Masters of Endovascular Neurosurgery

Abstract

INTRODUCTION: Chronic low back pain is a common presenting complaint among division 1A college football players. The optimal management of low back pain, and long-term outcomes with respect to performance status and disability in this patient population, however, is incompletely understood. METHODS: A prospective, institutional review board- approved study of 142 Division IA college football players evaluated at four institutions over a 15-year period. Evaluation of low back pain was assessed on presentation with radiographic imaging, as well as an Oswestry Disability Index (ODI). Patient records were reviewed retrospectively to determine management, outcomes, and whether the patient was able to continue playing football. At the most recent follow-up evaluation, flexion-extension radiographic studies were obtained and ODI questionnaires were readministered. A minimum of 2 years of follow-up was required for inclusion. RESULTS: Mean presenting ODI was 10 (range, 0–40). Eighty-four patients (59%) had radiographic abnormalities on presenting radiographic imaging. The most common abnormalities included anterior compression fractures (40 patients), disk degeneration/herniation (37 patients), and spondylolisthesis (24 patients). Forty patients (28%) presented with neurological symptoms along with back pain. Twelve of these patients (30%) required surgical treatment within 12 months of initial presentation. The remaining 130 patients were managed conservatively. Mean clinical follow-up was 46 months (range, 24–178 moths). During the follow-up period, an additional 15 patients required surgery for worsening neurological symptoms. Mean ODI at follow-up was 30 (range, 10–60). At the final follow-up evaluation, the mean ODI of the patients who had surgery was 14 (range, 0–60) compared with 30 (range, 20–50) in the group that had conservative treatment (Student's t test, P < 0.05). CONCLUSION: Management of low back pain can be complex in high-performance young athletes. When neurological symptoms are present, early intervention may provide improved long-term quality of life.