Cervical Spine Acute Bony Injuries in Sports Medicine Treatment & Management

  • Author: George L Hertner, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Sep 23, 2011
 

Acute Phase

Rehabilitation Program

Physical Therapy

Treat the site of injury with spinal precautions, and address the ABCs. Immobilize the athlete's neck in neutral position with a cervical collar, towel rolls, or whatever is available. Immobilize the spinal column on a backboard, with the head secured such that the entire column is in neutral position and can be moved en bloc. Transport the athlete to a facility with the ability to stabilize the athlete and to radiographically evaluate the neck.[4, 9, 12]

If a fracture is detected, immediately consult a spinal orthopedic surgeon or neurosurgeon. The consultant should make the recommendations regarding the further stabilization of the fracture if needed. This may include Gardner-Wells tongs, surgical intervention, halo immobilization, a cervical collar, or no intervention. The consultant should be a part of all further decisions regarding rehabilitation, return to play, and long-term prognosis.

The patient should rest and remain immobilized, as directed by the consultant. Some patients with very stable fractures may be able to enter an early strengthening and exercise program.[12, 30]

Occupational Therapy

Early occupational therapy may help increase function in those with neurologic deficits.

Medical Issues/Complications

The cervical spine must always be considered injured until proven otherwise by history and physical or radiologic evaluation.

Establishing the ABCs and searching for other injuries are priorities.

Early consultation of a spinal expert is mandatory for patients with fractures.

Surgical Intervention

Surgery may very well be necessary, especially in cases of unstable fractures. The consulting surgeon determines whether surgical intervention is necessary.

Consultations

Consult an orthopedic surgeon or neurosurgeon. Other consultants may be contacted, as determined by the patient's injuries. Early psychologic counseling may also be warranted because these injuries may be devastating to the athlete.

Other Treatment

Do not remove helmets and shoulder pads on the field if the athlete has a potential unstable cervical injury or if the patient is unconscious. Remove the face guard with a screwdriver or cutters. Athletes with respiratory compromise should be intubated with the helmet on.[2, 31]

Transport the athlete with helmet and pads in place. The chinstrap should remain attached if possible. No cervical collar should be placed, but the athlete and helmet should be secured to a backboard.

Unless the patient can be clinically cleared, obtain plain radiographs while the protective gear is in place. If the radiographs are inadequate, consider CT scanning with the helmet and pads in place. Caution: The helmet and shoulder pads should be removed by individuals who are trained and qualified in their removal.[32]

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Recovery Phase

Rehabilitation Program

Physical Therapy

Treatment is determined by the patient's injuries. An exercise and strengthening program may be initiated, as well as a maintenance program for uninvolved areas. At this time, all involved physicians should discuss the type of sports and activities that the athlete will be able to participate in. If a change in sports or activity is needed, plans to encourage the athlete should begin.

Occupational Therapy

Occupational therapy is initiated as determined by the injury and neurologic involvement.

Medical Issues/Complications

Monitor the athlete for signs of depression.

If the athlete is immobilized, monitor for problems such as skin breakdown or deep venous thrombosis (DVT).

Surgical Intervention

The consulting surgeon addresses any potential surgical intervention issues (eg, delayed surgical repair, revisions).

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Maintenance Phase

Rehabilitation Program

Physical Therapy

Treatment is determined by the patient's injuries. Continue exercise and strengthening program, as well as the maintenance program for uninvolved areas. Continue to evaluate the type of sports and level of activity that the athlete will be able to participate in. If a change in sports or activity is needed, plans to encourage the athlete should begin.

Medical Issues/Complications

  • Monitor the athlete for signs of depression.
  • If the athlete is immobilized, monitor for potential problems such as skin breakdown or DVT.

Surgical Intervention

The consulting surgeon addresses any potential surgical intervention issues (eg, delayed surgical repair, revisions).

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Contributor Information and Disclosures
Author

George L Hertner, MD  Medical Director, Department of Emergency Medicine, Memorial Hospital North 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, Department of Emergency Medicine, Palmetto Health Richland Hospital

Nathaniel Johnson Stewart Jr, MD, FACEP 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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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 and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Additional Contributors

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

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Anteroposterior view of atlantooccipital dislocation.
Odontoid view of a Jefferson fracture.
Lateral view of a C2 fracture dislocation.
Odontoid type 2 fracture.
Lateral view of type 3 odontoid fracture.
Computed tomography scans of odontoid type 3 fracture.
Lateral view of a C3 spinous fracture.
Lateral view of hangman's fracture.
C3 flexion fracture.
C4 burst fracture.
Clay shoveler's fracture.
Unilateral locked facets on C5 and C6.
Bilateral facet fracture/dislocation at C6/C7.
Child with C6 flexion wedge fracture.
C7 lamina fracture.
 
 
 
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