Cervical Disc Injuries Follow-up
- Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD more...
Return to Play
Guidelines for return to play following cervical spine injuries have been published by several authors with little consensus.
Torg et al have published guidelines for return to play following cervical spine injuries. The following is described in the context of cervical disc injury.
- No contraindications (Experience and data indicate no increase in risk of serious injury.)
- Spina bifida occulta
- Type II Klippel-Feil anomaly with no evidence of spinal instability
- Developmental stenosis of spinal canal (canal-vertebral body ratio < 0.8)
- Healed intervertebral disc bulge
- Asymptomatic cervical disc herniations treated conservatively in the past
- Stable, one-level anterior or posterior fusion at C-3 or below (only if the individual is neurologically normal, is free of pain, and has a normal range of cervical motion)
- Absolute contraindication (Experience and data clearly indicate an increase in risk of serious injury.)
- Odontoid agenesis, hypoplasia, or os odontoideum; atlanto-occipital fusion
- Type 1 Klippel-Feil mass fusion
- Developmental canal stenosis with ligamentous instability, cervical cord neuropraxia with signs or symptoms lasting longer than 36 hours, or multiple episodes of cervical cord neuropraxia.
- Atlantoaxial instability or atlantoaxial rotatory fixation
- Spear tackler's spine
- Ligamentous laxity (>3.5 mm anteroposterior displacement or 11° rotation)
- Intervertebral disc herniation with neurologic signs or symptoms, pain, or limitation of cervical ROM
- Anterior or posterior fusion of more than 3 levels
- Relative contraindication (No clear evidence of an increase in the risk of serious injury exists, but sequelae may include recurrent injury or temporary noncatastrophic injury. The player, coach, and parents must understand that there is some risk and agree to assume it.)
- Developmental canal stenosis with one episode of cervical cord neuropraxia, presence of intervertebral disc disease, or evidence of cord compression
- Ligamentous sprain with mild laxity (< 3.5 mm anteroposterior displacement and 11° rotation)
- Healed intervertebral disc herniation
- Stable, 2-anterior or posterior fusion (if the individual is neurologically normal, asymptomatic, and has full painless cervical motion)
- The presence of congenital spinal stenosis should be a taken into consideration for participation in contact sports after an athlete experiences an attack of transient cervical neuropraxia. Cantu and colleagues support the view that athletes with cervical spinal stenosis should not participate in contact sports because of an inherent risk of cervical cord injury. Cantu and Torg both agree that athletes who experience multiple episodes of cervical cord neuropraxia should not be allowed to return to their respective sports.
Injury prevention is accomplished best through good coaching, adequate preparticipation training, and implementation of proper techniques of sport-specific activity and appropriate safety measures. Studies imply that protective gear may not aid in injury prevention. Instruction and regulations that help educate players about how to avoid an axial loaded straight to the spine may have the greatest impact on cervical injury prevention. One review emphasized these points by recommending that athletes avoid spear tackling, diving in unknown or shallow water, diving while intoxicated, checking from behind in hockey, or using a trampoline without spotting equipment.
Prognosis is generally excellent for the individual with degenerative disc changes. This condition is usually asymptomatic, unless the individual has received trauma to a degenerative segment. As long as the individual maintains a good neck hygiene program emphasizing mechanical balance and conditioning, he or she generally returns to an asymptomatic state.
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