What is Spine Surgery in Athletes?
Spine surgery is an operative procedure performed to correct spinal abnormalities. Athletes can undergo sports injuries to the spine requiring spine surgery. A sports injury is a physical trauma sustained by a direct impact, overuse, or application of greater force than the body can withstand during a sports activity.
Spine surgery is performed with the intention of returning the athlete to their sports activity at the earliest. Early recovery is important as the more time spent away from the sport, the more difficult it is to get back to competitive form. Spine surgery for athletes involves tissue repair and reconstruction using open or minimally invasive surgical techniques, followed by intensive rehabilitation.
Anatomy of the Spine
The spine, also called the backbone, plays a vital role in stability, smooth movement and protection of the delicate spinal cord. It is made up of bony segments called vertebrae with fibrous tissue called intervertebral discs between them. The vertebrae and discs form the spinal column from the neck to the pelvis, giving symmetry and support to the body.
Indications for Spine Surgery in Athletes
Spine surgery in athletes is indicated to treat spinal injuries sustained during sports activity. These spinal conditions may include:
- Sprains and strains
- Fractured vertebrae
- Whiplash injury
- Dislocation of adjacent bones
- Partial misalignment (subluxation) of adjacent bones
- Disc compression (herniated disc)
- Hematoma (accumulation of blood)
- Partial or complete tears of ligaments
Common Types of Spinal Surgeries in Athletes
Some of the common types of spinal surgeries performed on athletes include:
- Laminectomy: Laminectomy refers to the removal or cutting of the lamina (roof) of the vertebral bones to provide space for the nerves to exit from the spine. The objective of laminectomy is to relieve pressure on the spinal nerves by removing the part of the lamina that is applying pressure on the nerves. It can also be performed to relieve symptoms of a narrowed spinal canal known as spinal stenosis.
- Foraminotomy: A foraminotomy is a surgical procedure that decompresses the spinal nerves by removing bone and other tissues that obstruct the neural foramen (a bony tunnel through which nerve roots exit the spinal canal) and increasing the space of the neural foramen for the nerve roots to exit freely.
- Spinal fusion: The surgical technique of combining two or more vertebrae is known as spinal fusion. In this procedure, your surgeon removes the spinal disc between two or more vertebrae and then fuses the adjacent vertebrae utilizing bone grafts or metal devices fixed by screws. Spinal fusion is the most common type of spine surgery.
- Discectomy: A discectomy is a surgical procedure to remove a herniated or ruptured intervertebral disc that is pressing on the nerve root or the spinal cord to relieve painful symptoms and pressure on the spinal nerves and/or spinal cord.
- Disc replacement: An artificial disc replacement is a surgical procedure employed to remove and replace a damaged or worn out disc in the spine with an artificial or synthetic disc to restore natural height and motion of the spine and relieve painful and debilitating symptoms caused by damaged or worn out discs.
Preparation for Spine Surgery in Athletes
Pre-procedure preparation for spine surgery in athletes will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to the surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
- You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
- You should arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Spine Surgery in Athletes
Spine surgery in athletes is performed either as an open surgery or a minimally invasive surgery and usually involves the following steps:
- You will lie face down on the operating table under the influence of general anesthesia.
- Under fluoroscopic (live X-ray) guidance, your surgeon passes a thin needle called a guidewire through the skin and muscles in your back to locate the diseased area.
- The needle is withdrawn and an incision is made over the spine area to be treated.
- A series of segmental dilators and tubular retractors are used to gradually separate the muscles and create a portal or tunnel through which the surgery can be performed.
- The dilators create a tunnel leading to the affected disc by splitting the back muscles instead of cutting them. Retractors are used to hold the tunnel open.
- The surgery is performed with special surgical instruments passed through the tunnel. Sometimes operative microscopes may also be used to magnify the visual field.
- Viewing through the microscope, the surgeon carries out the necessary spine repair to correct the damage caused by the spinal condition.
- After accomplishing satisfactory correction, the microscope, dilators, retractors, and special instruments are withdrawn, and the muscle fibers are joined back together.
- A small strip of adhesive bandage is applied over the incision site at the completion of the procedure.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after spine surgery will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the spine area is also recommended to reduce inflammation and pain.
- Walking and moving around in bed is strongly encouraged to prevent the risk of blood clots.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
- Instructions on surgical site care and bathing will be provided.
- Eating a high-calcium and low-fat diet is strongly recommended to promote healing and a faster recovery.
- A high-fiber diet and drinking 8 to 10 glasses of water daily are recommended to keep stools soft. Laxatives or stool softeners may also be recommended as needed.
- Activity restrictions until the first follow-up visit include:
- Avoid lifting, bending, or twisting your back
- Do not lift anything heavier than 5 pounds
- Refrain from any strenuous activities such as housework, yard work, or sex
- Refrain from smoking as it inhibits bone growth and delays healing.
- Walking is a good exercise and is strongly recommended to improve your endurance.
- A physical therapy protocol is recommended to help strengthen the spine and optimize its function after the first follow-up visit.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
- Complete recovery and return to sports may take 6 months to a year or longer as it is related to an athlete’s overall health status and the type of sports one is involved with.
- A periodic follow-up appointment will be scheduled to monitor the progress.
Risks and Complications
Spine surgery in athletes is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood loss
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Neurovascular injury
- Persistent pain
- Bowel or bladder problems
- Hardware failure
- Bone graft migration
- Failure of vertebral fusion
- Revision surgery