title: Outcomes after anterior cervical discectomy and fusion in professional athletes.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Maroon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Bost
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Petraglia
authors.forename: Darren B
authors.initials: DB
authors.lastname: Lepere
authors.forename: John
authors.initials: J
authors.lastname: Norwig
authors.forename: Christopher
authors.initials: C
authors.lastname: Amann
authors.forename: Michael
authors.initials: M
authors.lastname: Sampson
authors.forename: Matt
authors.initials: M
authors.lastname: El-Kadi
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D017586:Diskectomy / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D013123:Spinal Fusion / Q000379:methods*; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome