By Ryan C. Goodwin, MD
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Idiopathic scoliosis remains a common problem in pediatric orthopaedics. If progressive and untreated, it can lead to heart and lung compromise in adulthood as the deformity worsens. Scoliosis affects children of all ages, although it is most commonly seen in active teenage girls.
Return to sports a common concern
Spinal fusion surgery remains the gold-standard treatment for progressive curves and is best performed during the teenage years. Most spinal fusion procedures are performed via a posterior approach. Although minimally invasive techniques have been used to minimize muscle trauma, irrespective of the technique, fusion must occur before progression to full activity for the treatment to be successful. Since many children who seek surgical correction are involved in athletics, safe return to sports following spine fusion surgery is often a concern for patients and parents.
Fusion confirmation is imperative
With the advent of segmental instrumentation ‒ specifically, segmental pedicle screws ‒ safe return to sports and other physical activities has become commonplace among patients with idiopathic scoliosis who have undergone spine fusion surgery. It is now routine practice to permit return to many aggressive activities such as contact sports once a solid fusion has occurred.
Since there is no specific imaging modality that will confirm a solid fusion, careful clinical examination and scrutiny of radiographs are essential to ascertain whether a solid fusion has occurred. Once the clinician has determined that a solid fusion is present ‒ typically six months postoperatively in a healthy adolescent ‒ sports and other aggressive activities may be resumed as tolerated.
When a physician discusses return to sports in this setting, patient and family counseling is important to ensure that expectations are appropriate. Literature suggests that patients whose lowest level of fusion is at T12 or L1 have the highest percentage of full return to sports. As the fusion mass extends distally to L2 and L3, the likelihood of a return to sports decreases. Patients with fusions to L4 and below are unlikely to return to sports and activities requiring significant movement and flexibility. While return to sports after spine fusion surgery is more common now than in the past, it is important that patients and families have realistic expectations about the postoperative course, including return to sports, before undergoing the procedure.
Popular sports such as soccer, basketball, volleyball, track and swimming are all activities in which an adolescent with a successful fusion for deformity is likely to be able to participate. Activities such as ballet and gymnastics are more difficult to return to following fusion, but a high likelihood of return to full activity exists when the most distal fusion level is T12 or above. Fusion to the lumbar spine greatly decreases the rates of return to these activities that require significant flexibility.
True collision sports such as tackle football and rugby should be avoided by all post-fusion patients. Some surgeons advocate permanently excluding ice hockey as well, but many others permit participation in this highly aggressive sport after an informed discussion with the patient and family.
Despite successes, need for caution remains
Today, patients who return to sports following spine fusion for adolescent idiopathic scoliosis are more the rule than the exception. Once the surgeon has determined that a successful fusion has occurred, patients can safely return to all but the most aggressive of collision sports, as tolerated. Participation in these activities has immensely improved the quality of life for many teenage patients.
Caution must still be exercised, however, to ensure that a solid clinical fusion is present before allowing a return to full activity and unnecessarily putting the patient at risk. A more distal fusion level is a negative predictor of return to activity at previous levels or beyond.
Standing posteroanterior and lateral radiographs of a 15-year-old female patient three years after posterior spine fusion for scoliosis. She returned to tumbling (photograph) and gymnastics six months postoperatively.
About the author
Dr. Goodwin is Director of the Center for Pediatric Orthopaedic Surgery and a member of the Department of Orthopaedic Surgery specializing in scoliosis and spinal deformity