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Largest ACDF series in professional athletes provides insight on return-to-play decisions
In the treatment of professional athletes in contact sports, return-to-play recommendations after spine surgery are complicated by a host of factors. Often conflicting goals involving social, medical, legal and economic pressures not seen in non-professional athletes must be considered.
Following anterior cervical discectomy and fusion (ACDF), these factors along with limited outcome data can result in ultra-conservative return-to-play decisions. This can result in forced early retirement for the athletes despite good recovery and return to normal neurological function.
Single-surgeon study
In an article published in Neurosurgery, researchers from the University of Pittsburgh Medical Center and University of Rochester Medical Center presented the largest series published on professional athletes who had undergone single-level ACDF by a single surgeon from 2003 to 2012. The authors reported on 15 professional football players and wrestlers who presented with a history of neurapraxia and/or symptoms of cervical radiculopathy and had undergone single-level ACDF.
Joseph C. Maroon
Thirteen players returned to sport between 6 weeks and 12 months, with a mean of 6 months. Two athletes were also cleared to return to play, however, they chose to retire. All the athletes who returned to play remain asymptomatic for radicular or myelopathic symptoms or signs for a minimum of 2 years.
Although there are risks of catastrophic spinal injury inherent to contact sports, such as football and wrestling, that may theoretically increase following single-level ACDF, this has not been demonstrated in previous published smaller case studies. In the current study, of the 13 athletes who returned to play, only five athletes retired after an average of 2 years. The other athletes continue to play without sport-related cervical spine symptoms or injury.
Jeff Bost
Consistent standard
The authors noted that the majority of athletes initially presented with acute on-field symptoms and symptoms of neurapraxia following contact. In this group, MRI findings demonstrated a significant loss of cerebrospinal fluid signal at the single level of cord compression. Repeat MRI scans were reviewed for clearance in this subset. Two athletes had preoperative focal hyperintensity in the cord at the level of cervical stenosis that persisted postoperatively. With complete resolution of symptoms, signs and CT scan evidence of fusion, both athletes with persistent hyperintensity were cleared for return-to-play and did not report any further spine-related complications.
Commentators noted the important contribution this study provides where there is generally no universally agreement on postoperative management. The study provides a consistent standard for making return-to-play decisions following single-level ACDF for athletes who want to return to contact sports. The athlete must have a normal neurological examination and demonstrate full range of neck movement and solid arthrodesis with no movement on flexion and extension radiographs.
Despite limitations of having a limited number of athletes and a relatively short follow-up period, the study presents further evidence to assist spine surgeons in their return-to-play decisions.
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Jeff Bost, PAC, is from the Department of Neurosurgery, University of Pittsburgh Medical Center.
Disclosures: Maroon and Bost have no relevant financial disclosures.