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.