Endoscopic Lumbar Discectomy in Professional Athletes: A Case Series and Structured Rehabilitation Protocol Enabling Rapid Return to Play

Abstract

Background:

Full-endoscopic lumbar discectomy (FELD) has become a validated, minimally invasive treatment for lumbar disc herniation (LDH). However, evidence remains scarce regarding outcomes and rehabilitation strategies for professional athletes undergoing this procedure.

Purpose/Hypothesis:

The purpose of this study is to evaluate return to play (RTP) outcomes, functional recovery, and postoperative complications in professional athletes undergoing FELD, and to describe the structured postoperative rehabilitation protocol implemented. It was hypothesized that FELD, combined with standardized rehabilitation, would result in a high RTP rate within 3 months and restoration of preinjury performance levels.

Study Design:

Case series; Level of evidence 4.

Methods:

Twenty professional athletes with LDH who underwent FELD between 2021 and 2024 were included. All included patients were elite athletes, defined as professional or international-level competitors. This included athletes participating in top-tier professional basketball and rugby leagues, as well as winter sports athletes competing at the international level (World Cup and Olympic competitions). Outcome measures included pain (visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), quality of life (Short Form-12 [SF-12]), time to RTP, and postoperative level of athletic performance, which were objectively evaluated by return to official competition (defined as participation in official matches or competitive events at the preinjury level). All patients followed a standardized, phased rehabilitation protocol incorporating progressive strength and flexibility testing. Descriptive statistics were used to summarize the data. Paired comparisons were performed using the Student t test or the Wilcoxon signed-rank test, depending on data distribution, with statistical significance set at P < .05.

Results:

The mean age of patients was 25.5 ± 3.7 years, and 75% were men. The mean RTP time was 3.4 months. At 1-year follow-up, 80% of athletes had resumed their preinjury performance level. VAS and ODI scores improved significantly (P < .005), with 90% reporting excellent satisfaction. No major complications occurred, although 4 patients experienced recurrent herniation, and 3 underwent reoperation. One athlete did not RTP.

Conclusion:

Our study demonstrated that FELD combined with a structured rehabilitation pathway appears to be a safe and effective surgical option for professional athletes with LDH, which may facilitate early RTP and high functional recovery.

Keywords

full endoscopy lumbar disc herniation minimally invasive spine surgery postoperative rehabilitation professional athletes return to play

Low back pain (LBP) affects 1% to 30% of athletes, depending on factors such as sex, sport type, practice intensity, and duration.⁷ The differentials include muscle strain, degenerative disc disease, spondylolysis/listhesis, disc herniation, fracture, or infection.^6,31 The physical demands on the lumbar spine during high-impact or rotational sports predispose athletes to disc injury, especially L4-5 and L5-S1.³³ For professional athletes, the presence of lumbar disc herniation (LDH) represents not only a physical injury but also a significant interruption to their athletic pursuits, with the potential risk of never fully regaining their preinjury level of performance.^3,14,17 While nonoperative management remains the first-line treatment, professional and competitive athletes require expedited symptom resolution and return to play (RTP) and may therefore require consideration of surgical intervention when conservative management fails.³⁴

Endoscopic spine surgery has emerged as a minimally invasive alternative to conventional open or microdiscectomy techniques. Unfortunately, athletes undergoing open surgery for spinal pathology are sometimes (up to 25%) unable to achieve preoperative levels of athletic performance.^{10,14,37,44,45,48} First described by Kambin et al¹⁸ in 1988, full-endoscopic lumbar discectomy (FELD) has become a well-established and validated technique for treating LDH in the general population.^12,18,47 As a minimally invasive procedure, FELD minimizes disruption to paraspinal musculature, thereby enabling faster recovery and early return to preoperative functional status.²⁷ These advantages make it an appealing option for professional athletes, for whom rapid rehabilitation and return to high-performance activity are critical.

However, extrapolating outcomes from the general population to the athletic cohort poses challenges. In athletes, the surgical success must go beyond pain relief and radiological decompression; it must also ensure a full RTP with restoration of strength, flexibility, endurance, and functional range of motion.^9,11 Despite the growing adoption of FELD, there remains a paucity of research specifically examining its application in professional athletes. Critical details such as the optimal timing of intervention, postoperative rehabilitation strategies, and RTP criteria are often inadequately addressed in existing literature.^{1,15,22,32,40,46}

The purpose of our study was to evaluate RTP outcomes, functional recovery, and postoperative complications in professional athletes undergoing FELD, and to describe the structured postoperative rehabilitation protocol implemented. We hypothesized that FELD, combined with standardized rehabilitation, would result in a high RTP rate within 3 months and restoration of preinjury performance levels.

Methods

This retrospective, single-center study was conducted at the Centre Orthopédique Santy in Lyon, France, utilizing prospectively collected data. Ethical approval was obtained from the institutional review board (COS-RGDS-2023-05-009-D'ASTORG-H).

The cohort included professional athletes who underwent FELD for LDH between October 2021 and July 2024. All included patients were elite athletes defined as professional or international-level competitors. This study included athletes in top-tier professional basketball and rugby leagues, as well as winter-sport athletes competing at the international level (World Cup and Olympic competitions). The inclusion criteria were professional athletes with significant functional limitations and inability to continue sports due to unilateral radicular pain, after at least 6 weeks of failed conservative management (rest and nonsteroidal anti-inflammatory drugs), or earlier in cases of an urgent neurological indication (eg, motor deficit).

The exclusion criteria included patients <18 years and those with high-grade spondylolisthesis, severe scoliosis, or multilevel disc herniation. Diagnosis was confirmed with magnetic resonance imaging (MRI), and all patients demonstrated radiological evidence of nerve root compression. Preoperative imaging also included a full-length standing radiograph using the EOS edge system to rule out spondylolisthesis and lumbosacral transitional anomalies. All surgeries were performed by 3 experienced spine surgeons (X.C., H.D., and M.S.) affiliated with the same institution.

Surgical Technique

FELD surgery was performed under general anesthesia using a uniportal endoscopic approach. All procedures were performed using the Joimax ILESSYS system with an interlaminar approach.⁸

Postoperative Rehabilitation Protocol

All athletes followed the same rehabilitation program, beginning with ambulation on postoperative day 0 under physical therapist supervision. Patients were advised to rest and avoid low-seated positions for 3 weeks postoperatively.

At 3 weeks, a follow-up consultation with the surgeon was scheduled for clinical evaluation about radiculopathy, thus initiating physical therapy. Subsequently, the athlete underwent a comprehensive physiotherapy assessment, including evaluation of the flexibility and strength of the paravertebral muscle chains (Figure 1).

Muscular strength and endurance were assessed using standardized tests for the trunk flexors, extensors, and quadriceps. Trunk flexor endurance was evaluated with the Shirado test,³⁶ in which participants lay supine with hips and knees flexed at 90°, arms crossed over the chest, and shoulders raised off the examination table; the holding time in this position was recorded in seconds. Trunk extensor endurance was measured using the Sorensen test,¹³ with participants positioned prone on an examination table, the anterior superior iliac spines aligned with the table edge, and the lower body stabilized by straps or manual support; the duration for which the upper body was maintained horizontally was recorded. Quadriceps endurance was assessed using the Killy test,⁵ in which participants stood with their backs against a wall and slid down until their hips and knees were flexed at 90°, maintaining the wall-sitting position for as long as possible; the duration was recorded in seconds.

This assessment provides a baseline clinical status and measures progress throughout the muscle reconditioning program.

All athletes followed a standardized rehabilitation protocol supervised by the same sports physical therapy team (Figure 2). The program was structured into 3 progressive phases, each with specific functional and timeline-based criteria for advancement. Athletes attended physical therapy sessions 3 to 5 times per week.

Phase 1 (weeks 0-4): Focused on isometric core and trunk stabilization. Progression to phase 2 required completion of the following tests: front plank (3 × 1 min), side plank each side (3 × 30 s), Sorensen test (5 × 1 min), and Killy test (4 × 1 min).

Phase 2 (weeks 4-8): Emphasized dynamic strengthening in stable conditions. Advancement to phase 3 required completing 4 rounds of a functional circuit: 10 hip abductions in lateral plank (each side), 10 hip extensions in front plank, and 10 single-leg hip thrusts.

Phase 3 (weeks 8-12): Included dynamic strengthening in unstable conditions, isokinetic reinforcement, and eccentric strengthening of lumbar extensors. RTP was permitted after passing an isokinetic test demonstrating controlled motion from −10° extension to 70° flexion and achieving ≥5× body weight force in hip flexors and ≥7× in extensors.

The athlete initially performed muscle-strengthening exercises, followed by stable dynamic exercises, and finally unstable dynamic exercises. Progression from one phase to the next was contingent upon successful completion of a test event. The muscle reconditioning program included exercises targeting the erector spinae, abdominal wall, obliques, gluteal muscles, and quadriceps. Stretching of all muscles (hamstrings, psoas and rectus femoris, piriformis, and posterior lumbar chain) was also performed daily with the assistance of physical therapists.

A wide majority of athletes underwent their postoperative rehabilitation at the European Center for Sports Rehabilitation Capbreton–Ramsay Santé, a specialized facility dedicated to the recovery of professional and high-level athletes. The center provides individualized, sport-specific rehabilitation programs combining physical therapy, strength and conditioning, and functional reactivation under continuous medical supervision. Resumption of daily activities was immediately authorized, except for low sitting and driving during the first 3 weeks. RTP was permitted only after completion of physical therapy and a follow-up consultation with the surgeon. Athletes progressed through the structured rehabilitation pyramid depicted in Figure 2, which includes performance test events at each stage. If an athlete did not meet the criteria for a given stage, they remained in that stage until all requirements were met.

Follow-up

All patients were clinically assessed by the surgical team at 1, 3, 6, and 12 months postoperatively and were then followed up via digital questionnaires. The minimum follow-up was 12 months, with a mean duration of over 24 months. Prospectively collected self-reported questionnaires were performed, encompassing radicular and lumbar visual analog scale (VAS)²⁸ assessments, Oswestry Disability Index (ODI),⁴² and evaluations of personal satisfaction (Macnab Criteria).²⁹ For overall health-related quality of life, we analyzed both the Short Form Physical Component Summary (SF-PCS)³⁹ score for physical health and the SF-12 Mental Component Summary (SF-MCS)⁴³ score for mental health.

Complications were defined a priori as objective adverse events, including recurrence or the need for reoperation.

Authorization for RTP was determined upon completion of the rehabilitation protocol, following a joint agreement between the surgeon and the rehabilitation physician. We also objectively assessed the return to the previous competitive level through sports performance outcomes. Return to preinjury level was defined as participation and performance in official competitions at the same level as before surgery.

Data Analysis

Descriptive analyses were performed according to the nature of the variables. For qualitative variables, the number of available and missing observations was reported, along with frequencies and percentages for each category, calculated based on available data. For quantitative variables, the number of available and missing observations, mean, standard deviation, median, first and third quartiles, and minimum and maximum were reported. When appropriate, means were presented with their 95% CIs.

Comparisons of paired data were conducted using either the paired Student t test for normally distributed variables or the Wilcoxon signed-rank test for non-normally distributed variables, depending on the distribution of the data. Statistical significance was set at P < .05. No missing data were imputed. All statistical analyses were performed using SAS software (Version 9.4; SAS Institute Inc).

Results

Characteristics

In total, 20 athletes managed with FELD for LDH were included in our study. The mean age of the study sample was 25.5 ± 3.7 years (range, 19-33 years), comprising 75% men (n = 15) and 25% women (n = 5). Among them were 5 basketball players, 7 rugby players, 5 skiers, 2 biathletes, and 1 soccer player. The mean body mass index was 26.5 ± 4.8 kg/m². All patients were operated on after failed conservative management for 6 weeks, except for 1 athlete who underwent urgent surgery due to a motor deficit. The mean duration from symptom onset to surgery was 3.6 ± 3 months (range, 1-12 months), and intractable pain was the main indication for surgery.

Intraoperative Events

There were 8 cases (40%) at L4-5 and 10 (50%) at L5-S1. There was 1 case each for L2-3 and L3-4. Disc herniations were posterolateral in all 20 cases (100%), including one that also presented as a large median herniation. All patients with posterolateral and median herniations were treated using the iLESSYS technique. The mean operative time was 70.50 minutes. No dural tears or other complications were observed in any case. The mean hospital stay was 1.5 days. Specifically, 1 patient was hospitalized for 4 days, 1 for 3 days, 6 for 2 days, 11 for 1 day, and 1 was discharged the same day as surgery.

Follow-up and Functional Outcomes

At final follow-up, patients showed significant improvement across all functional measures. The mean VAS-Lumbar score decreased significantly from 4 ± 2.6 (95% CI, 2.8 to 5.2) preoperatively to 0.6 ± 0.8 (95% CI, 0.2 to 0.9) at the final follow-up (P < .0001). Eleven patients (55%) had a VAS-Lumbar score >3 at baseline, while all patients (100%) had scores ≤3 at the final follow-up.

The mean VAS-Radicular score also decreased significantly from 6.3 ± 1.6 (95% CI, 5.6 to 7.1) to 0.3 ± 0.7 (95% CI, –0.0 to 0.6) at the final follow-up (P < .0001). Nineteen patients (95%) reported a VAS-Radicular score >3 preoperatively, compared with 100% scoring ≤3 at the final follow-up.

Disability as measured by the Oswestry Disability Index (ODI) improved markedly, with a mean decrease from 36.1 ± 13.5 (95% CI, 29.7-42.4) preoperatively to 5.1 ± 6 (95% CI, 2.2-7.9) at the last follow-up (P < .0001).

Among the 11 evaluable patients who completed SF-12 assessments, the mean SF-PCS increased from 34.1 ± 5.5 (95% CI, 30.4-37.8) to 53.4 ± 5.5 (95% CI, 49.7-57.1) (P = .0010). The SF-MCS also improved significantly from 38.1 ± 6.4 (95% CI, 33.8-42.4) to 49.8 ± 9.8 (95% CI, 43.2-56.4) (P = .0420).

All results are summarized in Table 1.

Table 1

Patient Characteristics, Surgical Data, and Outcomes (n = 20) ^a

Variable	Value
Sample size	20 professional athletes
Age, years	25.5 ± 3.7 (19-33)
Sex	Male: 15 (75); female: 5 (25)
Sport disciplines, n	Basketball: 5; rugby: 7; ski, 5; biathlon: 2; football: 1
BMI, kg/m²	26.5 ± 4.8
Time from symptom onset to surgery, months	3.6 ± 3
Indication for surgery	Intractable radicular pain after ≥6 weeks of conservative care, n = 19; urgent surgery for motor deficit, n = 1
Disc level affected	L4-L5: 8 (40); L5-S1: 10 (50); L2-L3: 1 (5); L3-L4: 1 (5)
Herniation type	Posterolateral: 20 (100)
Surgical approach	Interlaminar FELD with iLESSYS (100)
Operative time, minutes	70.5 ± 31.12
Perioperative complications	None
Hospital stay, days	1.5 (0-4)
VAS-Lumbar	Preop: 4 ± 2.6 (2.8-5.2) Final FU: 0.6 ± 0.8 (0.2-0.9) P < .0001
VAS-Radicular	Preop: 6.3 ± 1.6 (5.6-7.1) Final FU: 0.3 ± 0.7 (–0.0 to 0.6) P < .0001
ODI,	Preop: 36.1 ± 13.5 (29.7-42.4) Final FU: 5.1 ± 6 (2.2–7.9) P < .0001
SF-12 Physical, n = 11	Preop: 34.1 ± 5.5 (30.4-37.8) Final FU: 53.4 ± 5.5 (49.7-57.1) P = .0010
SF-12 Mental, n =11	Preop: 38.1 ± 6.4 (33.8-42.4) Final FU: 49.8 ± 9.8 (43.2-56.4) P = .0420

Data are presented as mean ± SD (range), mean ± SD (95% CI), or n (%). Boldface P values indicate statistical significance. Perioperative complications are adverse events occurring within 30 days after surgery. BMI, body mass index; FELD, full endoscopic lumbar discectomy; FU, follow-up; ODI, Oswestry Disability Index; Preop, preoperative; SF-12, Short Form-12 Health Survey (physical and mental components); VAS-Lumbar, visual analog scale for lumbar pain; VAS-Radicular, visual analog scale for radicular pain.

Four patients (20%) experienced recurrent herniation, and 3 required reoperation. Patient satisfaction was rated as excellent in 90% of cases. One patient described the outcome as poor, and another as good. The mean time to RTP was 3.4 months. Also, 15 of 20 athletes (75%) resumed sports within 3 months, 4 (20%) returned after> 3 months, and 1 (5%) did not RTP. Among all patients, 80% reported returning to a level of physical performance equivalent to their preoperative state, while 20% reported a decline in performance. Of the operated athletes, 4 returned to high-level international competition, including participation in the EuroLeague Women, the Ski World Cup, and the Olympic Games—notably 1 athlete who won a Crystal Globe in alpine skiing.

Discussion

The major findings of our study demonstrated that FELD provides a minimally invasive option for LDH, with significant improvements in pain, function, and early RTP in professional athletes. In this cohort of 20 athletes treated after failed conservative management, FELD achieved clinical outcomes comparable to those of conventional techniques while minimizing downtime, a particularly important advantage for high-performance athletes, where rapid recovery may be career-defining.

The minimally invasive approach of FELD offers biomechanical advantages not found in open or microdiscectomy. Direct visualization of the pathology may facilitate effective neural decompression while preserving posterior spinal elements, reducing perioperative morbidity, and enabling a faster return to daily activities.^{19-21,23-26,41} Sivakanthan et al,⁴⁰ in their case series and literature review, observed an 88% RTP at 3 months for endoscopic discectomy. In contrast, the same was 81% between 5.2 and 8.7 months for both conventional open and minimally invasive surgery.⁴⁰ Most of our patients resumed their sports activity within 3 months (mean, 3.4 months). However, 1 patient did not resume athletic activity. This athlete was nearing the end of their professional career and experienced persistent postoperative pain, which contributed to the decision not to RTP.

Surgical treatment is considered if the pain is not amenable to conservative management, typically 4 to 8 weeks, as 70% of patients showed improvement within 4 weeks.² However, the literature is scarce on whether the surgical management has any advantages over conservative management when the patient is a professional athlete. A study by Hsu et al,¹⁴ observing the outcomes of LDH in 342 professional athletes, found no difference between the surgical and conservative cohorts (83% vs 81%, respectively).¹⁴ Moreover, the mean time to return was 5.2 months after lumbar discectomy versus 4.1 months after conservative management. In summary, if a surgeon must choose between surgery and conservative management in an athlete with LDH, the decision should be based on the symptoms of the patient, and surgery should be favored only when the symptoms are intractable. Once the type of surgery is decided, it can affect the time required for an athlete to RTP.

The open approach has definite disadvantages over microscopic and endoscopic techniques.⁴ Even the long-term outcomes of microscopic and endoscopic discectomy are comparable. However, the catch is that early postoperative outcomes are better with endoscopy than with microscopy. A comparative analysis by Şerifoğlu et al,³⁸ with 25 patients each managed with FELD and microdiscectomy, observed better outcomes in the FELD group (P = .025) at 1-week postoperative. However, it was the same at 3 and 9 months. Early recovery enables more effective participation in rehabilitation, positively impacting pain, disability, and quality of life.³⁵

The literature is sparse about rehabilitation protocols in athletes after FELD. As FELD avoids extensive muscle damage and denervation of stabilizing structures, this results in less postoperative pain, shorter hospital stays, and faster functional recovery.^30,35 Early mobilization is the cornerstone of all spine surgeries; athletes should undergo a structured rehabilitation protocol to regain their preoperative level of activity. In this study, we introduced our post-FELD rehabilitation protocol, which helped our athletes return to their sports early and, more importantly, at a similar intensity. Most of our athletes were able to resume in 3 to 4 months (mean, 3.4 months). In a case series by Maeda et al,³⁰ five baseball players were able to RTP within 3 months after endoscopic decompression spine surgery. They performed surgery under local anesthesia, whereas we used general anesthesia in all our patients. It is important to note that the RTP with traditional open and other minimally invasive surgeries is similar (>80%), but the postoperative period is 5.2 to 8.7 months for traditional surgery, which can be a negative factor for a professional athlete.⁴⁰ We closely observed the patient who did not RTP at all. He was a ski-cross player with a disc herniation at L5-S1. Postoperatively, he initially experienced pain relief, but later developed recurrent symptoms during rehabilitation, confirmed by MRI as recurrent disc herniation. He did not undergo repeat surgery, although he never returned to play. There were 3 more patients who experienced recurrent disc herniation, were reoperated on, and finally returned to play successfully.

The operative variables also depend on the surgeons’ experience.¹⁶ All our surgeons involved in this study have many years of experience. The FELD has a clear advantage over open approaches, with better, more direct neural decompression, as evidenced by improved VAS, ODI, and SF-12 scores.^22,38 All our patients reported immediate improvement in radicular pain, and their functional scores showed improvement during follow-up. We did not encounter any intra- or postoperative complications in these patients.

Our study is not without limitations. First, the retrospective design and the relatively small cohort of 20 professional athletes limit the statistical power and generalizability of our findings. Second, because all participants were professional athletes managed at a specialized spine center, there is a potential selection bias. These patients may not represent the broader population of individuals with LDH, particularly recreational athletes or the general public. Third, the absence of a control group (such as patients treated with microdiscectomy or conservative management) prevents direct comparisons of the relative effectiveness of FELD versus other surgical or nonsurgical options. Fourth, psychological and performance-related factors, such as motivation, fear of reinjury, and RTP confidence, were not systematically assessed and could have influenced the outcomes. Also, the limited follow-up duration limits our ability to evaluate long-term recurrence and reoperation rates. The reproducibility of this rehabilitation protocol across different centers was not assessed. Although the program was standardized and supervised by a dedicated sports physical therapy team, its application elsewhere may be influenced by resource availability, therapist expertise, and institutional infrastructure.

Conclusion

Our study demonstrated that FELD, combined with a structured rehabilitation pathway, appears to be a safe and effective surgical option for professional athletes with LDH, potentially facilitating early RTP and high functional recovery.

Footnotes

Final revision submitted April 18, 2026; accepted May 12, 2026.

One or more of the authors has declared the following potential conflict of interest or source of funding. M.S. is a consultant for Clairiance Spine Vision; reports royalties from Clairiance Spine Vision; receives fees from Joimax and Clairiance Spine Vision; and receives payment for expert testimony from Joimax. M.S. also serves as Treasurer of the SFCR. H.A. is a consultant for Clariance Spine Vision and Joimax and has received a grant in the last 36 months.

Ethical approval was obtained from the Conseil d’Orientation Scientifique Ramsay Santé (IRB No. IRB00010835; reference No. COS-RGDS-2023-05-009-D'ASTORG-H).

ORCID iDs

Xavier Castel

Thais Dutra Vieira

References

Abe

Takata

Higashino

, et al. Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player. J Med Investig JMI. 2015;62(3-4):238-241.

Alentado

Lubelski

Steinmetz

Benzel

Mroz

TE.

Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review. Glob Spine J. 2014;4(4):279-286.

Anakwenze

Namdari

Auerbach

, et al. Athletic performance outcomes following lumbar discectomy in professional basketball players. Spine. 2010;35(7):825-828.

Barber

Nakhla

Konakondla

, et al. Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis. J Neurosurg Spine. 2019;31(6):802-815.

Bernard

Bard

Pujol

, et al. Muscle assessment in healthy teenagers, comparison with teenagers with low back pain. Ann Readapt Med Phys. 2008;51(4):263-283.

Bharath

Gupta

Srivastava

Skip spondylolysis in a javelin thrower: a rare case report. Indian Spine J. 2023;6(2):181-185.

Bouras

Korovessis

Management of spondylolysis and low-grade spondylolisthesis in fine athletes. A comprehensive review. Eur J Orthop Surg Traumatol. 2015;25(suppl 1):S167-S175.

Choi

Lee

Raiturker

Lee

Chae

YS.

Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery. 2006;58(suppl 1):ONS59-ONS68.

Cook

Hsu

WK.

Return to play after lumbar spine surgery. Clin Sports Med. 2016;35(4):609-619.

10.

Cordover

Fleisig

Raszewski

Dumont

Cordover

AM.

Return to sport after lumbar microdiscectomy in high school and college-age athletes. World Neurosurg. 2022;163:e516-e521.

11.

Fryhofer

Smith

HE.

Return to play for cervical and lumbar spine conditions. Clin Sports Med. 2021;40(3):555-569.

12.

Gadjradj

Harhangi

Amelink

, et al. Percutaneous transforaminal endoscopic discectomy versus open microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis. Spine. 2021;46(8):538-549.

13.

Ghroubi

Jribi

Jdidi

, et al. Study of the validity and reproducibility of the Biering-Sorensen test in chronic low back pain. Ann Phys Rehabil Med. 2015;58:e88.

14.

Hsu

McCarthy

Savage

, et al. The professional athlete spine initiative: outcomes after lumbar disc herniation in 342 elite professional athletes. Spine J. 2011;11(3):180-186.

15.

Huang

Anissipour

McGee

Lemak

Return-to-play recommendations after cervical, thoracic, and lumbar spine injuries: a comprehensive review. Sports Health. 2016;8(1):19-25.

16.

Imoto

Umakoshi

Yunoki

, et al. Surgical outcomes of full-endoscopic lumbar discectomy in the early adoption phase. Asian J Neurosurg. 2022;17(3):474-479.

17.

Iwamoto

Sato

Takeda

Matsumoto

The return to sports activity after conservative or surgical treatment in athletes with lumbar disc herniation. Am J Phys Med Rehabil. 2010;89(12):1030-1035.

18.

Kambin

O’Brien

Zhou

Schaffer

JL.

Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop. 1998;(347):150-167.

19.

Kapetanakis

Charitoudis

Thomaidis

Theodosiadis

Papathanasiou

Giatroudakis

Health-related quality of life after transforaminal percutaneous endoscopic discectomy: an analysis according to the level of operation. J Craniovertebral Junction Spine. 2017;8(1):44.

20.

Kapetanakis

Giovannopoulou

Charitoudis

Kazakos

Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: a prospective cohort study - early results. J Back Musculoskelet Rehabil. 2017;30(6):1311-1317.

21.

Kapetanakis

Gkantsinikoudis

Chaniotakis

Charitoudis

Givissis

Percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation in obese patients: health-related quality of life assessment in a 2-year follow-up. World Neurosurg. 2018;113:e638-e649.

22.

Kapetanakis

Gkantsinikoudis

Charitoudis

Implementation of percutaneous transforaminal endoscopic discectomy in competitive elite athletes with lumbar disc herniation: original study and review of the literature. Am J Sports Med. 2021;49(12):3234-3241.

23.

Kapetanakis

Gkantsinikoudis

Charitoudis

The role of full-endoscopic lumbar discectomy in surgical treatment of recurrent lumbar disc herniation: a health-related quality of life approach. Neurospine. 2019;16(1):96-104.

24.

Kapetanakis

Gkantsinikoudis

Papathanasiou

Charitoudis

Thomaidis

Percutaneous endoscopic ventral facetectomy: an innovative substitute of open decompression surgery for lateral recess stenosis surgical treatment?

J Craniovertebral Junction Spine. 2018;9(3):188-195.

25.

Kapetanakis

Gkantsinikoudis

Thomaidis

Charitoudis

Theodosiadis

The role of percutaneous transforaminal endoscopic surgery in lateral recess stenosis in elderly patients. Asian Spine J. 2019;13(4):638-647.

26.

Kapetanakis

Gkasdaris

Angoules

Givissis

Transforaminal percutaneous endoscopic discectomy using transforaminal endoscopic spine system technique: pitfalls that a beginner should avoid. World J Orthop. 2017;8(12):874-880.

27.

Kim

CW.

Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine. 2010;35(suppl 26):S281-S286.

28.

Knop

Oeser

Bastian

Lange

Zdichavsky

Blauth

[Development and validation of the visual analogue scale (VAS) spine score]. Unfallchirurg. 2001;104(6):488-497.

29.

Macnab

Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971;53(5):891-903.

30.

Maeda

Takamatsu

Hashimoto

, et al. Return to play in professional baseball players following transforaminal endoscopic decompressive spine surgery under local anesthesia. J Spine Surg Hong Kong. 2020;6(suppl 1):S300-S306.

31.

Mortazavi

Zebardast

Mirzashahi

Low Back Pain in Athletes. Asian J Sports Med. 2015;6(2):e24718.

32.

Nakamae

Fujimoto

Yamada

, et al. Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in athletes under the local anesthesia. J Orthop Sci Off J Jpn Orthop Assoc. 2019;24(6):1015-1019.

33.

Ong

Anderson

Roche

A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med. 2003;37(3):263-266.

34.

Overley

McAnany

Andelman

, et al. Return to play in elite athletes after lumbar microdiscectomy: a meta-analysis. Spine. 2016;41(8):713-718.

35.

Özden

Koçyiğit

GZ.

The effect of early rehabilitation after lumbar spine surgery: a systematic review and meta-analysis. Egypt J Neurosurg. 2024;39(1):8.

36.

del Pozo-Cruz

Mocholi

del Pozo-Cruz

Parraca

Adsuar

Gusi

Reliability and validity of lumbar and abdominal trunk muscle endurance tests in office workers with nonspecific subacute low back pain. J Back Musculoskelet Rehabil. 2014;27(4):399-408.

37.

Sedrak

Shahbaz

Gohal

Madden

Aleem

Khan

Return to play after symptomatic lumbar disc herniation in elite athletes: a systematic review and meta-analysis of operative versus nonoperative treatment. Sports Health. 2021;13(5):446-453.

38.

Şerifoğlu

Etli

Özdoğan

Comparative Analysis of full endoscopic interlaminar lumbar discectomy and lumbar microdiscectomy. Clin Spine Surg. 2025;38(6):E312-E315.

39.

Singh

Gnanalingham

Casey

Crockard

Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine. 2006;31(6):639-643.

40.

Sivakanthan

Williams

Feroze

, et al. Endoscopic spine surgery in athletes: case series and review of literature. World Neurosurg. 2021;145:702-707.

41.

Sun

Fang

Gao

Wei

Qian

Comparison of effectiveness and safety between epidural anesthesia vs local anesthesia for percutaneous transforaminal endoscopic discectomy: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(1):e18629.

42.

Vianin

Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med. 2008;7(4):161-163.

43.

Vilagut

Forero

Pinto-Meza

, et al. The mental component of the short-form 12 health survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods. Value Health. 2013;16(4):564-573.

44.

Wang

Shapiro

Hatch

Knight

Dorey

Delamarter

RB.

The outcome of lumbar discectomy in elite athletes. Spine. 1999;24(6):570-573.

45.

Watkins

Hanna

Chang

Watkins

RG.

Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes. Am J Sports Med. 2012;40(11):2530-2535.

46.

Yamashita

Higashino

Sakai

, et al. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report. J Med Investig JMI. 2016;63(1-2):135-139.

47.

Yang

Chen

Lin

MHC

, et al. Complications of full-endoscopic lumbar discectomy versus open lumbar microdiscectomy: a systematic review and meta-analysis. World Neurosurg. 2022;168:333-348.

48.

Yoshimoto

Takebayashi

Ida

Tanimoto

Yamashita

Microendoscopic discectomy in athletes. J Orthop Sci. 2013;18(6):902-908.