Surgeons’ Views on Cervical Disc Arthroplasty for Elite Athletes

Study Design: A questionnaire study. Objective: To characterize spine surgeons’ opinions regarding treating elite athletes with cervical disc arthroplasty (CDA) and assess current recommendations regarding time to return to training and competition. Summary of Background Data: CDA is increasingly recommended to elite athletes as a surgical treatment option for degenerative cervical conditions but remains controversial due to limited research on indications and return to play guidelines. Methods: Surveys were designed to obtain spine surgeons’ opinions regarding treating elite athletes with CDA, including sport-specific considerations and current recommendations regarding time to return to training and competition. The surveys were administered electronically to members of the Cervical Spine Research Society (CSRS) via their membership listserv. Survey data was analyzed to identify patterns in recommendations for the use of CDA as a treatment option for elite athletes. Results: Sixty surgeons responded to the survey. Surgeons generally agreed (93.3%) that being an elite athlete was not a contraindication to a single-level disc arthroplasty. Some surgeons (73.3%) did report at least one absolute contraindication for CDA in elite athletes. Respectively, 53.3% and 66.7% of surgeons reported they would consider 2-level CDA or hybrid procedures for elite athletes. Opinions varied on the safety of returning to specific sports based on the number of CDAs surgeons perform annually. Surgeons recommended different timelines for resuming activity, most commonly advising clearance at 2 weeks for light cardio, 6 weeks for full cardio and strength training, and twelve weeks for sport-specific training and full competition. A total of 46.7% of surgeons were still concerned about either litigation or criticism in offering CDA to elite athletes. Conclusions: CDA as a treatment option for elite athletes has increased in recent years, and many surgeons feel quite comfortable with allowing return to most sports after a one-level CDA.