Dr Hsu is from the Departments of Orthopedic and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Dr Hsu has no relevant financial relationships to disclose.
Correspondence should be addressed to: Wellington K. Hsu, MD, Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 1350, Chicago, IL 60611 (email@example.com).
As a spine surgeon, I have had elite athletes present with severe extremity pain and the diagnosis of a disk herniation. They often ask me what their prognosis is to return to their respective sports and how likely they will perform at a high level after surgical treatment. Although the peer-reviewed literature is rich with studies on clinical outcomes in the general population, no studies existed that could answer the questions that these athletes often have. From being an avid sports fan, I knew that professional athletes often underwent surgery for these conditions and that many of them had excellent outcomes. However, since no one had compiled this information, it was unknown how we, as surgeons, could guide the decision-making process for this patient population. This study was designed to provide information not only for the professional athlete and surgeons who care for them, but also the general public who have their own concerns about maintaining their respective sport and activity level.1
Several factors could have affected the differences in clinical outcome. First, NFL athletes could have had underlying diagnoses such as congenital cervical stenosis or “spear-tackler’s spine” that might affect the decision to retire from the sport. This information may not have been divulged in the information sources I used. Second, for many players who met the inclusion criteria, I was unable to access imaging studies or medical records to confirm the formal criteria for surgical treatment. For this reason, I was not able to control for the reasons that a player underwent nonoperative or operative treatment. Finally, unpublicized personal reasons for retirement could have also affected this data. Despite these potential confounding factors, I concluded that NFL players who underwent surgical treatment for a cervical disk herniation experienced much better outcomes than expected.
Because of the realities of the NFL, I was not able to answer with this particular patient group. The NFL regular season is relatively short (4 months) compared to other sports, and consequently, a player’s ability and timeframe for returning to the field is more dependent on the time in which the injury is sustained than the type of treatment administered. Furthermore, since I could not control for the particular reason that a player was placed on injured reserve (and therefore ineligible for the rest of the season)—such as the quality of backup players, contractural issues, or the team success of the current season—I was not able to adequately address this question in NFL athletes.
For the lumbar disk herniation study, NFL players who were diagnosed with pathology other than a lumbar herniated disk were excluded from this study. Important examples were players confirmed with degenerative disk disease, “bulging disk,” lumbar strain, and surgical treatment other than a lumbar diskectomy.2
For the cervical disk herniation study, NFL players who were diagnosed with pathology other than a cervical herniated disk were excluded from this study. Important examples were players confirmed with cervical degenerative disk disease, “bulging disk,” neck strain, and surgical treatment other than an anterior cervical diskectomy and fusion or posterior foraminotomy.
Because of the nature of NFL athletes, I chose outcome measures for these studies that were important and unique to this population. Primary outcomes consisted of return-to-play rates (defined by successful return to the field)…