Cervical Spine Acute Bony Injuries in Sports Medicine Follow-up

Updated: Feb 03, 2017
  • Author: George L Hertner, MD; Chief Editor: Sherwin SW Ho, MD  more...
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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, 17, 32, 35] 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
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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.

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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.

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Prognosis

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

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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.

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