Return-to-Sport Recommendations in Athletes Requiring Cervical Spine Surgery: A Modified Delphi Consensus Survey of Expert Opinion

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 multi-level cervical spine surgical conditions studied included: anterior cervical discectomy and fusion (ACDF), cervical laminectomy and 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 1-level ACDF, 1-level cervical laminectomy, 1-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, while many others did not reach a consensus. These results provide useful data that can help spine surgeons navigate challenging postoperative RTS decisions.