• Matthew V Abola, Charles C Lin, Christopher A Colasanti, William Schreiber-Stainthorp, and Peter G Passias.
• NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA.
• Neurosurgery. 2022 Jan 1; 90 (1): 51-58.

BackgroundAmerican football players are at increased risk for many forms of spinal injury. Intervertebral disk herniations are particularly concerning as they are the leading cause of days lost to injury and can have long-term effects on player careers. Disk herniation management plays a major role in the likelihood and success of return-to-play (RTP).ObjectiveTo assess the incidence, demographic variables, treatment approaches, outcomes, and RTP rates of disk herniations in American football players.MethodsA systematic review of the literature investigating disk herniations in American football players using PubMed, Cochrane Library, and Embase was performed. RTP estimates were calculated by pooling study-specific data using a random-effects model.ResultsFour hundred twenty-two studies were identified, with 18 meeting inclusion criteria. Offensive and defensive linemen were the 2 most commonly injured positions. Players undergoing operations were on average younger, with higher body mass indexes, fewer seasons played, and longer post-treatment careers than nonsurgical counterparts. Postsurgical recovery periods lasted an average 106 d, with a mean RTP duration of 33 games over 2.7 yr and an 8.45% reoperation rate. Operative treatment offered a nonsignificant increase in the likelihood of return-to-play compared with nonoperative treatment (odds ratio = 2.81, 95% CI 0.83-9.51).ConclusionDisk herniations are a common injury, with surgery potentially improving post-treatment outcomes. The literature suffers from heterogeneous definitions of RTP and varying performance metrics, making it difficult to draw clear conclusions. To better understand the impact of disk herniation and treatment on player health and performance, more studies should be performed prospectively and with standardized metrics.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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