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Operative treatment allowed for professional athletes with lumbar disc herniation better return to play, study finds
A close look at linemen playing American football reveals strong return-to-play rates for operative patients.
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National Football League linemen who sustain a lumbar disc herniation have a higher return-to-play rate when treated operatively rather than nonoperatively, according to a recently presented study.
The findings were presented by Joseph K. Weistroffer, MD, at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.
A majority of players treated surgically, Weistroffer added, were able to achieve a starting role.
“Surgery for lumbar disc herniation has achieved high satisfaction rates and return-to-work rates as high as 82%,” Weistroffer said. “Despite these outstanding clinical results from the average patient, many are skeptical of this treatment option in elite athletes. This belief is likely rooted in the demands athletes place on their bodies — a belief supported by findings linking athletes to accelerated lumbar disc degeneration.”
“The inherent speed and strength of American football makes these professional athletes high-risk for degenerative disc disorders,” he added, noting that linemen in particular are susceptible to back injuries due to the hyperextension required for the position.
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Image: Orthopedics Today Staff |
Sixty-six linemen
Weistroffer’s group performed a search of records and identified 140 players on NFL rosters from 1979 to 2009 diagnosed with disc herniation by at least two independent sources. Sixty-six of the players were either offensive or defensive linemen, and thus were included in the study. These players’ statistics were compared.
“NFL players with lumbar disc herniation were identified using the public record, including press releases, team injury reports, team records and individual player profiles,” Weistroffer said. “A player was excluded when the search produced conflicting information, treatment with fusion, or the terms ‘lumbar strain,’ ‘bulging disc’ or ‘degenerative disc.’”
Only players treated with lumbar discectomy and/or laminotomy were included in the surgical cohort, and patients treated with open laminectomies were excluded.
Superior results for surgical patients
According to the study, 36 offensive linemen and 30 defensive linemen met inclusion criteria.
Weistroffer reported that 80.8% (42/52) of linemen who were treated surgically returned to play, with 55.8% (29/52) becoming starters.
“On average, the surgical group played for 61 games before the surgery and 40 games after the surgery,” Weistroffer said.
Following nonoperative intervention, only 28.6% (4/14) athletes returned to play, for an average of five games. Six of the seven linemen who required revision decompression returned to play.
“There are a number of reasons to believe that NFL players have poor outcomes after spine surgery,” Weistroffer said. “None so much as hearing commentators discuss these patients as ‘damaged goods,’ ‘red flags,’ or ‘not the same player.’ As a result, many of these players wear a scarlet letter when they get back onto the playing field.”
Comparable to return to work
“Even though this is not a comparative study, operative treatment for lumbar disc herniation in NFL linemen led to better performance-based outcomes than those of the nonoperative cohort,” Weistroffer said. “Surgical intervention helped these premiere athletes return to play on a professional level over 80% of the time, with over half of them attaining the elite status of starter.”
“The return-to-play rate is comparable to the return-to-work rates for the general population,” he added.
The difference in results between operative and nonoperative treatment “could have been affected by a number of confounding factors,” the study noted, adding that those linemen requiring revision decompression had similar return-to-play rates as the rest of the surgical cohort. – by Robert Press
Reference:
- Weistroffer JK, Hsu W. National Football League linemen with disc herniations have superior outcomes with discectomy. Paper 062. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
- Joseph K. Weistroffer, MD, can be reached at jkweistroffer@nmcsd.med.navy.mil.
 Scott D. Boden |
This article summarizes a new study on an interesting topic. It is important to remember that the majority of lumbar disc herniations resolve with nonoperative treatment. Surgery can certainly achieve faster resolution of sciatica compared with nonoperative treatment. The current study in athletes was not prospective nor randomized, so it is difficult to know if there were factors in athletes that did not undergo surgery that may have predicted an inferior outcome completely unrelated to the fact that they did not undergo surgery. I think this study certainly highlights a potential finding that deserves validation in a prospective randomized trial.
– Scott D. Boden, MD
Director of Emory
University Spine Center
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