Return to Play After Anterior Cervical Discectomy and Fusion in Professional Athletes Anterior cervical discectomy and fusion surgery (ACDF) has received a great deal of attention recently. We have all been inundated with news about Peyton Manning’s return to play after multiple neck surgeries and a year out of football. One of the questions always addressed is, “Can athletes return to competitive, contact sports, such as football or wrestling, after an anterior cervical discectomy and fusion?”
A new study by Maroon, et. al, in Neurosurgery, Vol. 73, 1, July 2013, has shown that it is safe to return to full contact sports after an ACDF as long as there is a solid fusion, full range of motion of the neck, and a normal neurological examination. In addition, hyperintensity within the spinal cord has been shown by Maroon, et. al. NOT to preclude participation in contact sports, as long as the neurologic exam is normal.
Many questions have arisen as to why it took Peyton Manning so long to return to play. Manning sustained a herniated disc in his neck and underwent a posterior cervical discectomy. Unfortunately, he had multiple revision surgeries posteriorly until he finally underwent an anterior cervical discectomy and fusion. As we all know, he has now returned to full play. Manning’s difficulties resulted from a nerve injury or neurapraxia that was sustained while removing the disc posteriorly. He subsequently underwent an anterior cervical discectomy and fusion and regained full function.
The new study in Neurosurgery clearly shows that Manning’s return to play is not only safe and appropriate, but athletes can function at a high level after this procedure.
One of the side effects of a cervical fusion is adjacent segment degeneration and the need for further surgery. The disks above and below the fusion breakdown over time due to the increased load the remaining disks must bear. This has clearly been established in the medical literature. We know that approximately 30% of patients will require surgery at a level above or below the fusion up to ten years after surgery. What we do not know is whether a high impact sport, such as football or wrestling, will accelerate this degeneration. Clearly, any type of return to play needs to be monitored by an orthopaedic surgeon or neurosurgeon. Athletes need to be made aware of the risks of adjacent segment degeneration prior to their return to play.
In conclusion, this study clearly shows athletes can safely return to competitive contact sports following an anterior cervical discectomy and fusion, as long as they have a solid fusion, full range of motion of the neck, and a normal neurologic examination. However, all athletes require clearance by their personal physician prior to any return to play.
Stephen P. Banco, MD
Fellowship-Trained Orthopaedic Spinal Surgeon