The Clinical Management of Professional Mixed Martial Arts Athletes Returning to Play after ACDF.

Cervical spine injuries in mixed martial arts athletes present unique challenges, especially regarding return to play after anterior cervical discectomy and fusion. While single-level anterior cervical discectomy and fusion has shown favorable return to play outcomes in collision sports, mixed martial arts involves higher cervical impact forces, increasing the risk of adjacent segment disease, muscle imbalances, and proprioceptive deficits. Return to play following multilevel anterior cervical discectomy and fusion remains controversial, with limited data and no standardized guidelines. Rehabilitation post-anterior cervical discectomy and fusion for mixed martial arts athletes should focus on early mobilization, trunk stabilization, advanced neck-specific exercises, and addressing psychological barriers like fear-avoidance behavior through multidisciplinary care. These concepts are highlighted through a case study of a 37-year-old professional Ultimate Fighting Championship athlete who successfully returned to competition within 6 months after two-level anterior cervical discectomy and fusion. This case emphasizes phased rehabilitation strategies, from postoperative management to precompetition training, underscoring gaps in advanced cervical training and psychological support. Future research should develop evidence-based guidelines to enhance safety performance in mixed martial arts.