1. 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

2. THE SPINE SURGEON NEUROSURGEON OR ORTHOPEDIC SURGEON WE ARE THE LAST RESORT! CAN’T WE FIX IT?

3. AND THEN … SURGERY ALL THE ATHLETE WANTS IS A “PERFECT” RESULT!

4. COMMON LUMBAR INJURIES THAT MAY REQUIRE SURGICAL INTERVENTION DISC HERNIATIONS STRESS FRACTURES TO PARS SPONYLOLISTHESIS DISC HERNIATIONS FRACTURES (rare)

5. DILEMMAS WE FACE RETURN TO PLAY CONFLICTS OF OPINION RADIOLOGIC REPORTS PARENTS, COACHES, AGENTS

6. CONSIDERATIONS THE ATHLETE: MOTIVATION TALENT THE SPORT: CONTACT NONCONTACT THE LEVEL OF COMPETITION

7. INDIVIDUALIZE

8. NETWORK

9. DIFFERENCES IN MANAGEMENT MIDDLE SCHOOL -AGE HIGH SCHOOL COLLEGE PROFESSIONAL

10. THE IMPORTANCE OF IMAGING STUDIES  MRI  CT  PLAIN X-RAYS

11. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

12. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

13. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

14. Active Pars Defect on Bone Scan (SPECT Image)

15. Bilateral L3, L4 and L5 Spondylolysis (right side shown)

16. Incomplete L5 pars interarticularis defect

17. Spondylolisthesis Sag T1 – L5 pars defect

18. Grade I Spondylolisthesis at L5-S1 (no slippage L3-4 and L4-5)

19. Spondylolisthesis Sag T2 – Grade I

20. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

21. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

22. LYSIS AND LISTHESIS ACUTE CHRONIC IMAGING STUDIES SPORT SPECIFIC INJECTIONS SURGICAL CONSIDERATIONS MINIMALLY INVASIVE TECHNIQUES

23. LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS

24. LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS

25. LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS

26. LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS

27. LUMBAR DISC HERNIATION FULL-BLOWN SYNDROME HALF-BAKED SYNDROME IMAGING STUDIES FREQUENCY OF VISITS DEFICITS

28. LUMBAR DISC HERNIATION LEADING SCORER CLAUSTROPHOBIC

29. Normal T1

30. Normal Sagittal T2

31. Large L5-S1 Herniation with sequestered fragment Sagittal T2

32. Large L5-S1 Herniation – Axial T2

33. Small L5-S1 Herniation – Sag T2

34. Small L5-S1 Herniation – Axial T2

35. LUMBAR DISC HERNIATION SURGICAL CONSIDERATIONS PERCUTANEOUS PROCEDURES MYELOSCOPY PERCUTANEOUS DISCECTOMY IDET DECOMPRESSION THERAPY

36. FRACTURES PEDICLE SURGICAL CONSIDERATIONS FACET (IMPACT) VERTEBRAL BODY KYPHOPLASTY VERTEBROPLASTY PEDICLE SCREW FIXATION

37. MAJOR LEAGUE PROSPECT PITCHING- RELATED BACK PAIN

42. PAIN RESOLVED

43. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

44. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

45. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

46. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

47. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

48. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION EVIDENCE-BASED GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

49. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OR MORE OPINIONS GURUS SPORTS PSYCHOLOGIST

50. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

51. RETURN TO ACTION NEUROLOGIC DEFICIT SPORT SPECIFIC LENGTH OF SEASON MOTIVATION GUIDELINES SECOND OPINION GURUS SPORTS PSYCHOLOGIST

52. ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON

53. 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

54. 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

55. 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

56. 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

57. ANECDOTES THE STAR THE BACK-UP THE FREE AGENT THE LONGTERM CONTRACT THE REDSHIRT THE WALK-ON

58. 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

59. 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

60. 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

61. THE SPINE SURGEON’S ROLE (with the professionals) CONSULTANT MEDICAL TEAM MEMBER SPEAKING AS ONE VOICE RESPONSIBILITY TO: THE ATHLETE THE CLUB THE MEDIA

62. CONCLUSIONS…

63. 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

64. REMEMBER ! PROFESSIONAL: SHORT CAREERS AND CHANGE TEAMS WEEKEND WARRIOR: YOURS FOREVER

65. THE MEDIA  IT’S BEST NOT TO TALK TO THE MEDIA

66. 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