title: Pre-existing lumbar spine diagnosis as a predictor of outcomes in National Football League athletes.
abstract: BACKGROUND
  It is currently unknown how pre-existing lumbar spine conditions may affect the medical evaluation, draft status, and subsequent career performance of National Football League (NFL) players.
  
  
  OBJECTIVE
  To determine if a pre-existing lumbar diagnosis affects a player's draft status or his performance and longevity in the NFL.
  
  
  METHODS
  Cohort study; Level 3.
  
  
  METHODS
  The investigators evaluated the written medical evaluations and imaging reports of prospective NFL players from a single franchise during the NFL Scouting Combine from 2003 to 2011. Players with a reported lumbar spine diagnosis and with appropriate imaging were included in this study. Athletes were then matched to control draftees without a lumbar spine diagnosis by age, position, year, and round drafted. Career statistics and performance scores were calculated.
  
  
  RESULTS
  Of a total of 2965 athletes evaluated, 414 were identified as having a pre-existing lumbar spine diagnosis. Players without a lumbar spine diagnosis were more likely to be drafted than were those with a diagnosis (80.2% vs. 61.1%, respectively, P < .001). Drafted athletes with pre-existing lumbar spine injuries had a decrease in the number of years played compared with the matched control group (4.0 vs. 4.3 years, respectively, P = .001), games played (46.5 vs. 50.8, respectively, P = .0001), and games started (28.1 vs. 30.6, respectively, P = .02) but not performance score (1.4 vs. 1.8, respectively, P = .13). Compared with controls, players were less likely to be drafted if they had been diagnosed with spondylosis (62.37% vs. 78.55%), a lumbar herniated disc (60.27% vs. 78.43%), or spondylolysis with or without spondylolisthesis (64.44% vs. 78.15%) (P < .001 for all), but there was no appreciable effect on career performance; however, the diagnosis of spondylolysis was associated with a decrease in career longevity (P < .05). Notably, 2 athletes who had undergone posterior lateral lumbar fusion were drafted. One played in 125 games, and the other is still active and has played in 108 games.
  
  
  CONCLUSIONS
  The data in this study suggest that athletes with pre-existing lumbar spine conditions were less likely to be drafted and that the diagnosis is associated with a decrease in career longevity but not performance. Players with lumbar fusion have achieved successful careers in the NFL.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA gregdschroeder@gmail.com.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Department of Orthopaedic Surgery, Columbia University, New York, New York, USA.
authors.forename: T Sean
authors.initials: TS
authors.lastname: Lynch
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Gibbs
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Chow
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: LaBelle
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Savage
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois, USA.
authors.forename: Wellington K
authors.initials: WK
authors.lastname: Hsu
authors.affiliation: Department of Orthopaedic Surgery, NorthShore University, Chicago, Illinois, USA.
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Nuber
mesh_terms: D056352:Athletes; D015331:Cohort Studies; D005538:Football / Q000293:injuries*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000473:pathology; D011446:Prospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D013168:Spondylolisthesis / Q000453:epidemiology; D013169:Spondylolysis / Q000453:epidemiology; D055009:Spondylosis / Q000453:epidemiology
keywords: football; herniated disc; lumbar spine; spondylosis