling) and athletics (AAP criteria: noncontact, contact and collision sports). SAQ was validated through the "test-retest" method on 25 patients and retesting after 3 weeks to minimize recall bias. Questions with kappa >0.7 were included. Patient demographics, x-ray measurements, and perioperative details were recorded.

Results: Ninety five patients completed the SAQ. By 3 months; 77% (72/93) returned to school, 60% (54/90) to bending, 52% (48/93) to carrying backpacks, 43% (37/87) to running, and 37% (30/81) to gym. By 6 months, 54% (27/50) returned to noncontact sports, and 63% (21/33) to contact sports. 79% and 53% returned to preoperative level of contact and noncontact sports, respectively. Higher body mass index (BMI) was a risk for delayed return (>3 mo) to school and gym (P < 0.05), while fusion below L2 and younger age for running, bending, and carrying backpacks (P < 0.05). In contrast, there was no patient/curve characteristics associated with a delay to sports. Lowest instrumented vertebra (LIV), Lenke types were not risk factors. There was no correction loss, implant failure, or complications.

Conclusion: Patients return to athletics much earlier than expected; a quarter returned by 3 months, and over half by 6 months. Age and LIV are determinants for return to "physical activity."

Level of evidence: 3.