Return-to-Sport Recommendations in Athletes Requiring Cervical Spine Surgery

Study Design. – Modified Delphi consensus survey. Objective. – To survey expert opinion on postoperative return-to-sport (RTS) decisions in athletes requiring cervical spine surgery. Summary of Background Data. – Postoperative sport participation recommendations for athletes requiring cervical spine surgery are lacking, and management of these athletes remains challenging. Methods. – A cross-sectional, modified Delphi consensus survey investigating RTS decisions in athletes requiring various cervical spine operations was undertaken. A panel of neurosurgery/orthopedic spine surgeons with sport expertise was identified from the United States and Australia. Single and multilevel cervical spine conditions studied included: anterior cervical discectomy and fusion (ACDF), cervical laminectomy and/or laminoplasty, posterior cervical fusion, occipito-cervical fusion, C1 fracture, and C1-C2 fusion. A 2×2 scheme was used to classify sport risk based on impact forces and frequency: low impact/low frequency, low impact/high frequency, high impact/low frequency, and high impact/high frequency. Consensus was a priori defined at ≥70%. Descriptive statistics were performed. Results. – Of the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons), survey completion was 100%. Consensus was achieved to recommend return to high-impact/high-frequency sport for individuals with one-level ACDF, one-level cervical laminectomy, one-level posterior cervical fusion, and for a healed C1 fracture treated with open reduction and internal fixation. For individuals with a healed occipito-cervical fusion, consensus was achieved to recommend return to low-impact/low-frequency sport. Conclusions. – Consensus was achieved to recommend return to high-impact/high-frequency sport after surgical treatment of a variety of cervical pathologies in athletes. Certain situations received consensus recommendations to return to low-impact/low-frequency sport, whereas many others did not reach a consensus. These results provide useful data that can help spine surgeons navigate challenging postoperative RTS decisions.