The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes

Study Design: Retrospective case series. Object: To compare postoperative outcomes of professional athletes treated for cervical disk herniation after anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), or total disk replacement (TDR). Summary of Background Data: ACDF, PF, and TDR have all led to excellent outcomes in the general population but the unique demands in the professional athlete necessitate specific study. Methods: Athletes of 4 major American professional sports leagues-National Football League, Major League Baseball, National Hockey League and National Basketball Association-diagnosed with cervical disk herniation and managed operatively were identified. Athletes were grouped into cohorts based on operation type. Athlete performance outcome measures were calculated based on sport-specific statistics and assessed as a percentage change after surgery to standardize comparison across sports. Results: A total of 101 professional athletes were identified (ACDF = 86, PF = 13, and TDR = 2). The PF cohort had a significantly greater return to play rate and shortest time to return after surgery (P = 0.03 and P = 0.04, respectively). However, the reoperation rate at the index level was significantly higher in PF athletes compared with ACDF (46.2% vs. 5.8%; P < 0.001) over the study follow-up period (average, 13.5 y). There was no significant difference in performance score after surgery for all surgical cohorts (P = 0.41) and among cohorts (P = 0.41). When analyzed by sport only baseball athletes experienced a significant decrease in performance after surgery (P = 0.049). Conclusions: ACDF and PF are both viable options with excellent outcomes in professional athletes. PF allows a significantly higher rate and quicker return to play but portends a higher risk for reoperation compared with ACDF. TDR results are limited in our cohort and require further study to determine professional athlete outcomes.