eMedicine Specialties > Sports Medicine > Spine

Cervical Disc Injuries: Follow-up

Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Coauthor(s): Ricardo A Nieves, MD, President, Colorado Spine, Pain and Sports Medicine, PC; Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group; Samuel Punnamoottil Thampi, MD, Consulting Staff, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Franklin Hospital Medical Center, North Shore-Long Island Jewish Health System; Frank J King, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Georgia Pain Physicians/Emory School of Medicine; Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Contributor Information and Disclosures

Updated: Apr 6, 2006

Follow-up

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 (Torg and Ramsey-Emrhein, 1997). 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, 1993). 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 (Torg and Ramsey-Emrhein, 1997)

Prevention

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. A recent review emphasizes 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 (Morganti, 2003).

Prognosis

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.

Education

For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education articles Shoulder and Neck Pain and Neck Strain.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Dr Dennis P White to the development and writing of this article.



More on Cervical Disc Injuries

Overview: Cervical Disc Injuries
Differential Diagnoses & Workup: Cervical Disc Injuries
Treatment & Medication: Cervical Disc Injuries
Follow-up: Cervical Disc Injuries
References
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References

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Further Reading

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Keywords

acute cervical spine injury, annular tear with herniation of the nucleus pulposus, annular tear without herniation of the nucleus pulposus, cervical degenerative disease

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Contributor Information and Disclosures

Author

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Ricardo A Nieves, MD, President, Colorado Spine, Pain and Sports Medicine, PC
Ricardo A Nieves, MD is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Kevin P Sullivan, MD, Consulting Staff, The Boston Spine Group
Kevin P Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, and North American Spine Society
Disclosure: BioAssets Development Corp Consulting fee Consulting

Samuel Punnamoottil Thampi, MD, Consulting Staff, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Franklin Hospital Medical Center, North Shore-Long Island Jewish Health System
Samuel Punnamoottil Thampi, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and North American Spine Society
Disclosure: Nothing to disclose.

Frank J King, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Georgia Pain Physicians/Emory School of Medicine
Frank J King, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Erik D Hiester, DO, Fellow in Interventional Pain Management, Emory Medical School/Georgia Pain Physicians
Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, and American Pain Society
Disclosure: Nothing to disclose.

Medical Editor

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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