Cervical Disc Herniation in Athletes

Abstract

Cervical disc injuries in athletes are career-threatening problems that can cause significant symptoms, such as upper extremity radiculopathy, neck pain, and coordination difficulties in this population. Historically, professional athletes have often received multiple conflicting opinions from different physician experts for the appropriate treatment for a cervical disc herniation (CDH). The natural history and pathology of cervical disc herniations are well known in the general population; however, there are differences in the elite athlete population. For example, NFL athletes are treated for CDH at a much higher rate at the upper levels of the cervical spine (C2-C3 and C3-C4), diagnosed at a younger age, and associated with sports-related trauma 82% of the time. Non-operative treatment is a reasonable approach initially, as many players can return to play (RTP) within a 6-week period. Operative treatment either in the form of a cervical fusion or a foraminotomy (PF) can be a successful option in allowing players to RTP in a collision sport. Current evidence suggests that the RTP rate is significantly higher in the PF cohort compared to ACDF. However, the reoperation rate at the index level is significantly higher for PF when compared to ACDF. Typical criteria for RTP include full neck range of motion, absence of neurologic deficits, absence of central cervical stenosis, and normal neurologic examination.