132. REVISION OF PROFESSIONAL RUGBY PLAYERS THREE MONTHS AFTER ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF) FOR SEVERE DISCECTOMY: SURGICAL TECHNIQUE AND REHABILITATION PROGRAMME

Abstract

Purpose of the study: ACDF is the cervical surgical technique the most widely used for the treatment of severe discopathy in rugby players. Different techniques have been applied, with no real consensus for the technical procedures or the postoperative rehabilitation. The goal is to normalise the surgical treatment and rehabilitation for elite rugby players who have had a cervical fusion for discopathy with the objective of resuming rugby three months postoperatively.

Material and methods: This was a retrospective study including 85 high-level rugby players (professional and semi-professional players) operated on by three surgeons from 2003 to 2008 for one or two levels presenting discal herniation (levels C3 to T1) with cervicobrachial nevralgia unresponsive to conservative treatment. Postoperative function was assessed with the cervical handicap index, a visual analogue scale for pain, consumption of analgesics, and possibility to resume rugby at three months. Flexion-extension radiographs of the cervical spine were obtained. All patients underwent ACDF using a Peek cage filled with autologous iliac bone fixed with a plate or a compressive staple. The patient completed a self-administered satisfaction questionnaire during follow-up. The radiographs and the clinical exam were done by an independent observer (GG).

Results: Mean follow-up was 26 months (4–55). Mean operative time was 50 minutes (30–70). Mean hospital stay 2.3 days (1–3). There was no difference between plate and staple fixation. There were no major postoperative complications. Fusion was radiographically achieved in all cases. All patients played competition rugby three months after surgery. At last follow-up, seven players had interrupted rugby playing for personal reasons or for other intercurrent medical conditions. Seventy-eight percent stated their clinical situation had improved and that they were satisfied.

Conclusion: The results of this series confirm the pertinence of this method to achieve effective fusion authorising resumption of rugby playing three months postoperatively. Use of a Peek cage filled with autologous bone and stabilised with fixation appears to be necessary to allow rapid functional rehabilitation exercises using a programme of three phases of one month. The normalisation of the treatment for sever cervical discopathies in the high-level rugby player appears to be possible and safe, compared with data in the literature.