{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:04:26Z","timestamp":1790712266380,"version":"4.1.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>There is a paucity of high-quality return-to-play (RTP) data following treatment of cervical spine injuries in contact sports. In this study, the authors gathered insights from National Football League (NFL) team spine surgeon consultants to highlight current practices in treating cervical spine injuries and report decision-making regarding RTP in professional American football players.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A cross-sectional, online survey was distributed to all NFL consulting physicians specializing in the management of spine injuries. The survey covered the following five clinical vignettes of cervical spine injuries: 1) radiculopathy, 2) myelopathy, 3) unilateral facet fracture, 4) unilateral facet dislocation, and 5) neck pain with MRI showing a ligamentous STIR signal. Participants were asked about management options and criteria to clear players for RTP using a combination of multiple-choice and open-ended answers.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 26 physicians from 21 of 32 (66%) teams responded. Anterior surgery was most commonly recommended for cervical disc herniation causing radiculopathy or myelopathy (73% and 88%, respectively). A rigid cervical orthosis was preferred by 68% of experts for initial management of nondisplaced unilateral facet fracture, but single-level anterior fusion was preferred by 56% for a unilateral facet dislocation. Common criteria to clear players for RTP with cervical disc herniation causing radiculopathy included a normal examination (85%), radiographic fusion postoperatively (58%), and pain-free range of motion (50%). Contraindications for RTP included persistent stenosis (35%), instability (31%), multilevel fusion (27%), and persistent cord signal change (23%). Additional criteria for RTP in players with facet fractures or dislocations included radiographic evidence of fracture healing (32% and 24%, respectively) and normal flexion\/extension radiographs (24% and 32%, respectively). Finally, for players with isolated ligamentous STIR signal changes, resolution of MRI findings was required by 36% of responding physicians prior to RTP.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Decision-making regarding RTP after cervical spine injuries in professional football players is complex and influenced by improvement of symptoms, pain-free range of motion, and radiographic evidence of fusion or fracture healing. Respondents preferred anterior cervical discectomy and fusion for disc herniations causing cervical radiculopathy and myelopathy, rigid orthosis for unilateral facet fractures, and surgery for unilateral facet dislocations. The results of this study provide insight into how surgeons serving as consultants to professional football teams may counsel players who sustain cervical spine injuries.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.8.spine24421","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T02:16:49Z","timestamp":1734747409000},"page":"1-10","source":"Crossref","is-referenced-by-count":4,"title":["Return to play in professional football players following traumatic cervical spine injury: expert opinions from the National Football League spine surgeons"],"prefix":"10.3171","author":[{"given":"Michael D.","family":"White","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Weber-Levine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Daniel","family":"Davidar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Bergstein","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas N.","family":"Vattipally","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen K.","family":"Sills","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall W.","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Am J Sports Med","first-page":"1755","article-title":"Spine and axial skeleton injuries in the National Football League","volume":"40","author":"Mall NA","year":"2012","unstructured":"Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ. Spine and axial skeleton injuries in the National Football League. Am J Sports Med. 2012;40(8):1755\u20131761."},{"issue":"1","key":"b2","series-title":"Neurosurgery","first-page":"103","article-title":"Outcomes after anterior cervical discectomy and fusion in professional athletes","volume":"73","author":"Maroon JC","year":"2013","unstructured":"Maroon JC, Bost JW, Petraglia AL,  Outcomes after anterior cervical discectomy and fusion in professional athletes. Neurosurgery. 2013;73(1):103\u2013112."},{"issue":"10","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"800","article-title":"Outcomes following nonoperative and operative treatment for cervical disc herniations in National Football League athletes","volume":"36","author":"Hsu WK","year":"2011","unstructured":"Hsu WK. Outcomes following nonoperative and operative treatment for cervical disc herniations in National Football League athletes. 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Operative and nonoperative treatment of cervical disc herniation in National Football League athletes. Am J Sports Med. 2013;41(9):2054\u20132058."},{"issue":"4","key":"b12","series-title":"Surg Neurol","first-page":"340","article-title":"A prospective analysis of three operative techniques","volume":"53","author":"Wirth FP","year":"2000","unstructured":"Wirth FP, Dowd GC, Sanders HF, Wirth C. Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol. 2000;53(4):340\u2013348."},{"issue":"1","key":"b13","series-title":"Clin Spine Surg","first-page":"E80","article-title":"The difference in clinical outcomes after anterior cervical fusion, disk replacement, and foraminotomy in professional athletes","volume":"31","author":"Mai HT","year":"2018","unstructured":"Mai HT, Chun DS, Schneider AD, Hecht AC, Maroon JC, Hsu WK. The difference in clinical outcomes after anterior cervical fusion, disk replacement, and foraminotomy in professional athletes. Clin Spine Surg. 2018;31(1):E80\u2013E84."},{"issue":"9","key":"b14","series-title":"Curr Rev Musculoskelet Med","first-page":"432","article-title":"The role of cervical disc arthroplasty in elite athletes","volume":"16","author":"Brecount H","year":"2023","unstructured":"Brecount H, Goodwin A, Hiltzik DM, Hsu WK. The role of cervical disc arthroplasty in elite athletes. Curr Rev Musculoskelet Med. 2023;16(9):432\u2013437."},{"issue":"9","key":"b15","series-title":"J Orthop Case Rep","first-page":"41","article-title":"Cervical disk arthroplasty in a collegiate football player","volume":"12","author":"Satalich J","year":"2022","unstructured":"Satalich J, Wyatt P, O\u2019Neill C, Kalluri P, O\u2019Connell R. Cervical disk arthroplasty in a collegiate football player. J Orthop Case Rep. 2022;12(9):41\u201343."},{"issue":"5","key":"b16","series-title":"J Orthop Case Rep","first-page":"19","article-title":"Return to football after a cervical disk arthroplasty: a case report","volume":"12","author":"Satalich J","year":"2022","unstructured":"Satalich J, Carter S, Fisichella A, Widmeyer J, Kalluri P, Vap A. Return to football after a cervical disk arthroplasty: a case report. J Orthop Case Rep. 2022;12(5):19\u201321."},{"issue":"4","key":"b17","series-title":"Neurosurgery","first-page":"647","article-title":"Updated return-to-play recommendations for collision athletes after cervical spine injury: a modified Delphi consensus study with the Cervical Spine Research Society","volume":"87","author":"Schroeder GD","year":"2020","unstructured":"Schroeder GD, Canseco JA, Patel PD,  Updated return-to-play recommendations for collision athletes after cervical spine injury: a modified Delphi consensus study with the Cervical Spine Research Society. 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Spine (Phila Pa 1976). 2000;25(16):2028\u20132034."},{"issue":"3","key":"b23","series-title":"Orthopedics","first-page":"311","article-title":"Unilateral facet dislocations and fracture-dislocations of the cervical spine: a review","volume":"15","author":"Beyer CA","year":"1992","unstructured":"Beyer CA, Cabanela ME. Unilateral facet dislocations and fracture-dislocations of the cervical spine: a review. Orthopedics. 1992;15(3):311\u2013315."},{"issue":"5","key":"b24","series-title":"Neurosurgery","first-page":"661","article-title":"Facet fracture-dislocation injuries of the cervical spine","volume":"30","author":"Hadley MN","year":"1992","unstructured":"Hadley MN, Fitzpatrick BC, Sonntag VK, Browner CM. Facet fracture-dislocation injuries of the cervical spine. Neurosurgery. 1992;30(5):661\u2013666."},{"issue":"24","key":"b25","series-title":"Spine (Phila Pa 1976)","first-page":"2815","article-title":"The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries","volume":"29","author":"Johnson MG","year":"2004","unstructured":"Johnson MG, Fisher CG, Boyd M, Pitzen T, Oxland TR, Dvorak MF. The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine (Phila Pa 1976). 2004;29(24):2815\u20132820."},{"issue":"1","key":"b26","series-title":"Neurosurgery","first-page":"23","article-title":"Significance of T2 hyperintensity on magnetic resonance imaging after cervical cord injury and return to play in professional athletes","volume":"77","author":"Tempel ZJ","year":"2015","unstructured":"Tempel ZJ, Bost JW, Norwig JA, Maroon JC. Significance of T2 hyperintensity on magnetic resonance imaging after cervical cord injury and return to play in professional athletes. Neurosurgery. 2015;77(1):23\u201331."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.8.SPINE24421\/article-10.3171-2024.8.SPINE24421.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.8.SPINE24421\/article-10.3171-2024.8.SPINE24421.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.8.SPINE24421\/article-10.3171-2024.8.SPINE24421.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T02:18:31Z","timestamp":1740795511000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2024.8.SPINE24421\/article-10.3171-2024.8.SPINE24421.xml"}},"subtitle":["Presented at the 2024 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves"],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":26,"URL":"https:\/\/doi.org\/10.3171\/2024.8.spine24421","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}