High Rates of Successful Return to Competitive Athletics After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Regardless of Distal Fusion Level: A Prospective Cohort Study : Spine

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High Rates of Successful Return to Competitive Athletics After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Regardless of Distal Fusion Level

A Prospective Cohort Study

Fabricant, Peter D. MD, MPHa; Pascual-Leone, Nicolas BAa,b; Gross, Preston W. BSa; Retzky, Julia S. MDa; Green, Daniel W. MD, MSa; Blanco, John S. MDa; Widmann, Roger F. MDa

Author Information

aHospital for Special Surgery, New York, NY

bPerelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

This study was approved by our institution’s Institutional Review Board.

This study was funded in part by the Orthopedic Research and Education Foundation (OREF)/DePuy Resident Research Grant ($5000).

P.D.F.: Clinical Orthopedics and Related Research: Editorial or governing board, Osso VR: Stock or stock Options, WishBone Orthopedics: Paid consultant. D.W.G.: American Academy of Orthopaedic Surgeons (AAOS): Board or committee member, AO Trauma International: Paid presenter or speaker, Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker, Current Opinion in Pediatrics: Editorial or governing board; Publishing royalties, financial or material support, New York County Medical Society: Board or committee member, New York State Society of Orthopedic Surgeons: Board or committee member, PatelloFemoral Foundation: Board or committee member, Pediatric Orthopedic Society of North America: Board or committee member, Pediatric Research in Sport Medicine: Board or committee member, Pega Medical: IP royalties, Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support. J.S.B.: OrthoPediatrics: Paid consultant, Wishbone: Paid consultant. R.F.W.: Medtronic: Paid consultant, OrthoPediatrics: IP royalties, Spine Deformity Journal Editorial Board: Editorial or governing board, Springer: Journal of Children’s Orthopedics Editorial Board: Editorial or governing board. The remaining authors report no conflicts of interest.

Address correspondence and reprint requests to Peter D. Fabricant, MD, MPH, Pediatric Orthopedic Surgery and Sports Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021; E-mail: [email protected]

Spine 48(11):p 737-741, June 1, 2023. | DOI: 10.1097/BRS.0000000000004599

Abstract

Study Design. 

Prospective cohort.

Objective. 

To determine if distal spinal fusion level is associated with postoperative sport participation after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Summary of Background Data. 

The concept of “saving a level” during PSF for AIS refers to minimizing the distal extent of lumbar fusion to theoretically allow for increased postoperative spinal mobility and a more predictable return to athletic activity, as well as minimizing the risk of degenerative disc disease. There are few prospective studies evaluating the correlation between distal fusion level and timing of return to sports.

Materials and Methods. 

Adolescent patients undergoing PSF for AIS between 2009 and 2019 were approached at their presurgical visit to participate in this prospective study. Participants were followed for a minimum of 2 years after surgery. Sports participation (classified by sport type and level of competitiveness) and radiographic data were collected at the initial visit. At each postoperative visit, it was noted whether patients returned to the same sport type and level of competitiveness.

Results. 

After an a priori power calculation was performed, a total of 106 participants were included in the analysis with a mean age of 14 ± 2 years. Distal fusion levels ranged from T11 to L4. There was no significant association between distal fusion level and return to the same level of sports participation (P = 0.192). Of the participants, 93% returned to sports with no significant differences by distal fusion level (P = 0.081). Distal fusion level demonstrated no difference in return to preoperative sport (P = 0.486) or return to the same type of sport (P = 0.247).

Conclusions. 

This study found no association between distal fusion level and postoperative sports participation. Even though many patients may elect to change sports, nearly all patients returned to sports, and the majority of patients returned to the same level of sports competition or higher after PSF for AIS.

© 2023 Wolters Kluwer Health, Inc. All rights reserved.

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