Return to Play

Return to play following treatment for cervical discogenic pain syndrome (CDPS) is an individualized process. No specific time frame exists for a particular injury. A review of the literature by Morganti revealed that there was agreement with regard to the general requirements for return to play.^[7]These included full and painless ROM, normal strength, a stable vertebral column, and adequate space for the neurolgic structures.

Players with compromise of C1-C2, acute fractures, residual neurologic deficit, spinal cord edema or deformity, acute disc herniation, or painful range of motion of the neck should not play collision sports.^[7]Certainly, playing with improper technique such as spear-tackling, diving in unknown depths, diving while intoxicated, using a trampoline without a spotter, and checking from behind in hockey should be avoided.

Complications

Complications of surgical intervention include bleeding, infection, nerve damage, chronic dural leak, and scar-tissue formation surrounding or compressing nervous tissue. Fortunately, these complications do not happen often, but when they do, they may, alone or in combination, cause the patient to be in a worse condition than before having had surgery.

Prevention

Injury prevention is accomplished best through good coaching, proper techniques of sport-specific activity, adequate preparticipation training, and appropriate safety measures, including proper protective equipment and adherence to the rules of the game.

Education

Inform patients that the natural history of an acute radiculopathy suggests that most patients recover within several weeks to months and that surgery is generally not necessary. Educate patients with cervical discogenic pain syndrome (CDPS) regarding home program activities, which may be performed on a routine basis to help strengthen their spine and associated muscle groups, which may help prevent injury in the future.

Hult L. Cervical, dorsal and lumbar spinal syndromes; a field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. Acta Orthop Scand Suppl. 1954. 17:1-102. [QxMD MEDLINE Link].
McKenzie RA. The Cervical and Thoracic Spine. Mechanical Diagnosis and Therapy. Wakainae, New Zealand: Spinal Publications; 1990.
Kramer J. Intervertebral Disk Diseases. Causes, Diagnosis, Treatment and Prophylaxis. George Thieme Verlag, Stuttgart Year Book, Medical Publishers Inc; 1981.
Bailes JE, Maroon JC. Management of cervical spine injuries in athletes. Clin Sports Med. 1989 Jan. 8(1):43-58. [QxMD MEDLINE Link].
Maroon JC, Steele PB, Berlin R. Football head and neck injuries--an update. Clin Neurosurg. 1980. 27:414-29. [QxMD MEDLINE Link].
Cantu RC. The cervical spinal stenosis controversy. Clin Sports Med. 1998 Jan. 17(1):121-6. [QxMD MEDLINE Link].
Morganti C. Recommendations for return to sports following cervical spine injuries. Sports Med. 2003. 33(8):563-73. [QxMD MEDLINE Link].
Bagduk N, Twomey LT. Clinical Anatomy of the Lumbar Spine. 2nd ed. New York, NY: Churchill Livingston; 1991.
Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat. 1981 Jan. 132:39-56. [QxMD MEDLINE Link].
Bogduk N, Windsor M, Inglis A. The innervation of the cervical intervertebral discs. Spine. 1988 Jan. 13(1):2-8. [QxMD MEDLINE Link].
Malinsky J. The ontogenetic development of nerve terminations in the intervertebral discs of man. (Histology of intervertebral discs, 11th communication). Acta Anat (Basel). 1959. 38:96-113. [QxMD MEDLINE Link].
Mendel T, Wink CS, Zimny ML. Neural elements in human cervical intervertebral discs. Spine. 1992 Feb. 17(2):132-5. [QxMD MEDLINE Link].
Panjabi MM, Vasavada A, White AA III. Cervical spine biomechanics. Semin Spine Surg. 1993. 5:10-6.
Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine. 1992 Jun. 17(6 suppl):S129-32. [QxMD MEDLINE Link].
Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. 1990 Jul. 15(7):674-8. [QxMD MEDLINE Link].
Ordway NR, Seymour RJ, Donelson RG, Hojnowski LS, Edwards WT. Cervical flexion, extension, protrusion, and retraction. A radiographic segmental analysis. Spine. 1999 Feb 1. 24(3):240-7. [QxMD MEDLINE Link].
Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994 Mar. 75(3):342-52. [QxMD MEDLINE Link].
White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia, Pa: JB Lippincott; 1991. 85-125.
Maroon JC. Burning hands' in football spinal cord injuries. JAMA. 1977 Nov 7. 238(19):2049-51. [QxMD MEDLINE Link].
Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: a comparison of three pillows. Arch Phys Med Rehabil. 1997 Feb. 78(2):193-8. [QxMD MEDLINE Link].
CLOWARD RB. Cervical diskography. A contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959 Dec. 150:1052-64. [QxMD MEDLINE Link]. [Full Text].
Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med. 1988 May-Jun. 3(3):230-8. [QxMD MEDLINE Link].
Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain?. JAMA. 1992 Aug 12. 268(6):760-5. [QxMD MEDLINE Link].
Yoss RE, Corbin KB, MacCarty CS, Love JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. 1957 Oct. 7(10):673-83. [QxMD MEDLINE Link].
Beatty RM, Fowler FD, Hanson EJ Jr. The abducted arm as a sign of ruptured cervical disc. Neurosurgery. 1987 Nov. 21(5):731-2. [QxMD MEDLINE Link].
Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989 Mar. 14(3):253-7. [QxMD MEDLINE Link].
Gumina S, Carbone S, Albino P, Gurzi M, Postacchini F. Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain. Eur Spine J. 2013 Jul. 22(7):1558-63. [QxMD MEDLINE Link]. [Full Text].
Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column. Spine. 1982 Mar-Apr. 7(2):116-22. [QxMD MEDLINE Link].
Handa T, Ishihara H, Ohshima H, et al. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine. 1997 May 15. 22(10):1085-91. [QxMD MEDLINE Link].
Hickey DS, Hukins DW. Relation between the structure of the annulus fibrosus and the function and failure of the intervertebral disc. Spine. 1980 Mar-Apr. 5(2):106-16. [QxMD MEDLINE Link].
Coventry MB, Ghormley RK, Kernohan JW. The intervertebral disc. Its microscopic anatomy and pathology. Part III. Pathological changes in the intervertebral disc. J Bone Joint Surg. 1945. 27:460-74. [Full Text].
Gower WE, Pedrini V. Age-related variations in proteinpolysaccharides from human nucleus pulposus, annulus fibrosus, and costal cartilage. J Bone Joint Surg Am. 1969 Sep. 51(6):1154-62. [QxMD MEDLINE Link]. [Full Text].
Lipson SJ, Muir H. Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum. 1981 Jan. 24(1):12-21. [QxMD MEDLINE Link].
Pearce RH, Grimmer BJ, Adams ME. Degeneration and the chemical composition of the human lumbar intervertebral disc. J Orthop Res. 1987. 5(2):198-205. [QxMD MEDLINE Link].
Harms-Ringdahl K. On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position. Scand J Rehabil Med Suppl. 1986. 14:1-40. [QxMD MEDLINE Link].
Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986 Jul-Aug. 11(6):521-4. [QxMD MEDLINE Link].
Deyo RA, ed. Occupational Back Pain. Spine: State of the Art Reviews. Philadelphia, Pa: Hanley and Belfus; 1987. Vol 2:
Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol. 1988 Mar-Apr. 9(2):367-70. [QxMD MEDLINE Link].
Karnaze MG, Gado MH, Sartor KJ, Hodges FJ 3rd. Comparison of MR and CT myelography in imaging the cervical and thoracic spine. AJR Am J Roentgenol. 1988 Feb. 150(2):397-403. [QxMD MEDLINE Link]. [Full Text].
Modic MT, Masaryk TJ, Mulopulos GP, et al. Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology. 1986 Dec. 161(3):753-9. [QxMD MEDLINE Link]. [Full Text].
Kramer J, Rivera CA, Kleefield J. Degenerative disorders of the cervical spine. Rheum Dis Clin North Am. 1991 Aug. 17(3):741-55. [QxMD MEDLINE Link].
Schellhas KP, Smith MD, Gundry CR, Pollei SR. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine. 1996 Feb 1. 21(3):300-11; discussion 311-2. [QxMD MEDLINE Link].
Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br. 1998 Jan. 80(1):19-24. [QxMD MEDLINE Link]. [Full Text].
Parfenchuck TA, Janssen ME. A correlation of cervical magnetic resonance imaging and discography/computed tomographic discograms. Spine. 1994 Dec 15. 19(24):2819-25. [QxMD MEDLINE Link].
Manchikanti L, Dunbar EE, Wargo BW, et al. Systematic review of cervical discography as a diagnostic test for chronic spinal pain. Pain Physician. 2009 Mar-Apr. 12(2):305-21. [QxMD MEDLINE Link]. [Full Text].
Siebenrock KA, Aebi M. [The value of diskography in disk-related pain syndrome of the cervical spine for evaluation of indications for spondylodesis] [German]. Z Orthop Ihre Grenzgeb. 1993 May Jun. 131(3):220-4. [QxMD MEDLINE Link].
Osler GE. Cervical analgesic discography. A test for diagnosis of the painful disc syndrome. S Afr Med J. 1987 Mar 21. 71(6):363. [QxMD MEDLINE Link].
Roth DA. Cervical analgesic discography. A new test for the definitive diagnosis of the painful-disk syndrome. JAMA. 1976 Apr 19. 235(16):1713-4. [QxMD MEDLINE Link].
Wilbourn AJ, Aminoff MJ. AAEE minimonograph #32: the electrophysiologic examination in patients with radiculopathies. Muscle Nerve. 1988 Nov. 11(11):1099-114. [QxMD MEDLINE Link].
Dvorak J. Epidemiology, physical examination, and neurodiagnostics. Spine. 1998 Dec 15. 23(24):2663-73. [QxMD MEDLINE Link].
Gangi A, Tsoumakidou G, Buy X, Cabral JF, Garnon J. Percutaneous techniques for cervical pain of discal origin. Semin Musculoskelet Radiol. 2011 Apr. 15(2):172-80. [QxMD MEDLINE Link].
[Guideline] Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations. Pain Physician. 2013 Apr. 16(2 Suppl):S49-S283. [QxMD MEDLINE Link].
Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine. 1997 May 15. 22(10):1115-22. [QxMD MEDLINE Link].
Donelson R, McKenzie R. Mechanical assessment and treatment of spinal pain. Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York, NY: Lippincott-Raven Publishers; 1997. 1821-35.
Donelson R, Silva G, Murphy K. Centralization phenomenon. Its usefulness in evaluating and treating referred pain. Spine. 1990 Mar. 15(3):211-3. [QxMD MEDLINE Link].
Benini A, Krayenbuhl H, Bruderl R. Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien). 1982. 61(1-3):105-10. [QxMD MEDLINE Link].
Martins AN. Anterior cervical discectomy with and without interbody bone graft. J Neurosurg. 1976 Mar. 44(3):290-5. [QxMD MEDLINE Link].
Palit M, Schofferman J, Goldthwaite N, et al. Anterior discectomy and fusion for the management of neck pain. Spine. 1999 Nov 1. 24(21):2224-8. [QxMD MEDLINE Link].
Yamamoto I, Ikeda A, Shibuya N, Tsugane R, Sato O. Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine. 1991 Mar. 16(3):272-9. [QxMD MEDLINE Link].
Green PW. Anterior cervical fusion. A review of thirty-three patients with cervical disc degeneration. J Bone Joint Surg Br. 1977 May. 59(2):236-40. [QxMD MEDLINE Link]. [Full Text].
Heller JG, Schimandle JH. Operative treatment of degenerative cervical disk disease. J South Orthop Assoc. 1996 Fall. 5(3):188-206. [QxMD MEDLINE Link].
Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J. 1996. 5(5):319-25. [QxMD MEDLINE Link].
Honet JC, Puri K. Cervical radiculitis: treatment and results in 82 patients. Arch Phys Med Rehabil. 1976 Jan. 57(1):12-6. [QxMD MEDLINE Link].
Rubin D. Cervical radiculitis: diagnosis and treatment. Arch Phys Med Rehabil. 1960 Dec. 41:580-6. [QxMD MEDLINE Link].
Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine. 1996 Aug 15. 21(16):1877-83. [QxMD MEDLINE Link].
Bush K, Chaudhuri R, Hillier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine. 1997 Jan 15. 22(2):183-6; discussion 187. [QxMD MEDLINE Link].
Maigne JY, Deligne L. Computed tomographic follow-up study of 21 cases of nonoperatively treated cervical intervertebral soft disc herniation. Spine. 1994 Jan 15. 19(2):189-91. [QxMD MEDLINE Link].
Mochida K, Komori H, Okawa A, et al. Regression of cervical disc herniation observed on magnetic resonance images. Spine. 1998 May 1. 23(9):990-5; discussion 996-7. [QxMD MEDLINE Link].
Schulman J. Treatment of neck pain with cervical epidural steroid injection. Reg Anesth. 1986. 11:92-94.
Diwan S, Manchikanti L, Benyamin RM, Bryce DA, Geffert S, Hameed H, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012 Jul-Aug. 15(4):E405-34. [QxMD MEDLINE Link].
Manchikanti L, Nampiaparampil DE, Candido KD, Bakshi S, Grider JS, Falco FJ, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Physician. 2015 Jan-Feb. 18 (1):39-60. [QxMD MEDLINE Link].
Slipman CW, Lipetz JS, Jackson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil. 2000 Jun. 81(6):741-6. [QxMD MEDLINE Link].
Boswell MV, Trescot AM, Datta S, et al, for the American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007 Jan. 10(1):7-111. [QxMD MEDLINE Link]. [Full Text].
Cantu RC, Mueller FO. Catastrophic spine injuries in football (1977-1989). J Spinal Disord. 1990 Sep. 3(3):227-31. [QxMD MEDLINE Link].
Cloward RB. Acute cervical spine injuries. Clin Symp. 1980. 32(1):1-32. [QxMD MEDLINE Link].
Delgado-Lo Pez PD, Rodri Guez-Salazar A, Castilla-Di Ez JM, et al. [Role of surgery in spinal degenerative disease. Analysis of systematic reviews on surgical and conservative treatments from an evidence-based approach] [Spanish]. Neurocirugia (Astur). 2005 Apr. 16(2):142-57. [QxMD MEDLINE Link]. [Full Text].
Haines T, Gross A, Goldsmith CH, Perry L. Patient education for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008 Oct 8. CD005106. [QxMD MEDLINE Link].
Heiskari M. Comparative retrospective study of patients operated for cervical disc herniation and spondylosis. Ann Clin Res. 1986. 18 suppl 47:57-63. [QxMD MEDLINE Link].
Kramer J. Intervertebral Disk Diseases: Causes, Diagnosis, Treatment and Prophylaxis. New York, NY: Thieme Medical Publishers; 1990.
LaPrade RF, Burnett QM, Zarzour R, Moss R. The effect of the mandatory use of face masks on facial lacerations and head and neck injuries in ice hockey. A prospective study. Am J Sports Med. 1995 Nov-Dec. 23(6):773-5. [QxMD MEDLINE Link].
Levin JH. Prospective, double-blind, randomized placebo-controlled trials in interventional spine: what the highest quality literature tells us. Spine J. 2008 Sep 11. epub ahead of print. [QxMD MEDLINE Link].
Majors R. Degenerative and morphological changes of the cervical spine in professional soccer players. Presented at: Annual meeting of the American Orthopaedic Society for Sports Medicine. Sun Valley, Idaho: 1997.
Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc. 1958 Jan 4. 166(1):23-8. [QxMD MEDLINE Link].
Schmidek HH. Cervical spondylosis. Am Fam Physician. 1986 May. 33(5):89-99. [QxMD MEDLINE Link].
Tator C. Injuries to the cervical spine and spinal cord resulting from ice hockey. Torg JS, ed. Athletic Injuries to the Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 124-32.
Tator CH, Carson JD, Edmonds VE. New spinal injuries in hockey. Clin J Sport Med. 1997 Jan. 7(1):17-21. [QxMD MEDLINE Link].
Taylor KF, Coolican MR. Spinal cord injuries in football-rugby union, rugby league and Australian rules. Torg JS, ed. Athletic Injuries in Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 174-97.
Torg JS, ed. Injuries to the cervical spine and spinal cord resulting from water sports. Athletic Injuries in Head, Neck and Face. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991. 157-73.
Wu WQ, Lewis RC. Injuries of the cervical spine in high school wrestling. Surg Neurol. 1985 Feb. 23(2):143-7. [QxMD MEDLINE Link].

Media Gallery

Appearance of torticollis as a result of sternomastoid fibrosis in a young child.
Lateral cervical spine plain radiograph illustrating the Torg/Pavlov ratio.
Axial computed tomography scan of cervical herniated nucleus pulposus.
T1-weighted magnetic resonance image of a cervical disk herniation.
T2-weighted magnetic resonance image of a cervical disk herniation.
Myelogram of cervical herniated disk. A filling defect is shown.
Three-dimensional computed tomography scan of C1.
Lateral view of a C2 fracture dislocation.

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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.

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.

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.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

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.