1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Clinicians are often asked by patients when they will be able to return to certain athletic activities following spinal surgery. Results of this systematic review will inform an evidence-based guideline which will provide recommendations regarding timing for return to physical activity after surgical intervention, considering the following outcomes: the need for additional surgery following return to activity, the worsening of neurological function following return to activity and the worsening of PROMs following return to activity.
2. Why are you struggling with this issue?
According to the World Health Organization, there are between 250,000 and 500,000 people that experience spinal cord injury every year. There is controversy regarding the timing for return to physical activity for patients (particularly professional or nonprofessional athletes engaged in contact sports and military personnel) after surgery following spinal injury. (1)
Surgeons are often asked by patients when they will be able to return to certain activities following spinal surgery including occupational or/and athletic activities. The PICO questions below were formulated to better address these common questions. The results of this systematic review will inform an evidence-based guideline which will provide recommendations regarding the timing for return to physical activity after the surgical interventions described above, considering the following outcomes: the need for additional surgery following return to activity, the worsening of neurological function following return to activity and the worsening of PROMs following return to activity.
The intended patient population includes adult athletes (professional and non-professional) as well as military personnel. The PICO questions were informed by several key studies on this topic, as well as “scoping” searches performed by the CNS medical librarian to ensure consistency and feasibility of this topic. This “scoping” search confirmed our definition of the population is consistent with the methodology of several studies on this topic as well as MESH terms commonly used.
This guideline will help inform clinical decision-making and most importantly help to improve patient outcomes.
1. Maroon, J. C., et al. (2013). "Outcomes after anterior cervical discectomy and fusion in professional athletes." Neurosurgery 73(1): 103-112.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
Definitions:
“High-impact or/and collision activities” pertains to athletic or occupational activities associated with repeated high biomechanical loads to the spine (i.e., collision sports, military)
“Early return to activity” pertains to return to activity less than 90 days after surgery
“Late return to activity” pertains to return to activity greater than 90 days after surgery
Inclusion:
• Age >= 18
• English Only
• Patients undergoing elective cervical non-fusion surgery, elective cervical fusion surgery, elective lumbar fusion surgery, or elective lumbar non-fusion surgery
• Patients with degenerative spine disorders of the cervical or thoracolumbar spine
• Disc herniation, spondylosis, stenosis, spondylolisthesis
• Myelopathy, radiculopathy, neurogenic claudication
Exclusion:
• Age < 18
• Mixed population in which analysis of the patient population cannot be performed
• Surgical interventions for other diagnoses such as infection, trauma, or neoplasm
• Non-human studies
• Case reports N <5
• Editorials
• Letters to Editor
• Systematic Reviews
PICOS:
1. In individuals undergoing elective cervical non-fusion surgery, does early return to activity increase the risk of adverse events compared to a delayed return to activity?
P: Individuals undergoing elective cervical non-fusion surgery
I: Return to activity
C: Early return versus delayed return to activity
O: Risk of adverse events
2. In individuals undergoing elective cervical non-fusion surgery, does early return to activity increase the risk of adverse events compared to a delayed return to activity?
P: Individuals undergoing elective cervical non-fusion surgery
I: Return to activity
C: Early return versus delayed return to activity
O: Risk of adverse events
3. In individuals undergoing elective lumbar non-fusion surgery, does early return to activity increase the risk of adverse events compared to a delayed return to activity?
P: Individuals undergoing elective lumbar non-fusion surgery
I: Return to activity
C: Early return versus delayed return to activity
O: Risk of adverse events
4. In individuals undergoing elective lumbar fusion surgery, does early return to activity
increase the risk of adverse events compared to a delayed return to activity?
P: Individuals undergoing elective lumbar non-fusion surgery
I: Return to activity
C: Early return versus delayed return to activity
O: Risk of adverse events
5. In patients with radiographic cervical stenosis, is it safe to participate in high-impact or collision activities?
P: Patients with radiographic cervical stenosis
I: Participate in high impact or collision activities
C: Participate in high impact or collision activities versus not participate
O: Risk of adverse events
4. When do you need the evidence report?
Thursday, 04/18/2024
5. What will you do with the evidence report?
The purpose of this topic nomination is to evaluate all available evidence, from which, the Congress of Neurological Surgeons (CNS) will develop a guideline to aid clinicians and guide clinical practice by determining the best options for return to physical activity after spinal cord injury.
The CNS maintains in-house infrastructure to lead, promote, and support the creation and methodological processes to produce evidence-based guidelines, which are critical tools to confront a rapidly changing health care environment. Using the CNS’s high quality, rigorous methodological process, a multidisciplinary task force will develop recommendations based on the available evidence provided by the Evidence Based Practice Center. Throughout development, the task force will use evidence-based methodologies and strictly adhere to a priori defined criteria as defined by the Institute of Medicine’s (IOM) standards for conducting systematic reviews and clinical evidence-based guidelines.
This topic was initiated by the Spine and Peripheral Nerves and Trauma Sections of the American Academy of Neurological Surgeons (AANS)/CNS. The CNS also recruited from a variety of institutions and subspecialty disciplines in an effort to have as broad a representation of opinions and expertise as possible. Additionally CNS plans to include at least two patient representatives on the task force including an athlete and active military serviceman or woman (or veteran). It is CNS’s goal to follow the IOM recommendations to be inclusive and inter-disciplinary when constructing our guidelines and subsequent recommendations. A conscientious effort will also be made to be sure that any conflict of interest is fully disclosed and avoided. Participants who have published extensively in certain areas will be asked to recuse themselves from voting and will be assigned to evaluate evidence in other topics. Every effort will be made to ensure that the guideline is accurate, reliable, and non-biased.
The CNS guidelines attempt to provide essential information for clinicians, globally, helping to improve patient care and outcomes. In addition to developing high quality guidelines, CNS is also committed to dissemination of guidelines in multiple, open access formats, such as publication in peer-reviewed journals, publication on the CNS webpage, webinars, conference seminars and courses, as well as other promotional efforts.
Optional Information About You
What is your role or perspective? Physician/professional society
If you are you making a suggestion on behalf of an organization, please state the name of the organization. Congress of Neurological Surgeons
May we contact you if we have questions about your nomination? Yes
