A commentary on cervical spondylolysis in the contact athlete

Abstract

Cervical spondylolysis, unlike lumbar spondylolysis, is an exceedingly rare clinical entity. Perlman and Hawes [1] first described cervical spondylolysis and spondylolisthesis in 1951. To date, approximately 150 cases have been documented in the English language literature. Of these, approximately one-fourth have been described in the pediatric population. Cervical spondylolysis is characterized as a corticated cleft between the superior and inferior articular facets of the articular pillar. With the exception of C1, cervical spondylolysis has been reported at all cervical levels, with most cases occurring at C6. In fact, in 70 case reports by Hirota et al. [2], C6 was the most common site of involvement, present in 47 cases, whereas C2 and C5 were involved in only 9 cases each. Of the 47 patients with spondylosis at C6, 38 patients had bilateral involvement with associated spondylolisthesis. The age range at presentation is wide, with cases reported in those as young as 20 months and as old as 80 years. Twice as many cases have been found in males as in females [3,4]. Symptoms vary at presentation with most people noting minor axial neck pain and stiffness, often after a minor trauma. The etiology of cervical spondylolysis has not been established, with theories including congenital, developmental, microtrauma, and posttraumatic nonunion with pseudarthrosis [5]. Cervical spondylolysis is often seen in the context of other congenital abnormalities, such as spina