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
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