Abstract
INTRODUCTION: American football players face a higher risk of spine injuries due to the sport's high-impact nature, especially in the lumbar and cervical spine regions. These injuries may require surgical interventions aimed at allowing athletes to return to the sport. However, the effects of these surgeries on players' performance and career longevity have yet to be comprehensively studied. OBJECTIVE: This study aims to evaluate the impact of spine surgeries on National Football League (NFL) players' return-to-play rates and performance. We hypothesize that players undergoing lumbar surgeries would demonstrate greater performance improvement and return-to-play rates compared to those undergoing cervical surgeries, with differences influenced by player position and injury location. Study design and methods: This is a retrospective cohort study (III) for which NFL injury reports from 2005 to 2022 were reviewed to identify players who had undergone spine surgery. Data collected included player position, return-to-play, and years played following the procedure. Performance metrics were gathered using Super Bowl wins and Pro Football Focus (PFF) player performance ratings. Statistical analysis was conducted using Python version 3.10.12 (Python Software Foundation, Wilmington, DE, USA) to evaluate differences in return-to-play rates, performance changes, and career duration post-surgery. RESULTS: The study identified 144 spine surgeries (77 lumbar, 67 cervical) among 136 players. Players who had lumbar surgery had a 61% return-to-play rate, with an average performance rating increase of 6.3%. In contrast, those who had cervical surgery had a 47% return-to-play rate and an average performance rating decrease of 5.8%. Lumbar surgeries were more common among linemen with higher BMIs, while cervical surgeries were more frequent in skill positions. Players with a history of lumbar surgeries were more likely to return to play than those without previous surgeries. CONCLUSION: Spinal surgeries significantly impact the careers of NFL players. Lumbar surgeries show better outcomes in terms of return-to-play rates and performance improvements compared to cervical surgeries. The differences in surgical outcomes based on injury location and player position highlight the need for tailored rehabilitation protocols. This study provides valuable insights for medical practitioners, team management, and athletes, contributing to a broader understanding of the implications of spine surgeries in professional football.