40 - Spinal Injuries in Sports

Abstract

Prevention of spinal injuries in sports is an important goal of modifications of rules, regulations, and equipment. The athlete and the provider face unique and urgent challenges once a spinal injury occurs. Spinal injuries can occur in most sports, but American football is associated with highest risk of significant spinal injury. The cervical spine, the most mobile segment of the spine, is at highest risk of injury in collision sports, including American football. Catastrophic spinal cord injury is rare, but must remain at the top of the list for differential diagnosis of neural impairment until proven otherwise. More common injuries, such as brachial plexus neuropraxia, burning hand syndrome, and cervical cord neuropraxia, should be distinguished from spinal cord injury and treated appropriately. There are five principles of on-field management of sports injuries: (1) preparation for any neurological injury, (2) suspicion and recognition, (3) stabilization and safety, (4) immediate treatment and possible secondary treatment, and (5) evaluation for return to play. Relative and absolute contraindications for return to play are fusions that cross the junctional zone and those that stop at the junctional zone, respectively. Return to play can be considered following anterior discectomy and fusion at up to two levels once a successful bone fusion has been documented radiographically and the patient is neurologically intact. We review spinal injuries unique to the patient-athlete, and the optimal approach to be adopted for diagnosis and management.