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Cervical Spine Dysfunction Following Pediatric Sports-Related Head Trauma

Ellis, Michael J., MD, FRCSC; McDonald, Patrick J., MD, MHSc, FRCSC; Olson, Ashley, BSc; Koenig, James, MD, FRCPC; Russell, Kelly, PhD

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p 103–110
doi: 10.1097/HTR.0000000000000411
Pediatric TBI 2019

Objective: To examine the prevalence of cervical spine injuries among children and adolescents referred with suspected and diagnosed sports-related concussion (SRC); and evaluate the effect of cervical spine dysfunction (CSD) on physician-documented clinical recovery following SRC.

Setting: A multidisciplinary pediatric concussion program.

Participants: A total of 266 patients (6-19 years) referred with suspected SRC.

Design: A retrospective cohort study.

Main Measures: CSD defined as neurological symptoms localized to the cervical spine or the presence of neck pain, headache, or dizziness and abnormal cervical spine examination findings; physician-documented clinical recovery.

Results: One patient was diagnosed with a T1 compression fracture. Of the 246 patients diagnosed with SRC, 80 (32.5%) met the clinical criteria for CSD including 4 patients with central cord neuropraxia and 1 with a spinal cord injury without radiographic abnormality (SCIWORA). Excluding patients with central cord neuropraxia OR SCIWORA, patients with SRC with CSD took longer to achieve physician-documented clinical recovery (28.5 days vs 17 days, P < .0001) and were 3.95 times more likely to experience delayed physician-documented clinical recovery (>4 weeks postinjury) compared with those without CSD.

Conclusions: Patients with suspected and diagnosed SRC can present with a wide spectrum of coincident cervical spine injuries. Cervical spine dysfunction may be a risk factor for delayed clinical recovery.

Department of Surgery (Dr Ellis), Pediatrics and Child Health (Drs Ellis and Russell), Diagnostic Radiology (Dr Koenig), and Section of Neurosurgery (Dr Ellis), University of Manitoba, Winnipeg, Canada; Pan Am Concussion Program, Pan Am Clinic, Winnipeg, Canada (Drs Ellis and Koenig); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada (Drs Ellis and Russell); Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Ms Olson); Canada North Concussion Network, Winnipeg, Manitoba (Drs Ellis, McDonald, and Russell); University of Manitoba, Winnipeg, Manitoba, Canada (Drs Ellis, Koenig, and Russell).

Corresponding Author: Michael J. Ellis, MD, FRCSC, Pan Am Concussion Program, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB R3M 3E4, Canada (

Drs Russell and Ellis conceptualized and designed the study, carried out the data collection and analysis, drafted the initial manuscript, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. Ms Olson and Drs McDonald and Koenig carried out data collection and analysis, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The authors declare no conflicts of interest.

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