Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes

Study Design. Retrospective cohort study. Objective. To determine the performance-based outcomes in elite athletes of the National Football League (NFL) after a cervical disc herniation. Summary of Background Data. Because outcomes after the treatment of cervical disc herniations (CDH) in elite athletes are currently unknown, the treatment decisions for this injury in professional football players are often controversial. Methods. NFL players diagnosed with a CDH were identified through previously published protocols using team injury reports and newspaper archives. The "Performance Score" for each player was calculated on the basis of pertinent statistical data, before and after diagnosis of CDH. Data analysis was performed for players with at least a 2-year follow-up. Results. A total of 99 NFL athletes met the inclusion criteria. In the operative group, on average, 38 of 53 (72%) players successfully returned to play for 29 games over a 2.8-year period, which was significantly greater than that of the nonoperative group, in which only 21 of 46 (46%) players successfully returned to the field to play after treatment for 15 games over a 1.5-year period (P < 0.04). Performance scores and the percentage of games started were not statistically significantly different for either cohort, before and after treatment. Notably, defensive backs had a significantly poorer outcome after treatment for CDH than any other position, playing in only 10 games over a 1.2-year period compared with all others (P < 0.0008). Age at diagnosis demonstrated a negative effect on career longevity after treatment. Conclusion. The data in this study suggest that players have higher return-to-play rates and longer careers after operative treatment than players treated with nonoperative means. Although confounding variables such as concomitant cervical stenosis could have affected these data, these performance-based outcomes after surgical treatment for CDH are better than previously thought. Defensive backs have a poorer prognosis after CDH compared with players of all other positions.