Return to Play
The absolute decision of when to return to play after a cervical spine fracture is dependent on the injury. [12, 19, 34, 37] Professional athletes, who are more likely to sustain severe injuries and require surgical treatment than high school or college athletes are, typically have a longer wait before they can return to play. [38]
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:
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Neurologic symptoms or deficits
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Loss of ROM or pain with ROM
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Acute cervical fracture
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Spear tackler's spine
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Atlantoaxial instability, with or without fracture
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Atlantooccipital instability, with or without fracture
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Limited ROM
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Ligamentous laxity
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Vertebral body fracture with a sagittal segment
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Anterior teardrop fracture
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Fusion of 3 or more vertebrae
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Healed fractures with associated neurologic symptoms
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Fracture with canal involvement
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Odontoid fracture
Relative contraindications for contact and high-risk sports include the following:
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Developmental canal stenosis with history of symptoms
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Healed, nondisplaced Jefferson fracture
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Stable 2-level surgical fusion
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Healed, stable, mildly displaced body fracture without neural ring or sagittal components
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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:
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Developmental canal stenosis
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Healed stable compression fracture of body
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Healed spinous process fracture (clay-shoveler's fracture)
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Stable, one-level surgical fusion
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Healed, stable end-plate fracture
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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Anteroposterior view of atlantooccipital dislocation.
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Odontoid view of a Jefferson fracture.
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Lateral view of a C2 fracture dislocation.
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Odontoid type 2 fracture.
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Lateral view of type 3 odontoid fracture.
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Computed tomography scans of odontoid type 3 fracture.
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Lateral view of a C3 spinous fracture.
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Lateral view of hangman's fracture.
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C3 flexion fracture.
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C4 burst fracture.
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Clay shoveler's fracture.
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Unilateral locked facets on C5 and C6.
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Bilateral facet fracture/dislocation at C6/C7.
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Child with C6 flexion wedge fracture.
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C7 lamina fracture.
