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High-Energy Contact Sports and Cervical Spine Neuropraxia Injuries: What Are the Criteria for Return to Participation?

Dailey, Andrew MD*; Harrop, James S. MD†‡; France, John C. MD§

doi: 10.1097/BRS.0b013e3181f32db0
Consensus-Based Review

Study Design. Clinically based systematic review.

Objective. To define optimal clinical care for patients after sport-related neuropraxic injuries using a systematic review supported with expert opinion.

Summary of Background Data. Athletes who participate in contact sports may experience cervical cord neuropraxia, with bilateral motor or sensory symptoms such as burning, numbness, or loss of sensation referable to the cervical spinal cord. The symptoms last from minutes to hours, but recovery is usually believed to be complete. The underlying condition is cervical spinal stenosis that predisposes the athlete to a transient compression or concussive injury to the spinal cord.

Methods. Focused questions on the treatment of cervical spine sport-related injuries resulting in transient neuropraxia were refined by a panel of spine traumatology surgeons consisting of fellowship-trained neurologic and orthopedic surgeons. Medical subject heading keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify pertinent English-language abstracts and articles whose focus was human subjects. The quality of literature was rated as high, moderate, low, or very low. The proposed questions were answered using the Grading of Recommendations Assessment, Development and Evaluation evidence-based review system. These treatment recommendations were rated as either strong or weak based on the quality of evidence and clinical expertise.

Results. The literature searches revealed low and very low quality evidence with no prospective or randomized studies. One hundred fifty-three pertinent articles were identified; these were supplemented with additional articles to form an evidentiary table with 17 original articles containing unique patient data.

Conclusion. Literature regarding the optimal treatment of patients with transient neuropraxia is of low quality. On the basis of expert opinion, there was a recommendation that a return to full participation in high-energy contact sports could be based on radiographic findings: patients with transient neuropraxia without stenosis could return as a strong recommendation, whereas stenotic patients could not return as a weak recommendation. Furthermore, a strong recommendation was made to permit players to return to full participation after decompression with a single-level anterior cervical fusion.

A systematic review supported by expert opinion was performed to define optimal clinical care for patients after sport-related neuropraxic injuries and recommend criteria for a return to full-contact sports. A strong recommendation is established that patients with transient neuropraxia without radiologic stenosis be able to return to full participation in high-energy contact sports whereas those with radiographic stenosis be prevented from returning, as a weak recommendation, unless single-level anterior cervical discectomy and fusion can eliminate any neural compression.

From the *Department of Neurosurgery, University of Utah, Salt Lake City, UT; Departments of †Neurological and ‡Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; and §Department of Orthopedic Surgery, West Virginia University, Morgantown, WV.

Acknowledgment date: September 30, 2009. First revision date: June 27, 2010. Second revision date: July 20, 2010. Acceptance date: July 21, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to John C. France, MD, Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26505; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.