Predicting Return to Play following Lumbar Discectomy in Professional Football Players
Orthopaedic Spine Surgeon Wellington K. Hsu, MD discusses return to play after lumbar discectomy in NFL players.
Earlier this month, New England Patriot’s Rob Gronkowski underwent surgery to repair a disc herniation and is not expected to return to the field this season. Clinical outcomes in elite professional athletes after spine injury are difficult to predict, and players and their teams eagerly await news of expected recovery time and return to the field.
Researchers from Northwestern University Feinberg School of Medicine have found high return to play rates—80.8% (42/52)—after lumbar discectomy for lumbar disc herniation in a study involving National Football League (NFL) linemen. These athletes successfully returned to play an average of 33 games over 3 years after surgery, with 63.5% (33/52) becoming starters after treatment.
“Before publishing this data, the common thought was that if athletes had spine surgery, their career would be shortened or they would not have as productive a career as they did before the surgery,” explained senior author Wellington K. Hsu, MD, an orthopaedic surgeon at the Center for Comprehensive Orthopaedic and Spine Care at Northwestern Memorial Hospital in Chicago.
“However, our research certainly has proven otherwise,” Dr. Hsu said, adding that no significant difference was found in the athletes’ performance after surgery as compared to before surgery.
In addition, the study showed a higher than expected return to play rate (85.7%) in the 7 linemen who required revision surgery, noted Dr. Hsu, who also is the Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery and Director of Research for the Department of Orthopaedic Surgery at Northwestern University Feinberg School of Medicine.
“Again, that common thought was that a revision surgery would be career ending, but we were able to show that players have an 85% chance having a productive career after revision surgery,” Dr. Hsu noted.
Previous research by Dr. Hsu and colleagues demonstrated that younger age and greater experience were linked to increased likelihood of return to play following lumbar discectomy among NFL players.
Expected Return to Play after Lumbar Discectomy is 10 to 12 Weeks
“Usually, we do not expect a collision athlete to return to the field for at least 10 to 12 weeks after lumbar discectomy, at the most optimistic time frame,” Dr. Hsu noted.
Dr. Hsu noted that defensive lineman J.J. Watt recently resumed play sooner than the standard 10- to 12-week mark, and subsequently was placed on injured reserve after playing three games. “There is a danger of getting back too soon in my opinion, because it does increase the risk of a recurrence,” Dr. Hsu explained.
More recently, Wellington Hsu, MD, and colleagues created the NFL Orthopaedic Surgery Outcomes Database (NO-SOD), a comprehensive injury database that compares return-to-play rates and performance-based outcomes in NFL players who had orthopaedic surgery.
Of the 559 athletes included in this study, 79.4% returned to play after an orthopedic procedure (range, 50.0%-96.3%). Players who underwent surgical procedures for tendon injuries had significantly lower return to play rates (50%) than players who had bony injuries or sports hernia (90.2%-96.3%), Dr. Hsu said. Patellar tendon repair, in particular, had the greatest effect on NFL careers, with anterior cruciate ligament repair and Achilles tendon repair also having a strong impact on players’ careers. The return to play rate following lumbar discectomy was 73%.
“Through our research efforts over the past six or seven years, we actually have good data to base our guidance and patient counseling on,” Dr. Hsu told SpineUniverse. “And that, in my opinion, greatly increases our ability to improve outcomes for this patient population, because we are doing it in a scientific way. We are making conclusions when we can, but we are also deferring some conclusions when we don’t have enough data.”
Dr. Hsu and colleagues have studied return to play rates after surgery in the National Basketball Association and are currently working to assess this information for Major League Baseball and the National Hockey League.
“My end goal is to be able to compare all injuries in all sports, and be able to predict when an injury might occur based upon an athlete’s playing time, demographic, and position,” Dr. Hsu said. “This information could lead to intervention before injury occurs using different training regimens and rehabilitation protocols.”