High-level athletes can return to play after cervical disc herniation, study finds

NEW ORLEANS — National Football League players undergoing surgery for cervical disc herniations stand a good chance of returning to the same level play and for a longer period of time afterwards compared to players treated nonoperatively, according to the results a study presented here.

“Of those patients who underwent operative treatment for a CDH, 72% successfully returned to play in an NFL game and averaged 29 games over a 2.8 year period,” Wellington K. Hsu, MD, said.

“This was statistically significantly greater than those we had nonoperative treatment, where only 46% returned to play 14 games over a 1.5 year period.”

He presented the results of one of the first studies focusing on these injuries in elite athletes at 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. Hsu decided to conduct the study after being unable to answer a question regarding a National Football League (NFL) player’s odds for resuming play after cervical disc herniation (CDH) surgery.

Defensive backs affected

Hsu used public records to identify players on NFL rosters between 1979 and 2008 who were diagnosed with CDH. Players were included in the study if two independent sources confirmed the diagnosis and were excluded if they only had degenerative or bulging discs or strained necks.

Ninety-nine players were diagnosed with a CDH. “The defensive backs seem to be over-represented in this patient population,” Hsu noted.

Of those players, 55 underwent operative and 46 underwent nonoperative treatment. The groups were similar demographically, but the operative group had a significantly greater body mass index.

Further analysis

Hsu used two performance-based outcome measures: a validated performance score calculated based on player statistics and the percent of games started before and after treatment.

“There is no statistically significant difference in either of these outcomes before or after treatment, or between groups,” he said.

The multivariate regression analysis he performed showed that age was a negative predictor of how long a player would play after being treated for CDH. “What was surprising was the position seemed to matter,” Hsu said, with all the positions consistent in terms of games played except for defensive backs, who averaged 10 games during 1.2 years after CDH treatment. By comparison, players in other positions played 28 games over a 2.7-year period, Hsu said.

Hsu is now expanding the study to cover four other major North American sports.

Reference:
Hsu W. Outcomes following nonoperative and operative treatment for cervical disc herniations in NFL players. Paper #534. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.

In reading this paper, which read very well and was interesting, it is important to point out that the information was gleaned mostly from media reports and it is hard to control for that. Therefore, we should be careful about the conclusions that we draw from this study, particularly that athletes with cervical disc herniations treated surgically do better than athletes treated nonsurgically. We cannot say that definitively from the study because we do not know whether the athletes that were treated nonoperatively were even surgical candidates to begin with. All that we can safely say is that high-level athletes can return to play after having an anterior cervical discectomy and fusion (ACDF).

Michael J. Vives, MD
Assistant Professor of Orthopedic Surgery
University of Medicine and Dentistry of New Jersey
Newark, N.J.