Revista de Medicina Desportiva (English) July 2018 - Page 19

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
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 subsid- ence 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 func- tional 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 impor- tant 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 activ- ity on an average time of 10.3 weeks (interval 7-13 weeks). When com- pared with patients subjected to arthrodesis, the recovery time was 16.5 weeks, with a statistically sig- nificant difference (P = 0.008). Twelve militaries underwent lumbar disc 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 limita- tions. On the group with lumbar arthrodesis, only 67% returned to the previous level of activity, on an aver- age time of 32.4 weeks, without any statistically significant difference (P = 0.156). About the discs arthroplas- ties, 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 radic- ulopathy, 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 sub- mitted to lumbar discs replacement took approximately twice as long to return to physical activity without limitations compared to the cervi- cal 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 con- straints that the surgeons them- selves imposed to the patients that underwent arthrodesis, only allowing physical activity without restrictions after imaging confir- mation of the arthrodesis heal- ing. In turn, there is no radiological Figure 3 – Lumbar disc arthroplasty: schematic image and X-ray in lateral incidence of lumbar spine safety limit for physical activity without limitations for arthroplasties, and it is difficult for surgeons not to allow their prac- tice after the complete resolution of symptoms. This study also highlights the importance of applying rigor- ous 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 arthroplas- ties, 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 physi- cal 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 initi- ated to slight impact and if all the conditions previously referred to cervical arthroplasties are assem- bled 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, fo չ)ѡЁѡɥɕɹѼ)ѥѥٔ́Ѐāݕ̰)хѕɅ܁́ѕȁѡ)ɝѕٕѥQѡ)ٕѥѡЁݼѡѕ)ɽѡȁՑݽ́)ȁѡ́ѕȁѡɝ䁅)ѥЁݡЁɅѥ)ɔѡɝ䁉ѼɅѥ)QٕɅܵѥ݅)ȁ啅́ѡѡ́)ѥ䁅䁍ѥ̰ѡ)I٥ф5ѥلɵձ ܀