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Outcomes After Anterior Cervical Discectomy and Fusion in Professional Athletes

Maroon, Joseph C. MD*,‡; Bost, Jeffrey W. PA-C*; Petraglia, Anthony L. MD§; LePere, Darren B. BS*; Norwig, John ATC; Amann, Christopher MD; Sampson, Michael DO; El-Kadi, Matt MD, PhD*

doi: 10.1227/01.neu.0000429843.68836.91
Research-Human-Clinical Studies
Press Release

BACKGROUND: Significant controversy exists regarding when an athlete may return to contact sports after anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data.

OBJECTIVE: The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries.

METHODS: Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded.

RESULTS: Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs.

CONCLUSION: After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP.

ABBREVIATIONS: ACDF, anterior cervical discectomy and fusion

CCN, cervical cord neurapraxia

NFL, National Football League

RTP, return to play

*Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

Team Neurosurgeon, Pittsburgh Steelers, Pittsburgh, Pennsylvania;

§Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York;

Head Athletic Trainer, Pittsburgh Steelers, Pittsburgh, Pennsylvania;

Ringside Physician, World Wrestling Entertainment, Inc, Stamford, Connecticut

Correspondence: Jeff Bost, PA-C, Department of Neurosurgery, UPMC Presbyterian Hospital, 200 Lothrop Street, Suite 5C, Pittsburgh, PA 15213. E-mail:

Received September 28, 2012

Accepted March 19, 2013

Copyright © by the Congress of Neurological Surgeons