Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis.

STUDY DESIGN: Meta-analysis. OBJECTIVES: To assess return to play (RTP) rates in adolescent athletes with lumbar spondylolysis without spondylolisthesis treated conservatively or operatively. METHODS: A review of Medline, EMBASE, and Cochrane Reviews was performed. The pooled results were performed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I2 value. RESULTS: The initial literature search resulted in 724 articles, of which 29 were deemed relevant on abstract review. Overall, 11 studies provided data for 376 patients with a pars interarticularis defect. Return to athletic competition, based on logit event rate, was found to be statistically favored after both nonoperative and operative treatment (92.2% vs 90.3%). There was no heterogeneity noted among the studies reporting nonoperative treatment (Q value of 4.99 and I2 value of 0). There was mild heterogeneity within the operative studies (Q value of 3.54 and I2 value of 15.18). CONCLUSIONS: Adolescent athletes RTP 92.2% of the time with nonoperative management, compared with 90.3% when treated operatively, though both treatment groups strongly favor RTP. As this is the first study to pool results of all relevant literature, it provides strong evidence to guide decision making and help manage expectations in this unique patient population.

Return to Play in Elite Athletes After Lumbar Microdiscectomy: A Meta-analysis.

STUDY DESIGN: Systematic literature review and meta-analysis of English language studies. OBJECTIVE: This study is a meta-analysis assessing elite athlete's return-to-play (RTP) rates after a lumbar herniated nucleus pulposus (HNP) treated with microdiscectomy. Additionally, we compare RTP rates of those treated operatively versus nonoperatively. SUMMARY OF BACKGROUND DATA: Microdiscectomy for a lumbar HNP in elite athletes remains a controversial subject with no consensus in the literature regarding true RTP. METHODS: A literature search of Medline, Embase, and Cochrane Reviews was performed. The pooled results were analyzed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance, which included both within and between study errors. Confidence intervals (CIs) were reported at 95%. Heterogeneity was assessed using the Q statistic and I. RESULTS: The initial literature search resulted in 547 articles, of which 14 were determined relevant on abstract review. Overall, nine studies provided data for 558 patients who underwent a lumbar microdiscectomy. The pooled clinical success rate was 83.5% (CI: 79.7%, 88.0%), which was statistically significant (P < 0.0001). The studies demonstrated minimal heterogeneity Q value of 7.41 and I value of 5.53. Four studies included operative and nonoperative cohorts. The odds ratio of RTP with a symptomatic lumbar disc herniation was 1.13 (CI: 0.37-5.90). There was no statistical difference in RTP between the two groups (P = 0.59). CONCLUSION: Elite athletes return to competition 83.5% of the time after undergoing a single level lumbar microdiscectomy. Additionally, when comparing lumbar microdiscectomy to non-operative treatment, there is no difference in RTP rates, suggesting that a more aggressive approach to managing a symptomatic HNP in this population with earlier surgical intervention may be employed judiciously if timing necessitates for the athlete's benefit. LEVEL OF EVIDENCE: 3.