sports performance being achieved after an average time of 5.2 months after the surgery . About 85 % of the sample significantly improved its sports performance , however , there was a decrease on the sports level in 8 %. Overall , the average sports practice frequency increased by 94 %, from 1.7 times a week before surgery to 3.3 times during the postoperative period . The authors identified that 30 % of the sample developed subsidence of the implant , defined as a minor migration of the prosthesis ( less than 5mm ), with maintenance of its function , and that always occurred in the first three months after its application . Only in one of these patients there was progression of the migration , but without functional impairment of the prosthesis . The authors did not find any relation between the levels of subsidence and sports activity , since other studies on non-athletes demonstrated similar subsidence indices . 48 No radiographic signs of wear of the artificial disc have been identified .
Tumialán L M et al . retrospectively studied military individuals , all with a demanding physical activity , often with high impact causing an important axial and rotational stress on the spine . 5 Twelve soldiers underwent cervical disc arthroplasty at C5-C6 ( n = 8 ) and C6-C7 ( n = 4 ) levels and they could see that they all returned to the same level of physical activity on an average time of 10.3 weeks ( interval 7-13 weeks ). When compared with patients subjected to arthrodesis , the recovery time was 16.5 weeks , with a statistically significant difference ( P = 0.008 ). Twelve militaries underwent lumbar disc
Figure 3 – Lumbar disc arthroplasty : schematic image and X-ray in lateral incidence of lumbar spine arthroplasties at L4-L5 ( n = 5 ) and L5-S1 ( n = 7 ) levels and 83 % ( n = 10 ) returned to the previous activity level on an average time of 22.6 weeks . One of the patients retired from military activity because of persistent symptoms while other returned to physical activity with some limitations . On the group with lumbar arthrodesis , only 67 % returned to the previous level of activity , on an average time of 32.4 weeks , without any statistically significant difference ( P = 0.156 ). About the discs arthroplasties , one of the patients with cervical disc prosthesis developed osteolysis , had its implant removed and an interbody arthrodesis was performed , while another military with lumbar disc prosthesis developed a S1 radiculopathy , that needed decompression surgery . The average follow-up time was only 12.2 months for cervical arthroplasty and 10.7 months for lumbar arthroplasty . The authors concluded that the disc arthroplasty and the interbody arthrodesis have similar results , and these two groups only become functionally equivalent at six months for the cervical spine and at nine months post-operatively for the lumbar spine . Patients submitted to lumbar discs replacement took approximately twice as long to return to physical activity without limitations compared to the cervical arthroplasties , which is probably due to the greater invasion of the lumbar anterior approach fo and to the greater support of loads by the lumbosacral spine . The recovery time is faster for disc arthroplasty compared to arthrodesis , however the authors claim that these results may not have to do directly with the arthroplasty , but with the constraints that the surgeons themselves imposed to the patients that underwent arthrodesis , only allowing physical activity without restrictions after imaging confirmation of the arthrodesis healing . In turn , there is no radiological safety limit for physical activity without limitations for arthroplasties , and it is difficult for surgeons not to allow their practice after the complete resolution of symptoms . This study also highlights the importance of applying rigorous patient selection criteria with correct indication for the success of disc arthroplasty , stating that this can be an excellent option when a faster return to the activity physical is required .
The authors propose algorithms for returning to sports practice after discs arthroplasties 5 : 1 . For the cervical discs arthroplasties , they suggest that the patient can initiate physical activity without impact during the first postoperative month when they no longer have pain or do not need painkillers . During the 2 nd month , they progressively start activity with slight impact . If they are asymptomatic , with mobility of the cervical spine preserved in the dynamic radiographs and if there are no complications with the prosthesis , the patients are allowed from the 3 rd month on to practice physical activity without any restriction , including high impact and contact activities ;
2 . For the lumbar spine prosthesis , they suggest initiation of physical activity without impact when they asymptomatic or without the need for painkillers , which typically occurs only after the 3 rd postoperative month . During the 4 th and 5 th months exercise is initiated to slight impact and if all the conditions previously referred to cervical arthroplasties are assembled is allowed physical exercise without restrictions only after the 6 th month . A German study , carried out with 51 sports practitioners subjected to cervical disc arthroplasty , found that the majority returned to competitive sports in just 11 weeks , and started training a few days after the surgical intervention . 49 The authors even mention that two athletes from their study won medals only four months after the surgery and a patient who did not practice sports before the surgery began to practice . The average follow-up time was four years and the authors did not identify any complications , all the
Revista de Medicina Desportiva informa july 2018 · 17