What's the proper timing for return to sports after posterior spinal fusion to treat adolescent idiopathic scoliosis (AIS)? A recent study offers insight into how surgeon volume and experience may impact patient recommendations.
A survey of surgeons who perform posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) found that when practitioners allow these patients to return to sports depends on physician-related factors. Conversely, patient-related factors did not impact protocols.
Investigators gave the 170 survey participants a questionnaire that presented clinical vignettes involving patients with AIS who had undergone PSF and differed in various ways, such as sex, age, obesity, skeletal maturity, levels fused, and extension of the fusion construct into lumbar vertebrae. Surgeons were asked to list when they would allow patients to return to 4 categories of activity: jogging, non-contact, contact, and collision sports.
Overall, surgeons recommended taking more time to return to more physically demanding sports (collision, 9.8 months; contact, 6.8 months; noncontact, 4.6 months; jogging, 4.1 months), and surgeons with more years in practice and higher case volume allowed faster return to activity.
Surgeon volume was a major factor in decisions; for example, surgeons who performed 25 to 50 PSFs annually allowed the quickest return to jogging and noncontact sports. Similarly, surgeons with 16 to 20 years of experience allowed a faster return to jogging than their peers with less experience.
Pediatric orthopedic–trained surgeons called for a faster return to sports than their colleagues who had other kinds of fellowships. Finally, surgeons working in community children’s hospitals allowed more rapid return to sports activity than their colleagues in academic and community general/adult settings.
Thoughts from Dr. Farber
Bottom line, there is no good science to back up recommendations, so we are flying blind here. If a child is being restricted for what seems to you an unduly long time, you may want to encourage the orthopedist to rethink his or her position (eg, by having him or her talk to colleagues).
1. Ho D, Du JY, Erkilinc M, Glotzbecker MP, Mistovich RJ. Getting them back in the game: when can athletes with adolescent idiopathic scoliosis safely return to sports? a mixed-effects study of the Pediatric Orthopaedic Association of North America. J Pediatr Orthop. 2021;41(9):e717-e721. doi:10.1097/BPO.0000000000001902