Global Spine J 2016; 06(08): 792-797
DOI: 10.1055/s-0036-1582394
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Return to Play after Cervical Spine Injuries: A Consensus of Opinion

John C. France1, Michael Karsy2, James S. Harrop3, Andrew T. Dailey2
  • 1Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, United States
  • 2Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States
  • 3Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Further Information

Publication History

05 January 2016

25 February 2016

Publication Date:
12 April 2016 (eFirst)

Abstract

Study Design Survey.

Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making.

Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant.

Results Evaluation of the surgeons' responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology.

Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.