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Presentation #74: The Difference in Clinical Outcomes between ACDF and Posterior Foraminotomy in Professional Athletes

Mai, Harry T. MD; Schneider, Andrew D. BA; Mitchell, Sean M. MD; Savage, Jason W. MD; Patel, Alpesh A. MD; Hecht, Andrew C. MD; Hsu, Wellington K. MD

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Spine Journal Meeting Abstracts: 2016 - Volume 2016 - Issue - p 242–243
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Introduction: Excellent clinical outcomes after operative management of cervical disc herniation (CDH) have been reported, however, there is has been no comparative study to guide a surgeon's choice of particular operative procedure in the professional athlete. Anterior cervical discectomy and fusion (ACDF), posterior foraminotomy (PF) have all been reported to have excellent clinical outcomes in the general population but the intense physical regimen of the professional athlete necessitates different outcome measures specific to his sport.

Materials and Methods: Professional athletes of the four major professional sports leagues ‐ National Football League (NFL), Major League Baseball (MLB), National Hockey League (NHL) and National Basketball Association (NBA) ‐ diagnosed with CDH and managed operatively were identified through team injury reports and archives on public record through a previously established protocol. Athletes were grouped into cohorts based on the type of operation (ACDF and PF). Outcome measures including games played, games started, seasons played and sport specific statistics were compared in each cohort before and after surgery. As used in previously established protocols, athlete performance score based on sport specific statistics was calculated and standardized for comparison across the sports.

Results: A total of 101 professional athletes met the inclusion criteria; 86 underwent ACDF, 13 underwent PF and 2 underwent TDA. The PF cohort had a significantly greater rate of return to play (92.3% vs. 70.9%, p = .03) and the shortest time to return after surgery (238 vs. 367 days, p = .0345) [Table 1]. However, the reoperation rate at the index level was significantly higher for PF patient compared to ACDF (46.2% versus 1.2%, respectively) (p = .0001). While there was an overall decrease in performance score after surgery, there was not significant difference between the surgical cohorts (p = .336). There was also no difference in long‐term survival (p = 0.11) [Figure 1].

Table 1
Table 1:
Table 1. Comparison of Operative Management Strategies for CDH in Elite Athletes

Conclusion: Anterior cervical discectomy and fusion, posterior foraminotomy both represent viable options for the operative management of CDH in the professional athlete. The role of total disc arthroplasty in elite athletes remains to be determined and may depend on the particular sport. Posterior foraminotomy provides athletes with significantly higher rate of return to play and quicker time to return compared to ACDF. However, athletes who undergo posterior foraminotomy must accept the significantly higher risk for reoperation at the index level.

Figure 2
Figure 2:
Figure 2. Kaplan‐Meier survivorship curve demonstrating similar rates of survival after operative management of cervical disc herniations in professional athletes (Wilcoxon p = .11).
© 2016 Lippincott Williams & Wilkins, Inc.