Structured Abstract
Study Design:
Retrospective cohort study
Objective:
To determine performance outcomes and contract-signing ability for the most recent cohort of professional football players treated for lumbar disc herniation (LDH).
Summary of Background Data:
LDH can have a significant impact on the career of a National Football League (NFL) player. Previous studies have found favorable return to play (RTP) and performance outcomes for players with LDH, but the impact on ability to sign new contracts (an important surrogate to assess continued success) has not previously been studied.
Methods:
NFL players treated for LDH from 2000-2020 were identified from a public records search. Age, position, type of treatment, and return to play measures were collected. Pro Football Focus (PFF) performance grade and contract values were compared before injury and after treatment. Multivariable logistic regression was used to identify independent risk factors associated with ability to return to play and sign high-value contracts.
Results:
101 players were treated for a LDH, of which 75 returned to play. Post-treatment performance as measured by PFF was similar to pre-injury levels (p=0.2). However, both total and guaranteed contract values were significantly reduced (p<0.01). In multivariable analysis, both lower age and higher pre-injury PFF grade were independent predictors of return to play and ability to sign a new contract. A pre-injury contract that contained a high proportion of guaranteed money was found to be an independent predictor of ability to sign a contract that was >20% guaranteed.
Conclusion:
Although the majority of players were able to return to play at preserved performance levels following LDH treatment, their contract values were significantly reduced. RTP and contract-signing ability were not associated with the type of treatment, but rather baseline factors such as the player’s age, performance, and pre-injury compensation.
Level of Evidence:
4
Keywords: National Football League, American Football, NFL, lumbar disc herniation, discectomy, performance, professional athlete, lumbar spine, outcomes, pro football focus
Introduction
Lumbar disc herniations (LDH) can be significant injuries that result in morbidity and loss of playing time1 for professional athletes in contact sports with physical demands involving compressive forces and high velocity impacts, such as American football.2 When not actively competing, professional American football players follow intense exercise regimens that can include heavy weightlifting, further increasing their risk for injury. As established rules of the National Football League (NFL) largely prohibit tackles below the waist and above the shoulders, tackles are often targeted to the lower torso, which may further increase the risk of lumbar spine injury.
Return to play (RTP) rates for American football players following surgery for a LDH range from 72.7% to 80.8%.3–6 However, some of these studies included players from as far back as 1979, before modern treatment options and surgical techniques were available. The NFL has progressively prioritized player safety, with improved player tracking and injury reporting. As the perceived implications of a LDH include the loss of income, poor performance, or the end of a career,7 it is important to assess the impact, if any, that LDH and its management may have on the professional football player’s ability to sign future contracts, which has not previously been studied.
This work sought to evaluate the return to play rates, game play performance, and contract value of professional football players who sustained a LDH over the past two decades. We hypothesized that surgical vs. non-surgical management of LDH had no impact on return to play and contract prospects. The findings of this report are intended to assist elite athletes, teams, and team physicians in clinical decision-making and managing player/team expectations following a LDH.
Materials and Methods
This work utilized publicly available datasets from the internet and thus did not require institutional review board approval. This work studied NFL players who were diagnosed with a LDH and treated either operatively or non-operatively from 2000-2020. Players with injuries reported as “back,” “spine,” or “disc herniation” were consecutively identified from weekly NFL injury reports and prosportstransactions.com. To gather more details about the injury, a second round of screening was performed using NFL.com, ESPN.com, and publicly available press releases. Players were included if their LDH diagnosis and treatment were corroborated by at least two sources and were drafted or had played at least one regular season NFL game before their injury. Players were excluded if there was conflicting information about their injury or if the LDH occurred while they were not on an active NFL roster (such as on a practice squad). Each player’s age, BMI, position, type of treatment, and date of treatment were recorded. To calculate return to play rates and career longevity, the date of the first game played, number of games played/started, and length of career after treatment were collected.
To assess the impact of treatment on performance, player scores were collected from PFF.com, which uses the Pro Football Focus (PFF) grading system.8 This system was developed as an alternative to traditional performance statistics because it evaluates each player’s contribution to their team’s production rather than the overall outcome of a single game or season. Each play that a player is involved in is assigned a score from −2 to +2 by trained analysts. The scores are then compiled, and each player is assigned a “grade” between 0-100 that reflects their overall performance for the season. Performance grades were collected for the season before injury and after treatment for all players. If the injury occurred before week 5, or the player had played fewer than 4 games of a given season, then the PFF grade from the preceding season was used to represent pre-injury performance.
Contract information before and after treatment was collected from spotrac.com and overthecap.com. The contract signed most recently prior to injury was defined as the pre-injury contract. The first contract signed after LDH treatment was defined as the post-treatment contract. For both pre-injury and post-treatment contracts, the total value, guaranteed value, and length of contract in years were recorded. The average total and guaranteed values per year were calculated by dividing their values by the length of the contract in years. The ratio of guaranteed to total contract value was also calculated. Players with pre-injury rookie contracts were excluded from this comparison due to the value of their contracts being artificially capped.
The primary outcome in this study was RTP. To identify factors associated with RTP, players were sorted into RTP and non-RTP cohorts and compared by age, BMI, position, type of treatment, PFF, and pre-injury contracts. Secondary outcomes were career longevity, player performance, and contract values following LDH. To identify factors associated with the player’s ability to sign a new contract, players were split into cohorts depending on whether their post-treatment contract was greater or less than 20% guaranteed. This 20% value was chosen because it was closest to the median guaranteed ratio of the full cohort’s post-treatment contracts. These two cohorts were then compared to determine which factors were associated with the player’s ability to sign a contract with >20% guaranteed following treatment for LDH.
Data Collection and Statistical Analysis
Data was collected and managed using REDCap (Research Electronic Data Capture)9,10 supported by the National Center For Advancing Translational Science of the National Institute of Health under award number: UL1 TR002384. REDCap is a secure, HIPAA-compliant web-based software platform designed to support data capture and data management for research studies.
Statistical analysis was performed using JMP (Version 16.0.0, SAS Institute). Normality of distribution was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were reported as mean ± standard deviation; non-normally distributed variables were reported as median (interquartile range). Normally and non-normally distributed continuous data were evaluated using independent samples Student’s t-test and Wilcoxon rank-sum (Mann-Whitney U) test, respectively. Categorical variables were compared using Pearson’s chi-squared test. PFF grades and contract values were compared before and after treatment using either a paired sample t-test or Wilcoxon signed-rank test. Multivariable logistic regression was used to identify independent risk factors associated with ability to return to play and sign contracts. Variables with P-values <0.20 in the univariable analysis were included in the multivariable analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and reported. P-values <0.05 were considered statistically significant.
Results
A total of 101 players were identified using available internet records as being treated for a LDH between 2000 and 2020. The median age for the entire cohort at the time of injury was 26.9 years, and the median NFL experience of the cohort was 4.5 years. Of the 101 players identified, 24 players were managed non-operatively, and the remaining 77 players ultimately required surgical treatment. There were no demographic factors associated with requiring operative management, and there were no differences in the baseline characteristics of the operative and non-operative cohorts (Table 1).
Table 1:
Demographics and Baseline Characteristics
| Total (n=101) | Operative (n=77) | Non-op (n=24) | p-Value | |
|---|---|---|---|---|
| Age at treatment (years) | 26.9 (24.8-30.7) | 26.8 (24.6-30.1) | 27.9 (25.1-31.6) | 0.125 |
|
|
||||
| BMI (kg/m2) | 32.5 (29.4-37.3) | 33.2 (29.6-37.3) | 30.8 (28.0-37.2) | 0.349 |
|
|
||||
| NFL Experience (years) | 4.5 (2.4-8.3) | 4.0 (2.1-7.4) | 5.0 (3.4-9.4) | 0.088 |
|
|
||||
| Defensive Player | 45/101 (44.6%) | 34/77 (44.2%) | 11/24 (45.8%) | 0.885 |
|
|
||||
| Lineman | 50/101 (49.5%) | 40/77 (52.0%) | 10/24 (41.7%) | 0.378 |
|
|
||||
| Pre-injury PFF | 64.7 (58.6-73.5) | 64.1 (58.3-73.5) | 67.7 (58.7-73.9) | 0.724 |
|
|
||||
| On a Rookie Contract | 42/101 (41.6%) | 31/77 (40.3%) | 11/24 (45.8%) | 0.629 |
|
|
||||
| Pre-injury contract | ||||
|
|
||||
| Total (millions US$)a | 2.55 (0.82-5.77) | 2.68 (0.81-5.87) | 2.36 (0.86-6.25) | 0.916 |
|
|
||||
| Guaranteed (millions US$)a | 0.60 (0.06-1.94) | 0.55 (0.05-1.86) | 0.60 (0.06-2.33) | 0.821 |
|
|
||||
| Guaranteed/Total ratio | 0.3 (0.07-0.46) | 0.33 (0.07-0.46) | 0.28 (0.09-0.46) | 0.971 |
|
|
||||
| Return to Play | 75/101 (74.3%) | 58/77 (75.3%) | 17/24 (70.8%) | 0.663 |
BMI: body mass index; NFL: National Football League; LDH: lumbar disc herniation; PFF: Pro Football Focus grade; OR: odds ratio; CI: confidence interval
Reported as average annual value over length of the contract.
In total, 75 out of 101 players (74.3%) returned to play at least one NFL game after being treated for a LDH. Of the players that did RTP, those that could be managed non-operatively played their first NFL game a median of 1.8 (0.6-9.7) months after treatment compared with a median of 7.9 (4.0-9.7) months for those that required additional operative treatment (p=0.03). When comparing players that could be managed non-operatively to players that required further surgical intervention, no differences were observed in the number of games played/started or the overall career length (Table 2).
Table 2:
Return to Play following Operative vs. Non-operative Treatment
| Total RTP (n=75) | Operative RTP (n=58) | Non-op RTP (n=17) | p-Value | |
|---|---|---|---|---|
| RTP same team | 58/75 (77.3%) | 43/58 (74.1%) | 15/17 (88.2%) | 0.198 |
|
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| RTP same season | 26/75 (34.7%) | 17/58 (29.3%) | 9/17 (52.94) | 0.077 |
|
|
||||
| Time until RTP (months) | 7.9 (3.3-9.7) | 7.9 (4.0-9.7) | 1.8 (0.6-9.65) | 0.031 |
|
|
||||
| Career length after treatment (months) | 38.8 (22.5-64.8) | 42.1 (24.0-66.7) | 28.7 (15.2-55.7) | 0.147 |
|
|
||||
| Games Played after treatment | 35 (15-73) | 36.5 (16-76) | 32 (15-63) | 0.425 |
|
|
||||
| Games Started after treatment | 16 (2-51) | 18.5 (4-51) | 11 (0-47.5) | 0.370 |
|
|
||||
| Started/Played ratio | 0.62 (0.11-0.90) | 0.63 (0.18-0.90) | 0.59 (0-0.81) | 0.357 |
RTP: return to play
68 players had PFF grades before injury and after treatment for comparison. The mean PFF grade after treatment was 65.6±12.2 compared with 67.9±11.5 before, a non-significant difference (p=0.2). Pre- and post-LDH contracts were compared between 33 players after excluding rookie contracts. Following treatment, the median total contract value decreased from 5.97 (3.11-8.50) to 2.00 (0.95-4.00) million US$, and guaranteed contract value decreased from 1.67 (0.20-3.86) to 0.47 (0.00-1.13) million US$, both of which were statistically significant (p<0.01).
Table 3 shows factors associated with RTP following treatment for LDH. In univariable analysis, younger age (p=0.004) and higher pre-injury PFF performance grades (p=0.03) were associated with RTP. In multivariable analysis, lower age (OR=0.75; 95%CI 0.59-0.96) and higher pre-injury PFF grade (OR=1.08; 95%CI 1.01–1.16) were independent predictors of RTP.
Table 3:
Factors associated with RTP following treatment for LDH
| RTP (n=75) | NRTP (n=26) | Univariable |
Multivariable |
||
|---|---|---|---|---|---|
| p-Value | OR | 95% CI | |||
| Age at treatment (years) | 26.6 (24.5-29.7) | 29.7 (27.1-31.7) | 0.004 | 0.75 | (0.59-0.96) |
|
|
|||||
| BMI (kg/m2) | 33.0 (29.4-36.4) | 31.4 (28.7-37.5) | 0.681 | ||
|
|
|||||
| Defensive Player | 32/75 (42.7%) | 13/26 (50.0%) | 0.517 | ||
|
|
|||||
| Lineman | 38/75 (50.7%) | 12/26 (46.2%) | 0.692 | ||
|
|
|||||
| Surgery for LDH | 58/75 (77.3%) | 19/26 (73.1%) | 0.660 | ||
|
|
|||||
| Rookie Contract | 34/75 (45.3%) | 8/26 (30.8%) | 0.194 | 1.17 | (0.20-6.82) |
|
|
|||||
| Pre-injury PFF | 67.6±11.5 | 62.9±7.2 | 0.032 | 1.08 | (1.01-1.16) |
|
|
|||||
| Pre-injury contract | |||||
|
|
|||||
| Total (millions US$)a | 2.55 (0.81-6.14) | 2.60 (0.83-4.83) | 0.855 | ||
|
|
|||||
| Guaranteed (millions US$)a | 0.60 (0.09-1.94) | 0.54 (0.00-1.90) | 0.366 | ||
|
|
|||||
| Guaranteed/Total ratio | 0.33 (0.09-0.49) | 0.24 (0.00-0.34) | 0.107 | 6.03 | (0.37-97.4) |
BMI: body mass index; LDH: lumbar disc herniation; PFF: Pro Football Focus grade; RTP: return to play; NRTP: no return to play; OR: odds ratio; CI: confidence interval
Reported as average annual value over length of the contract.
Factors associated with the ability to sign a new contract following treatment for a LDH are shown in Table 4. Univariable analysis identified lower age (p=0.01), return to play during the same season (p=0.01), and higher pre-injury PFF grade (p=0.01) as associated with increased contract signings. Only age (OR=0.82; 95%CI 0.69-0.98) and pre-injury PFF (OR=1.11; 95%CI 1.03-1.20) were independent predictors of a new contract.
Table 4:
Factors associated with signing a new contract following treatment for LDH
| Contract (n=70) | No contract (n=31) | Univariable |
Multivariable |
||
|---|---|---|---|---|---|
| p-Value | OR | 95% CI | |||
| Age at treatment (years) | 26.7 (24.7-29.3) | 29.7 (25.6-31.7) | 0.012 | 0.82 | (0.69-0.98) |
|
|
|||||
| BMI (kg/m2) | 32.9 (29.4-37.4) | 31.4 (29.4-37.3) | 0.586 | ||
|
|
|||||
| Defensive Player | 28/70 (40%) | 17/31 (54.8%) | 0.166 | 0.31 | (0.09-1.08) |
|
|
|||||
| Lineman | 37/70 (52.9%) | 13/31 (41.9%) | 0.311 | ||
|
|
|||||
| Surgery for LDH | 54/70 (77.1%) | 23/31 (74.2%) | 0.748 | ||
|
|
|||||
| Rookie Contract | 33/70 (47.1%) | 9/31 (29.0%) | 0.089 | 1.85 | (0.34-10.14) |
|
|
|||||
| RTP Same Season | 23/70 (32.9%) | 3/31 (9.7%) | 0.014 | 3.55 | (0.70-18.03) |
|
|
|||||
| Pre-injury PFF | 68.1±11.3 | 62.3 ±8.5 | 0.013 | 1.11 | (1.03-1.20) |
|
|
|||||
| Pre-injury contract | |||||
|
|
|||||
| Total (millions US$)a | 2.73 (0.85-6.12) | 2.42 (0.78-4.65) | 0.659 | ||
|
|
|||||
| Guaranteed (millions US$)a | 0.75 (0.10-1.97) | 0.17 (0.00-2.00) | 0.196 | 1.00 | (1.00-1.00) |
|
|
|||||
| Guaranteed/Total ratio | 0.33 (0.13-0.48) | 0.25 (0.00-045) | 0.166 | 21.35 | (0.74-612.1) |
BMI: body mass index; LDH: lumbar disc herniation; PFF: Pro Football Focus grade; OR: odds ratio; CI: confidence interval
Reported as average annual value over length of the contract.
Table 5 compares players with >20% guaranteed and <20% guaranteed money in their post-treatment contract. In univariable analysis, being a non-lineman (p=0.02), a pre-injury contract with more guaranteed money (p=0.04), and a higher guaranteed to total ratio (p=0.004) were associated with a post-treatment contract that was >20% guaranteed (Table 5). Multivariable analysis found that only a higher guaranteed to total ratio in the pre-injury contract was an independent predictor of the injured player’s ability to sign a post-treatment contract that was more than 20% guaranteed (OR=16.57; 95%CI 1.19-229.8).
Table 5:
Factors associated with signing a contract that is >20% guaranteed
| >20% (n=30) | <20% (n=40) | Univariable |
Multivariable |
||
|---|---|---|---|---|---|
| p-Value | OR | 95% CI | |||
| Age at treatment (years) | 26.7 (24.4-28.8) | 26.6 (24.7-29.5) | 0.744 | ||
|
|
|||||
| BMI (kg/m2) | 30.7 (29.4-34.6) | 35.5 (28.4-37.7) | 0.081 | 0.75 | (0.02-28.77) |
|
|
|||||
| Defensive Player | 12/30 (40%) | 16/40 (40%) | >0.99 | ||
|
|
|||||
| Lineman | 11/30 (36.7%) | 26/40 (65%) | 0.019 | 0.39 | (0.07-2.19) |
|
|
|||||
| Surgery for LDH | 23/30 (76.7%) | 31/40 (77.5%) | 0.935 | ||
|
|
|||||
| Rookie Contract | 14/30 (46.7%) | 19/40 (47.5%) | 0.945 | ||
|
|
|||||
| RTP Same Season | 11/30 (36.7%) | 12/40 (30.0%) | 0.557 | ||
|
|
|||||
| Pre-injury PFF | 68.19±10.82 | 68.08±11.82 | 0.969 | ||
|
|
|||||
| Pre-injury contract | |||||
|
|
|||||
| Total (millions US$)a | 11.57 (3.27-45.60) | 8.09 (2.65-30.15) | 0.280 | ||
|
|
|||||
| Guaranteed (millions US$)a | 6.80 (0.95-16.97) | 2.01 (0.08-8.30) | 0.036 | 1.00 | (1.00-1.00) |
|
|
|||||
| Guaranteed/Total ratio | 0.41 (0.28-0.52) | 0.22 (0.03-0.43) | 0.004 | 16.57 | (1.19-229.8) |
BMI: body mass index; LDH: lumbar disc herniation; PFF: Pro Football Focus grade; OR: odds ratio; CI: confidence interval
Reported as average annual value over length of the contract.
Discussion
LDH in professional American football players can be significant career altering injuries. The present study assessed a cohort of NFL players who were treated for a LDH between 2000 and 2020. Although most players returned to play at pre-injury performance levels, their ability to sign high value contracts was limited, as evidenced by the significantly reduced total and guaranteed values of the post-treatment contracts. LDH requiring surgery was not associated with reduced ability to RTP and sign contracts. Instead, a player’s post-LDH status was associated with pre-injury factors such as age, performance, and pre-injury compensation. These findings may help guide players and physicians regarding LDH outcomes and treatment expectations.
The present work reports that outcomes after LDH were favorable for most players, with 74.3% successfully returning to play following treatment. This RTP rate is comparable to that reported by previous works.4,11,12 Furthermore, we found that on-field performance was maintained, as evidenced by PFF grades that were relatively unchanged post-treatment. This finding is supported by similar conclusions from Savage and Hsu11 in their focused assessment of offensive skill position players in the NFL who required a discectomy for a LDH. Despite high RTP rates and preserved performance, contract values were significantly reduced after treatment. This lost compensation may be attributed to negative perceptions held due to post-LDH performance differences seen in other North American professional sport leagues. Among 87 ice hockey players in the National Hockey League of the United States/Canada, Schroeder et al.13 reported an 85% return to play rate but found that players had played fewer games per season, scored fewer points per game, and had lower overall performance scores after their injury. While professional basketball players in the National Basketball Association of the United States/Canada returned to their pre-injury performance levels 2 years after returning from management of a LDH, Minhas et al.14 reported that players played fewer games and had lower player efficiency ratings in their first year after returning from injury. Decreased post-injury contracts may also be the result of the difficult to refute perception that a player who misses a significant number of games is injury prone. In their systematic review of return to sport and performance outcomes after LDH among professional, Olympic, or United States National Collegiate Athletic Association Division I athletes, Nair et al.15 reported that current data on LDH performance is insufficient to permit accurate conclusions about post-injury performance. Such high quality, high sample size works on American football players would be a significant challenge due to the regional nature of the sport and the heterogeneous performance roles and expectations held for each position.
Of 101 NFL players identified in our study, 77 (76.2%) required surgical treatment for their LDH, whereas only 24 (23.8%) were able to be managed with just non-operative treatment. This difference may be explained by under-reporting of non-operatively treated players in public records since a player who manages their injury without surgery may not be as newsworthy as a player undergoing surgery. It is also our educated assumption that all 101 players attempted appropriate non-operative management, yet more than 75% of these players still required surgery. Many players likely attempted and failed appropriate non-surgical management before undergoing surgery, and thus the true number of non-operatively treated players should be higher than reported in this study.
Our study found that players with LDH requiring surgical treatment had similar RTP rates, career longevity, and contract signings compared with those that could be managed non-operatively. The only difference was that the players treated non-operatively returned to play sooner. This is likely due to the post-surgery recovery period being longer, and many players using non-operative treatment to manage their pain while continuing to play. These findings contrast with Hsu et al.4, who found that surgically treated players played more games and had longer careers than players managed non-operatively. However, their non-operative cohort was significantly older than the operative cohort, which may explain this discrepancy. The systematic all-sports review by Sedrak et al.16 reported a shorter time until RTP among non-operatively treated elite athletes following a LDH, but did not perform a statistical comparison because only two of the 20 included studies reported times until RTP. Time until RTP is a challenge to compare because American football is not a year-round sport. The timing of a LDH likely influences time until return. Players that sustain a LDH late in the season will likely miss the remainder of that season, and therefore the earliest time until RTP is 6-9 months after the LDH. These players might have also played injured for a time, but this would not be public knowledge until the player was placed on injured reserve. The small sample size of this work made a temporal injury assessment impossible. It is therefore possible that our findings with respect to time until RTP are inconsequential.
Although previous studies have suggested that surgery may result in better performance and RTP after LDH, most studied outcomes related to pre-injury characteristics such as prior performance score, contract value, and age. These are all variables that may indicate that a player was already highly valued by their team. For example, lower age and higher baseline PFF grade were associated with higher rates of RTP and contract signing ability. Similarly, the ability to sign a contract following LDH was also associated with lower age and higher baseline performance. A possible interpretation is that if a player is young and perceived by teams to be an important asset prior to being injured (or perhaps was a high draft pick, which is of itself a particularly valuable asset), then this player may be given a chance to demonstrate their ability to return to their pre-injury quality of play. Conversely, players that are older and perceived to be less productive prior to sustaining a LDH might find it difficult to RTP and sign a new contract regardless of whether surgery was performed.
Unsurprisingly, the ability to sign a contract with a reasonable guaranteed amount, which was arbitrarily set at 20%, was associated with having a highly guaranteed initial contract. This suggests that re-signing a post-injury player may depend on the pre-injury contract, and players that were initially receiving guaranteed money will continue to do so despite their injury. This has potential implications for players that are recovering from an injury and looking to negotiate guaranteed money in their new contracts.
This study has several limitations beyond those that are intrinsic to retrospective analyses. The use of publicly available information is subject to reporting errors and may lead to selection bias. Our study likely does not capture all players diagnosed with a LDH, and players who retired rather than disclose their injury status may not have been identified during a public records search. Moreover, many players reported as sustaining “back” injuries were excluded because neither the type nor location of the injury could be confirmed. Another source of selection bias is the potential under-reporting of non-operatively treated players in the public records, which may cause our sample to not be entirely representative of the true study population. Nonetheless, a public database search was the only method available to us and has been successfully used widely in the literature.17–19 Given the sensitive nature of injuries to professional athletes and the potential fiscal impact of injury reporting to both player and team, alternative study modalities using patient records would be challenging to perform. The PFF grade to evaluate player performance in the present work was also a challenge. As PFF grade is calculated by human analysts who watch and rate players, personal biases may be introduced. However, we believe that the PFF grade provides a more holistic assessment of player performance than traditional statistics because it measures each player’s contribution to their team’s production. PFF is used by all 32 NFL teams for scouting purposes and player analysis, and the methodology has also been used in the literature to assess player performance after sustaining injuries.18,20 Finally, details of a player’s LDH were gathered from NFL.com, ESPN.com, and press releases, but specifics such as whether these were free fragments were not collected, which is another potential limitation.
In conclusion, our study suggests that although most NFL players can return to play at maintained performance following treatment for a LDH, they receive less compensation than before their injury. Furthermore, ability to RTP and sign contracts is primarily associated with age, performance, and pre-injury compensation. We hope that these results can assist teams, players, and team physicians in the management of players who sustain a LDH.
Footnotes
Financial Disclosures:
Marcel M. Dupont: has nothing to disclose
Mitchell S. Fourman: has nothing to disclose
Sravisht Iyer: • Globus Medical: Paid presenter or speaker
• Healthgrades: Other financial or material support
• Stryker: Paid presenter or speaker
• Vertebral Columns/International Society for the Advancement of Spine Surgery (ISASS): Editorial or governing board
Sheeraz A Qureshi: • Annals of Translational Medicine: Editorial Board
• Association of Bone and Joint Surgeons: Program Committee member; Professional Society member
• Tissue Differentiation Intelligence: Ownership Interest
• Cervical Spine Research Society: Publications Committee member; Professional Society member
• Contemporary Spine Surgery: Editorial Board
• Globus Medical: Paid presenter or speaker; Consultant; Royalties
• International Society for the Advancement of Spine Surgery: Program Committee member; Professional Society member
• LifeLink.com Inc: Advisory Board
• Lumbar Spine Research Society: Website Committee member; Professional Society member
• Minimally Invasive Spine Study Group: Treasurer
• North American Spine Society: Value Committee member; MIS Committee member; Advocacy Committee member; CME Committee member; Professional Society member
• Simplify Medical, Inc.: Clinical Events Committee Member
• Stryker: Consultant; Royalties
• Society of Minimally Invasive Spine Surgery: Program Committee member; Professional Society member; 2018 Annual Meeting Program Chair; Board of Directors
• Spinal Simplicity, LLC: Advisory Board
• Program chair for International Society for Advancement of Spine Surgery Annual Meeting in 2021
• Appointed Chair of Publication Committee for Cervical Spine Research Society in 2021.
• Secretary for Society of Minimally Invasive Spine Surgery for 2021
Evan Sheha: has nothing to disclose
Julia Rhie-Lee1: has nothing to disclose
James Dowdell: has nothing to disclose
References
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