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Intervertebral disc herniation in elite athletes

International Orthopaedics volume 43, pages 833–840 (2019)Cite this article

Abstract

Intervertebral disc herniations are a common cause of neck and back pain in athletes. It is thought to be more prevalent in athletes than in the general population due to the consistent pressure placed on the spine and concurrent microtraumas that are unable to heal. Prevention focuses on neck and trunk stability and flexibility, training on proper technique, and rule changes to minimize catastrophic injuries. The evaluation for athletes includes a full neurologic exam and imaging. The imaging modality of choice is MRI, but CT myelography can be a useful alternative. Standard management includes a six week trial of conservative treatment with hiatus from injurious activity and anti-inflammatory medication. If nonoperative management fails, operative treatment has been shown to lead to excellent clinical outcomes in this patient population. Special consideration to prevention needs to be further analyzed. Furthermore, more robust studies on alternative non-operative and operative treatment modalities for this patient population are also needed.

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References

  1. Baker RJ, Patel D (2005) Lower back pain in the athlete: common conditions and treatment. Prim Care 32(1):201–229. https://doi.org/10.1016/j.pop.2004.11.004

    Article  PubMed  Google Scholar 

  2. Bono CM (2004) Low-back pain in athletes. J Bone Joint Surg Am 86-a(2):382–396

    Article  Google Scholar 

  3. Dunn IF, Proctor MR, Day AL (2006) Lumbar spine injuries in athletes. Neurosurg Focus 21(4):E4

    PubMed  Google Scholar 

  4. Hsu WK (2011) Outcomes following nonoperative and operative treatment for cervical disc herniations in National Football League athletes. Spine 36(10):800–805. https://doi.org/10.1097/BRS.0b013e3181e50651

    Article  PubMed  Google Scholar 

  5. Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, Yabe Y, Shiga H (1998) MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg (Br) 80(1):19–24

    Article  CAS  Google Scholar 

  6. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(3):403–408

    Article  CAS  Google Scholar 

  7. Takatalo J, Karppinen J, Niinimaki J, Taimela S, Nayha S, Jarvelin MR, Kyllonen E, Tervonen O (2009) Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine 34(16):1716–1721. https://doi.org/10.1097/BRS.0b013e3181ac5fec

    Article  PubMed  Google Scholar 

  8. Triantafillou KM, Lauerman W, Kalantar SB (2012) Degenerative disease of the cervical spine and its relationship to athletes. Clin Sports Med 31(3):509–520. https://doi.org/10.1016/j.csm.2012.03.009

    Article  PubMed  Google Scholar 

  9. Farahbakhsh F, Rostami M, Noormohammadpour P, Zade AM, Hassanmirazaei B, Jouibari MF, Kordi R, Kennedy DJ (2018) Prevalence of low back pain among athletes: a systematic review. J Back Musculoskelet Rehabil. https://doi.org/10.3233/bmr-170941

  10. Rajeswaran G, Turner M, Gissane C, Healy JC (2014) MRI findings in the lumbar spines of asymptomatic elite junior tennis players. Skelet Radiol 43(7):925–932. https://doi.org/10.1007/s00256-014-1862-1

    Article  CAS  Google Scholar 

  11. Trompeter K, Fett D, Platen P (2017) Prevalence of back pain in sports: a systematic review of the literature. Sports Med 47(6):1183–1207. https://doi.org/10.1007/s40279-016-0645-3

    Article  PubMed  Google Scholar 

  12. Mundt DJ, Kelsey JL, Golden AL, Panjabi MM, Pastides H, Berg AT, Sklar J, Hosea T (1993) An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. The northeast collaborative group on low back pain. Am J Sports Med 21(6):854–860. https://doi.org/10.1177/036354659302100617

    Article  CAS  PubMed  Google Scholar 

  13. Lawrence JP, Greene HS, Grauer JN (2006) Back pain in athletes. J Am Acad Orthop Surg 14(13):726–735

    Article  Google Scholar 

  14. Gray BL, Buchowski JM, Bumpass DB, Lehman RA Jr, Mall NA, Matava MJ (2013) Disc herniations in the national football league. Spine 38(38):1934–1938. https://doi.org/10.1097/BRS.0b013e3182a67678

    Article  PubMed  Google Scholar 

  15. Hsu WK, Jenkins TJ (2017) Management of lumbar conditions in the elite athlete. J Am Acad Orthop Surg 25(7):489–498. https://doi.org/10.5435/jaaos-d-16-00135

    Article  PubMed  Google Scholar 

  16. Commandre FA, Argenson C, Fornaris E, Aboulker C, De Peretti F, Zakarian H (1991) Lumbar spine, sport and actual treatment. J Sports Med Phys Fitness 31(2):129–134

    CAS  PubMed  Google Scholar 

  17. Chao S, Pacella MJ, Torg JS (2010) The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med 40(1):59–75. https://doi.org/10.2165/11319650-000000000-00000

    Article  PubMed  Google Scholar 

  18. Torg JS, Guille JT, Jaffe S (2002) Injuries to the cervical spine in American football players. J Bone Joint Surg Am 84-a(1):112–122

    Article  Google Scholar 

  19. Marshall LW, McGill SM (2010) The role of axial torque in disc herniation. Clin Biomech (Bristol, Avon) 25(1):6–9. https://doi.org/10.1016/j.clinbiomech.2009.09.003

    Article  Google Scholar 

  20. Fleisig GS, Hsu WK, Fortenbaugh D, Cordover A, Press JM (2013) Trunk axial rotation in baseball pitching and batting. Sports Biomech 12(4):324–333. https://doi.org/10.1080/14763141.2013.838693

    Article  PubMed  Google Scholar 

  21. Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ (2012) Spine and axial skeleton injuries in the National Football League. Am J Sports Med 40(8):1755–1761. https://doi.org/10.1177/0363546512448355

    Article  PubMed  Google Scholar 

  22. Weistroffer JK, Hsu WK (2011) Return-to-play rates in National Football League linemen after treatment for lumbar disk herniation. Am J Sports Med 39(3):632–636. https://doi.org/10.1177/0363546510388901

    Article  PubMed  Google Scholar 

  23. Kepler CK, Vaccaro AR (2012) Injuries and abnormalities of the cervical spine and return to play criteria. Clin Sports Med 31(3):499–508. https://doi.org/10.1016/j.csm.2012.03.005

    Article  PubMed  Google Scholar 

  24. Torg JS, Vegso JJ, Sennett B, Das M (1985) The National football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984. Jama 254(24):3439–3443

    Article  CAS  Google Scholar 

  25. Andrews J, Jones A, Davies PR, Howes J, Ahuja S (2008) Is return to professional rugby union likely after anterior cervical spinal surgery? J Bone Joint Surg (Br) 90(5):619–621. https://doi.org/10.1302/0301-620x.90b5.20546

    Article  CAS  Google Scholar 

  26. Mai HT, Burgmeier RJ, Mitchell SM, Hecht AC, Maroon JC, Nuber GW, Hsu WK (2016) Does the level of cervical disc herniation surgery affect performance-based outcomes in National Football League Athletes? Spine 41(23):1785–1789. https://doi.org/10.1097/brs.0000000000001868

    Article  PubMed  Google Scholar 

  27. Torg JS, Sennett B, Vegso JJ, Pavlov H (1991) Axial loading injuries to the middle cervical spine segment. An analysis and classification of twenty-five cases. Am J Sports Med 19(1):6–20. https://doi.org/10.1177/036354659101900103

    Article  CAS  PubMed  Google Scholar 

  28. Patel DR, Kinsella E (2017) Evaluation and management of lower back pain in young athletes. Transl Pediatr 6(3):225–235. https://doi.org/10.21037/tp.2017.06.01

    Article  PubMed  PubMed Central  Google Scholar 

  29. Maroon JC, El-Kadi H, Abla AA, Wecht DA, Bost J, Norwig J, Bream T (2007) Cervical neurapraxia in elite athletes: evaluation and surgical treatment. Report of five cases. J Neurosurg Spine 6(4):356–363. https://doi.org/10.3171/spi.2007.6.4.13

    Article  PubMed  Google Scholar 

  30. Eck JC, Riley LH 3rd (2004) Return to play after lumbar spine conditions and surgeries. Clin Sports Med 23(3):367–379, viii. https://doi.org/10.1016/j.csm.2004.03.002

    Article  PubMed  Google Scholar 

  31. Tong HC, Haig AJ, Yamakawa K (2002) The Spurling test and cervical radiculopathy. Spine 27(2):156–159

    Article  Google Scholar 

  32. Banerjee R, Palumbo MA, Fadale PD (2004) Catastrophic cervical spine injuries in the collision sport athlete, part 2: principles of emergency care. Am J Sports Med 32(7):1760–1764. https://doi.org/10.1177/0363546504268931

    Article  PubMed  Google Scholar 

  33. Weir Tea (2017) On-field evaluation and transport of the injured athlete. Spine Injuries In Athletes American Academy of Orthopedic Surgeons (1st ed):32–39

  34. Del Rossi G, Horodyski M, Powers ME (2003) A comparison of spine-board transfer techniques and the effect of training on performance. J Athl Train 38(3):204–208

    PubMed  PubMed Central  Google Scholar 

  35. Tempel ZJ, Bost JW, Norwig JA, Maroon JC (2015) Significance of T2 hyperintensity on magnetic resonance imaging after cervical cord injury and return to play in professional athletes. Neurosurgery 77(1):23–30; discussion 30-21. https://doi.org/10.1227/neu.0000000000000728

    Article  PubMed  Google Scholar 

  36. Rosenthal BD, Boody BS, Hsu WK (2017) Return to play for athletes. Neurosurg Clin N Am 28(1):163–171. https://doi.org/10.1016/j.nec.2016.08.003

    Article  PubMed  Google Scholar 

  37. Paulus S, Kennedy DJ (2014) Return to play considerations for cervical spine injuries in athletes. Phys Med Rehabil Clin N Am 25(4):723–733. https://doi.org/10.1016/j.pmr.2014.06.005

    Article  PubMed  Google Scholar 

  38. Joaquim AF, Hsu WK, Patel AA (2016) Cervical spine surgery in professional athletes: a systematic review. Neurosurg Focus 40(4):E10. https://doi.org/10.3171/2016.1.Focus15560

    Article  PubMed  Google Scholar 

  39. Hsu WK, McCarthy KJ, Savage JW, Roberts DW, Roc GC, Micev AJ, Terry MA, Gryzlo SM, Schafer MF (2011) The professional athlete spine initiative: outcomes after lumbar disc herniation in 342 elite professional athletes. Spine J 11(3):180–186. https://doi.org/10.1016/j.spinee.2010.12.009

    Article  PubMed  Google Scholar 

  40. Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L, Smith W, Carver R, Maratukulam A, Won LA, Carragee E, Avins AL (2015) Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. Jama 313(19):1915–1923. https://doi.org/10.1001/jama.2015.4468

    Article  PubMed  PubMed Central  Google Scholar 

  41. Krych AJ, Richman D, Drakos M, Weiss L, Barnes R, Cammisa F, Warren RF (2012) Epidural steroid injection for lumbar disc herniation in NFL athletes. Med Sci Sports Exerc 44(2):193–198. https://doi.org/10.1249/MSS.0b013e31822d7599

    Article  CAS  PubMed  Google Scholar 

  42. Clark R, Doyle M, Sybrowsky C, Rosenquist R (2012) Epidural steroid injections for the treatment of cervical radiculopathy in elite wrestlers: case series and literature review. Iowa Orthop J 32:207–214

    PubMed  PubMed Central  Google Scholar 

  43. Manchikanti L, Cash KA, Pampati V, Malla Y (2014) Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial. Int J Med Sci 11(4):309–320. https://doi.org/10.7150/ijms.8069

    Article  PubMed  PubMed Central  Google Scholar 

  44. Harvey J, Tanner S (1991) Low back pain in young athletes. A practical approach. Sports Med 12(6):394–406

    Article  CAS  Google Scholar 

  45. Zieger M, Schwarz R, Konig HH, Harter M, Riedel-Heller SG (2010) Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review. Cen Eur Neurosurg 71(1):26–34. https://doi.org/10.1055/s-0029-1225325

    Article  CAS  Google Scholar 

  46. Roberts DW, Roc GJ, Hsu WK (2011) Outcomes of cervical and lumbar disk herniations in Major League Baseball pitchers. Orthopedics 34(8):602–609. https://doi.org/10.3928/01477447-20110627-23

    Article  PubMed  Google Scholar 

  47. Jegede KA, Ndu A, Grauer JN (2010) Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am 41(2):217–224. https://doi.org/10.1016/j.ocl.2010.01.003

    Article  PubMed  Google Scholar 

  48. Stuber KJ, Bruno P, Sajko S, Hayden JA (2014) Core stability exercises for low back pain in athletes: a systematic review of the literature. Clin J Sport Med 24(6):448–456. https://doi.org/10.1097/jsm.0000000000000081

    Article  PubMed  Google Scholar 

  49. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. Jama 296(20):2441–2450. https://doi.org/10.1001/jama.296.20.2441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Dvorak H, Kujat C, Brumitt J (2011) Effect of therapeutic exercise versus manual therapy on athletes with chronic low back pain. J Sport Rehabil 20(4):494–504

    Article  Google Scholar 

  51. Vangelder LH, Hoogenboom BJ, Vaughn DW (2013) A phased rehabilitation protocol for athletes with lumbar intervertebral disc herniation. Int J Sports Phys Ther 8(4):482–516

    PubMed  PubMed Central  Google Scholar 

  52. Hrysomallis C (2016) Neck muscular strength, training, performance and sport injury risk: a review. Sports Med 46(8):1111–1124. https://doi.org/10.1007/s40279-016-0490-4

    Article  PubMed  Google Scholar 

  53. Schroeder GD, McCarthy KJ, Micev AJ, Terry MA, Hsu WK (2013) Performance-based outcomes after nonoperative treatment, discectomy, and/or fusion for a lumbar disc herniation in National Hockey League athletes. Am J Sports Med 41(11):2604–2608. https://doi.org/10.1177/0363546513499229

    Article  PubMed  Google Scholar 

  54. Mai HT, Chun DS, Schneider AD, Hecht AC, Maroon JC, Hsu WK (2018) The difference in clinical outcomes after anterior cervical fusion, disk replacement, and foraminotomy in professional athletes. Clin Spine Surg 31(1):E80–e84. https://doi.org/10.1097/bsd.0000000000000570

    Article  PubMed  Google Scholar 

  55. Kang DG, Anderson JC, Lehman RA Jr (2016) Return to play after cervical disc surgery. Clin Sports Med 35(4):529–543. https://doi.org/10.1016/j.csm.2016.05.001

    Article  PubMed  Google Scholar 

  56. McAnany SJ, Overley S, Andelman S, Patterson DC, Cho SK, Qureshi S, Hsu WK, Hecht AC (2017) Return to play in elite contact athletes after anterior cervical discectomy and fusion: a meta-analysis. Global Spine J 7(6):552–559. https://doi.org/10.1177/2192568217700112

    Article  PubMed  PubMed Central  Google Scholar 

  57. Wang JC, Shapiro MS, Hatch JD, Knight J, Dorey FJ, Delamarter RB (1999) The outcome of lumbar discectomy in elite athletes. Spine 24(6):570–573

    Article  CAS  Google Scholar 

  58. Burgmeier RJ, Hsu WK (2014) Spine surgery in athletes with low back pain-considerations for management and treatment. Asian J Sports Med 5(4):e24284. https://doi.org/10.5812/asjsm.24284

    Article  PubMed  PubMed Central  Google Scholar 

  59. Reiman MP, Sylvain J, Loudon JK, Goode A (2016) Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis. Br J Sports Med 50(4):221–230. https://doi.org/10.1136/bjsports-2015-094691

    Article  PubMed  Google Scholar 

  60. Nair R, Kahlenberg CA, Hsu WK (2015) Outcomes of lumbar discectomy in elite athletes: the need for high-level evidence. Clin Orthop Relat Res 473(6):1971–1977. https://doi.org/10.1007/s11999-014-3762-z

    Article  PubMed  Google Scholar 

  61. Iwamoto J, Sato Y, Takeda T, Matsumoto H (2011) Return to play after conservative treatment in athletes with symptomatic lumbar disc herniation: a practice-based observational study. Open Access J Sports Med 2:25–31. https://doi.org/10.2147/oajsm.S17523

    Article  PubMed  PubMed Central  Google Scholar 

  62. Iwamoto J, Sato Y, Takeda T, Matsumoto H (2010) The return to sports activity after conservative or surgical treatment in athletes with lumbar disc herniation. Am J Phys Med Rehabil 89(12):1030–1035. https://doi.org/10.1097/PHM.0b013e3181f71044

    Article  PubMed  Google Scholar 

  63. Savage JW, Hsu WK (2010) Statistical performance in National Football League athletes after lumbar discectomy. Clin J Sport Med 20(5):350–354. https://doi.org/10.1097/JSM.0b013e3181efc259

    Article  PubMed  Google Scholar 

  64. Minhas SV, Kester BS, Hsu WK (2016) Outcomes after lumbar disc herniation in the National Basketball Association. Sports Health 8(1):43–49. https://doi.org/10.1177/1941738115608361

    Article  PubMed  PubMed Central  Google Scholar 

  65. Earhart JS, Roberts D, Roc G, Gryzlo S, Hsu W (2012) Effects of lumbar disk herniation on the careers of professional baseball players. Orthopedics 35(1):43–49. https://doi.org/10.3928/01477447-20111122-40

    Article  PubMed  Google Scholar 

  66. Watkins RG, Williams LA, Watkins RG 3rd (2003) Microscopic lumbar discectomy results for 60 cases in professional and Olympic athletes. Spine J 3(2):100–105

    Article  Google Scholar 

  67. Cook RW, Hsu WK (2016) Return to play after lumbar spine surgery. Clin Sports Med 35(4):609–619. https://doi.org/10.1016/j.csm.2016.05.006

    Article  PubMed  Google Scholar 

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  1. Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 1350, Chicago, IL, 60611, USA

    Jonathan T. Yamaguchi & Wellington K. Hsu

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  1. Jonathan T. Yamaguchi
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All of the following authors contributed significantly to the development of this manuscript through data analysis, manuscript preparation, or analysis and editing of the final manuscript.

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Correspondence to Jonathan T. Yamaguchi.

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Author JTY has no conflicts of interest. Author WKH has received research grant from Wright Medical and IP royalties from Stryker; advisory board for the Journal of Bone and Joint Surgery; consulted for Stryker, Medtronic, Mirus, Allosource, Biovenus, Micromedicine, and Agnovos.

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Jonathan T. Yamaguchi and Wellington K. Hsu have contributed in the manuscript preparation and literature review.

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Yamaguchi, J.T., Hsu, W.K. Intervertebral disc herniation in elite athletes. International Orthopaedics (SICOT) 43, 833–840 (2019). https://doi.org/10.1007/s00264-018-4261-8

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Keywords

  • Herniations
  • Elite athletes
  • Return to play
  • Intervertebral disc
  • Lumbar spine
  • Cervical spine