title: Does the Level of Cervical Disc Herniation Surgery Affect Performance-based Outcomes in National Football League Athletes?
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  The aim of this study was to determine whether the level of a cervical disc herniation (CDH) procedure will uniquely impact performance-based outcomes in elite athletes of the National Football League (NFL).
  
  
  BACKGROUND
  Comparative assessments of postsurgical outcomes in NFL athletes with CDH at different levels are unknown. Further, the surgical decision-making for these types of injuries in professional football athletes remains controversial.
  
  
  METHODS
  NFL players with a CDH injury at a definitive cervical level were identified through a review of publicly available archives. Injuries were divided into upper- (C2-C4) and lower-level (C4-T1) CDH. The impact on player outcomes was determined by comparing return to play statistics and calculating a "Performance Score" for each player on the basis of pertinent statistical data, both before and after surgery.
  
  
  RESULTS
  A total of 40 NFL athletes met inclusion criteria. In the upper-level group, 10 of 15 (66.6%) players successfully returned to play an average of 44.6 games over 2.6 years. The lower-level cohort had 18 of 25 (72%) players return to play with an average of 44.1 games over 3.1 years. There was no significant difference in the rate of return to play (P = 0.71). Postsurgical performance scores of the upper and lower-level groups were 1.47 vs. 0.69 respectively, with no significant difference between these groups (P = 0.06). Adjacent segment disease requiring reoperation occurred in 10% of anterior cervical discectomy and fusion patients. In 50% of foraminotomy patients, a subsequent fusion was required.
  
  
  CONCLUSIONS
  A uniquely high percentage of upper-level disc herniations develop in NFL athletes, and although CDH injuries present career threatening implications, an upper-level CDH does not preclude a player from successfully returning to play at a competitive level. In fact, these athletes showed comparable postsurgical performance to those athletes who underwent CDH procedures at lower cervical levels.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Los Angeles, CA.|Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Harry T
authors.initials: HT
authors.lastname: Mai
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Burgmeier
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Mitchell
authors.affiliation: Department of Orthopaedic Surgery, Mt. Sinai Hospital, New York, New York.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hecht
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Maroon
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Gordon W
authors.initials: GW
authors.lastname: Nuber
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Wellington K
authors.initials: WK
authors.lastname: Hsu
mesh_terms: D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D005538:Football / Q000293:injuries*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012916:Soccer; D055815:Young Adult