*Drew-UCLA Medical Education Program, David Geffen School of Medicine at UCLA, Los Angeles, CA. †Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix ‡Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York; §Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
STUDY DESIGN: Retrospective cohort study OBJECTIVE.: To determine if the level of a cervical disc herniation (CDH) procedure will uniquely impact performance-based outcomes in elite athletes of the National Football League (NFL). SUMMARY OF BACKGROUND DATA: Comparative assessments of post-surgical outcomes in NFL athletes with CDH at different levels are unknown. Further, the surgical decision making for these types of injuries in professional football athletes remains controversial.
METHODS: NFL players with a CDH injury at a definitive cervical level were identified through a review of publicly available archives. Injuries were divided into upper (C2-C4) and lower-level (C4-T1) CDH. The impact on player outcomes was determined by comparing return to play statistics and calculating a "Performance Score" for each player on the basis of pertinent statistical data, both before and after surgery.
RESULTS: A total of 40 NFL athletes met inclusion criteria. In the upper-level group, 10 out of 15 (66.6%) players successfully returned to play an average of 44.6 games over 2.6 years. The lower-level cohort had 18 out of 25 (72%) players return to play with an average of 44.1 games over 3.1 years. There was no significant difference in the rate of return to play (p = 0.71). Post-surgical performance scores of the upper and lower-level groups were 1.47 vs. 0.69 respectively, with no significant difference between these groups (p = 0.06). Adjacent segment disease requiring reoperation occurred in 10% of ACDF patients. In 50% of foraminotomy patients, a subsequent fusion was required.
CONCLUSIONS: A uniquely high percentage of upper-level disc herniations develop in NFL athletes, and while CDH injuries present career threatening implications, an upper-level CDH does not preclude a player from successfully returning to play at a competitive level. In fact, these athletes showed comparable post-surgical performance to those athletes who underwent CDH procedures at lower cervical levels. LEVEL OF EVIDENCE: 4.