Sports Medicine: Just the Facts

CHAPTER 41 • CERVICAL SPINE 247

PREVENTION

• Reductions in the numbers of cervical spine injuries
  in sport can be made by the following:
  
  
  1. Rule changes: In the National Football League, for
     instance, rule changes in 1976 eliminated the head
     as an initial contact area for blocking and tackling.
     Coaches are encouraged to instruct players to
     block and tackle with their head up. Spearing with
     the head has been banned.
     2. Conditioning exercises to strengthen the neck and
     sports-specific training.
     3. Prohibiting spearing or tackling using the head as
     a battering ram or grabbing the facemask.
     4. Strict enforcement of the rules by officials and
     intolerance of illegal play.
     5. Understand that football players playing defensive
     positions are more likely to sustain a catastrophic
     injury, so safe blocking and tackling techniques
     should be reinforced and stressed.
     6. Ensure that equipment properly fits.
     7. Expert on-site medical care. A certified athletic
     trainer, and if possible, a sports medicine physician
     should be available at the playing field. A plan for
     managing a catastrophic neck injury must be
     rehearsed and be in place.
     8. Any athlete with a suspected head or neck injury
     should be managed as if they have an unstable cer-
     vical spine fracture until proven otherwise. The
     player should be instructed not to move, the head
     and neck should be immobilized, and trained pro-
     fessionals should coordinate safe transfer onto a
     spine board and referral to a trauma center.
     9. When possible identifying congenital anomalies of
     the spine through a thorough preparticipation his-
     tory and physical examination.
  
  
  
  

REFERENCES

Albright JP, Moses JM, Feldich HG, et al: Non-fatal cervical spine

injuries in interscholastic football. JAMA 236:1243–1245,

1976.

Cantu RC: Cervical spine injuries in the athlete. Semin Neurol

20(2):173–178, 2000.

Cantu RC, Bailes JE, Wilberger JE: Guidelines for return to con-

tact or collision sport after a cervical spine injury. Clin Sports

Med 17(1):137–146, 1998.

Cantu RC, Mueller FO: Catastrophic football injuries:

1977–1998. Neurosurg47(3): 673–677, 2000.

Castro FP, Ricciardi J, Brunet ME, et al: Stingers, the Torg ratio,

and the cervical spine. Am J Sports Med25(5):603–608, 1997.

Feinberg JH: Burners and stingers. Phys Med Rehabil Clin N Am

11(4):771–784, 2000.

Levitz CL, Reilly PH, Torg JS: The pathomechanics of chronic,

recurrent cervical nerve root neurapraxia—the chronic burner

syndrome. Am J Sports Med 25(1):73–76, 1997.

Malanga GA: The diagnosis and treatment of cervical radicu-

lopathy. Med Sci Sports Exerc 29(7 Suppl):S236–S245, 1997.

McAlindon RJ: On field evaluation and management of head and

neck injured athletes. Clin Sports Med 21(1):1–14, 2002.

Meyer SA, Schulte KR, Callaghan JJ, et al: Cervical spinal steno-

sis and stingers in collegiate football players. Am J Sports Med

22(2):158–166, 1994.

TABLE 41-1 Torg & Ramsey-Emrhein Collision Sport
Participation Guidelines
NO CONTRAINDICATION

Congenital
Spina bifida occulta
Type II Klippel-Feil at C3 and below
Developmental
Torg-Pavlov ratio <0.8
Nondisplaced stable healed fracture at compression or endplate, no
posterior involvement; or clay shoveler fracture
Healed herniated nucleus pulposus
One-level fusion
RELATIVE CONTRAINDICATION

Developmental

Pavlov ratio <0.8, with motor and/or sensory neurapraxia

Previous episodes of neurapraxia

Two- or three-level fusions

Healed but displaced stable fracture C3-C7 at posterior ring or

compression fracture

Healed, nondisplaced stable fracture C1-C2

Instability <3.5 mm or 11°

Healed herniated nucleus pulposus with residual facet instability

ABSOLUTE CONTRAINDICATION

Congenital

Odontoid (C2) abnormalities such as odontoid agenesis, odontoid

hypoplasia, or os odontoidium

Atlantooccipital fusion

C1-C2 anomaly or fusion

Klippel-Feil anomaly with congenital fusion of one or more vertebral

segments and a loss of segmental motion or instability

Developmental

Spear tackler’s spine

Residual pain or limited range of motion

Acute fracture or central herniated nucleus pulposus

Recurrent cervical cord neurapraxia

Fracture or ligamentous laxity at C1-C2

Acute or chronic hard disk

C1-C2 fusion

Instability >3.5mm or 11°

Body fracture with sagittal compression, arch fracture, ligament

injury, fragmentation at canal

Lateral mass fracture with facet incongruity

>Three level fusion

SOURCE: (Malanga, 1997; Torg, Guille, and Jaffe, 2002)