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Cervical Disc Injuries Follow-up

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Jan 22, 2015
 

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.[33] 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.[34] 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.[33]
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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. 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.[35]

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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.

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Education

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Shoulder and Neck Pain and Neck Strain.

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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, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ricardo A Nieves, MD, FAAPMR President, Colorado Spine, Pain and Sports Medicine, PC

Ricardo A Nieves, MD, FAAPMR is a member of the following medical societies: North American Spine Society, American Society of Interventional Pain Physicians, American Academy of Physical Medicine and Rehabilitation, 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, North American Spine Society, International Spine Intervention 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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Samuel Punnamoottil Thampi, MD Attending Pain Management, Anesthesiology, North Shore Pain Service

Samuel Punnamoottil Thampi, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Erik D Hiester, DO Fellow in Interventional Pain Management, Georgia Pain Physicians, Emory University School of Medicine

Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American Pain Society

Disclosure: Nothing to disclose.

R Blake Windsor, MD Resident Physician, Department of Pediatrics, Boston Children's Hospital and Boston Medical Center

R Blake Windsor, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

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 Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

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, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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

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