eMedicine Specialties > Sports Medicine > Spine

Cervical Spine Acute Bony Injuries: Follow-up

Author: George L Hertner, MD, Consulting Staff, Department of Emergency Medicine, Memorial Hospital of Colorado Springs
Coauthor(s): Nathaniel Johnson Stewart Jr, MD, FACEP, Director for Education and Professional Services, Chief, Department of Emergency Medicine, Palmetto Richland Memorial Hospital
Contributor Information and Disclosures

Updated: May 27, 2008

Follow-up

Return to Play

The absolute decision of when to return to play after a cervical spine fracture is dependent on the injury.12,16,29 The consulting surgeon should play a large role in determining what type of activity can be performed and when it may begin. Failure to respect the severity of an injury may place the athlete in a position for further injury and possible disability. An athlete with persistent pain or neurologic symptoms certainly should be held from play. This may be frustrating to an athlete. An athlete does not want to be needlessly held from play, but proper evaluation and stabilization is paramount. Various sources indicating contraindications for play are available.

  • Absolute contraindications for contact and high-risk sports include the following:
    • Neurologic symptoms or deficits
    • Loss of ROM or pain with ROM
    • Acute cervical fracture
    • Spear tackler's spine
    • Atlantoaxial instability, with or without fracture
    • Atlantooccipital instability, with or without fracture
    • Limited ROM
    • Ligamentous laxity
    • Vertebral body fracture with a sagittal segment
    • Anterior teardrop fracture
    • Fusion of 3 or more vertebrae
    • Healed fractures with associated neurologic symptoms
    • Fracture with canal involvement
    • Odontoid fracture
  • Relative contraindications for contact and high-risk sports include the following:
    • Developmental canal stenosis with history of symptoms
    • Healed, nondisplaced Jefferson fracture
    • Stable 2-level surgical fusion
    • Healed, stable, mildly displaced body fracture without neural ring or sagittal components
    • Healed stable neural ring fractures
  • Indicators that the patient is safe for participation (when asymptomatic with normal findings and pain-free examination) include the following:
    • Developmental canal stenosis
    • Healed stable compression fracture of body
    • Healed spinous process fracture (clay-shoveler's fracture)
    • Stable, one-level surgical fusion
    • Healed, stable end-plate fracture

Complications

An extensive list of complications to cervical fractures exists. Neurologic impairment is the most obvious and severe. The neurologic complications may range from paresthesias to complete loss of function. Cervical spinal cord injuries can be devastating because they may involve respiratory function and death. Spinal shock is also challenging to care for in the initial phase of injury. Long-term complications are related to immobilization and loss of function. These complications include skin breakdown, infections, loss of muscle mass, depression, and increased risk of suicide. Halo immobilization is associated with pin-site infections and osteomyelitis. Long-term collar immobilization is associated with skin breakdown.

Prevention

Athletes, especially those in contact sports, should participate in neck-strengthening exercises. Encourage education on proper technique and coaching. Rules of play to avoid tackling while leading with the head should be enforced. Additional education for the public should be supported. This should include prevention of diving injuries from shallow pools and natural water sources and avoidance of drinking alcohol while swimming. After the occurence of a cervical fracture, a change of sports or activity modification may be needed to prevent reinjury. Proper rehabilitation may also be necessary.

Prognosis

The prognosis for the athlete is completely dependent on the type and extent of his or her injuries as well as associated problems.

Education

A strong educational program should be included in all sports, especially contact and high-risk sports. Proper tackling must be taught from the beginning. A community education program should also be encouraged to prevent unsupervised sports injuries. Water and pool safety must be widely encouraged, including emphasis on feet-first water entry and avoidance of chemical impairment while engaging in water sports.

Everyone exposed to athletes (eg, physicians, coaches, trainers, referees, parents) should aid in providing this education. The rules of play for sports should reflect an effort to prevent injury and promote safe play. Paramedics and hospital personnel should be educated in proper care of a patient wearing equipment such as helmets and pads.

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Patient Safety
Resource Center Spinal Disorders
Resource Center Trauma

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize spinal injuries is a significant medicolegal pitfall.
  • Failure to recognize spinal injuries is the source of a copious amount of litigation and, many times, results in the loss of suits.

Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author coauthor Mark Leski, MD, to the development and writing of this article.



More on Cervical Spine Acute Bony Injuries

Overview: Cervical Spine Acute Bony Injuries
Differential Diagnoses & Workup: Cervical Spine Acute Bony Injuries
Treatment & Medication: Cervical Spine Acute Bony Injuries
Follow-up: Cervical Spine Acute Bony Injuries
Multimedia: Cervical Spine Acute Bony Injuries
References
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Further Reading

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Keywords

cervical spine fracture, C-spine trauma / injury, spinal injury, spinal trauma, neck fracture, neck injury

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Contributor Information and Disclosures

Author

George L Hertner, MD, Consulting Staff, Department of Emergency Medicine, Memorial Hospital of Colorado Springs
George L Hertner, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Colorado Medical Society, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nathaniel Johnson Stewart Jr, MD, FACEP, Director for Education and Professional Services, Chief, Department of Emergency Medicine, Palmetto Richland Memorial Hospital
Nathaniel Johnson Stewart Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, University of California at Davis; Director of Amputee Clinic, Chief of Orthopedic Trauma, Kaiser Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Hungarian Medical Association of America, Orthopaedic Trauma Association, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
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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