GLATA 2010 EVALUATION OF THE SURGICAL BACK CANDIDATE Hank Feuer, MD, FACS Goodman Campbell Brain and Spine Methodist Sports Medicine Center Hank Feuer, MD, FACS Goodman Campbell Brain and Spine Methodist Sports Medicine Center
THE SPINE SURGEON NEUROSURGEON OR ORTHOPEDIC SURGEON WE ARE THE LAST RESORT! CAN’T WE FIX IT?
AND THEN … SURGERY ALL THE ATHLETE WANTS IS A “PERFECT” RESULT!
COMMON LUMBAR INJURIES THAT MAY REQUIRE SURGICAL INTERVENTION DISC HERNIATIONS STRESS FRACTURES TO PARS SPONYLOLISTHESIS DISC HERNIATIONS FRACTURES (rare)
DILEMMAS WE FACE RETURN TO PLAY CONFLICTS OF OPINION RADIOLOGIC REPORTS PARENTS, COACHES, AGENTS
CONSIDERATIONS THE ATHLETE: MOTIVATION TALENT THE SPORT: CONTACT NONCONTACT THE LEVEL OF COMPETITION
INDIVIDUALIZE
NETWORK
DIFFERENCES IN MANAGEMENT MIDDLE SCHOOL -AGE HIGH SCHOOL COLLEGE PROFESSIONAL
THE IMPORTANCE OF IMAGING STUDIES MRI CT PLAIN X-RAYS
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
Active Pars Defect on Bone Scan (SPECT Image)
Bilateral L3, L4 and L5 Spondylolysis (right side shown)
Incomplete L5 pars interarticularis defect
Spondylolisthesis Sag T1 – L5 pars defect
Grade I Spondylolisthesis at L5-S1 (no slippage L3-4 and L4-5)
Spondylolisthesis Sag T2 – Grade I
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES
LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS
LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS
LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS
LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS
LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS
LUMBAR DISC HERNIATION LEADING SCORER CLAUSTROPHOBIC
Normal T1
Normal Sagittal T2
Large L5-S1 Herniation with sequestered fragment Sagittal T2
Large L5-S1 Herniation – Axial T2
Small L5-S1 Herniation – Sag T2
Small L5-S1 Herniation – Axial T2
LUMBAR DISC HERNIATION SURGICAL CONSIDERATIONS PERCUTANEOUS PROCEDURES MYELOSCOPY PERCUTANEOUS DISCECTOMY IDET DECOMPRESSION THERAPY
FRACTURES PEDICLE SURGICAL CONSIDERATIONS FACET (IMPACT) VERTEBRAL BODY KYPHOPLASTY VERTEBROPLASTY PEDICLE SCREW FIXATION
MAJOR LEAGUE PROSPECT PITCHING- RELATED BACK PAIN
PAIN RESOLVED
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION EVIDENCE-BASED GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OR MORE OPINIONS GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON THE WEEKEND WARRIOR THE YOUTHFUL OLDIE THE EX-ATHLETE
THE SPINE SURGEON’S ROLE (with the professionals) CONSULTANT MEDICAL TEAM MEMBER SPEAKING AS ONE VOICE RESPONSIBILITY TO: THE ATHLETE THE CLUB THE MEDIA
CONCLUSIONS…
GOOD HISTORY FROM THE ATHLETE HOW MUCH LBP HOW MUCH TRULY RADICULAR PAIN HOW MANY GAMES MISSED RECURRENT DISC CAN IT BE FIXED PRESERVATION OF THE DISC WITH SPONDYLOLISTHESIS DEGENERATIVE DISC DISEASE HOW LONG WILL HE LAST HIPAA
REMEMBER ! PROFESSIONAL: SHORT CAREERS AND CHANGE TEAMS WEEKEND WARRIOR: YOURS FOREVER
THE MEDIA IT’S BEST NOT TO TALK TO THE MEDIA
TALKING TO THE MEDIA PROVIDE INFORMATION THROUGH A DESIGNATED PERSON BE ABSOLUTELY SURE OF THE DIAGNOSIS AND ATHLETE’S CONDITION REFRAIN FROM INFLAMMATORY LANGUAGE OBEY HIPAA REGULATIONS