Catastrophic Cervical Spine Injuries Research Articles

An Extended Neck Position is Likely to Produce Cervical Spine Injuries Through Buckling in Accidental Head-First Impacts During Rugby Tackling.

Catastrophic cervical spine injuries in rugby often occur during tackling. The underlying mechanisms leading to these injuries remain unclear, with neck hyperflexion and buckling both proposed as the causative factor in the injury prevention literature. The aim of this study was to evaluate the effect of pre-impact head-neck posture on intervertebral neck loads and motions during a head-first rugby tackle. Using a validated, subject-specific musculoskeletal model of a rugby player, and computer simulations driven by in vivo and in vitro data, we examined the dynamic response of the cervical spine under such impact conditions. The simulations demonstrated that the initial head-neck sagittal-plane posture affected intervertebral loads and kinematics, with an extended neck resulting in buckling and supraphysiologic intervertebral shear and flexion loads and motions, typical of bilateral facet dislocation injuries. In contrast, an initially flexed neck increased axial compression forces and flexion angles without exceeding intervertebral physiological limits. These findings provide objective evidence that can inform injury prevention strategies or rugby law changes to improve the safety of the game of rugby.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players.

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

104. At-risk tackling techniques in American football

BACKGROUND CONTEXT In American football, fewer fatalities and severe injuries have been seen annually since 1976, when rules were enacted to prohibit certain types of aggressive tackling. The National Football Head and Neck Injury Registry was established in 1975 and data from 1971-1975 were retrospectively reviewed to better understand the mechanisms involved in catastrophic cervical spine injury. PURPOSE This study was an assessment of (1) tackling techniques coaches were teaching at 3 levels: youth (4th–5th grades), middle (6th–8th grades), and high school (9th–12th grades); (2) tackling techniques used during games; and (3) successful tackle rates of these techniques. STUDY DESIGN/SETTING Descriptive epidemiology study. PATIENT SAMPLE Not applicable. OUTCOME MEASURES Not applicable. METHODS This study received IRB approval. Surveys were distributed via email to 500 coaches of football teams in Texas. Coaches provided video recordings of football games with players from youth league (YL), middle school (MS), and high school (HS). All tackle attempts were graded by one reviewer who watched game videos; 1000 consecutive tackles were observed for each group. Survey data included how coaches instructed their players to tackle, the types of tackles, the number of tackles vs missed tackles, the head position, and the initial contact. Data were analyzed using the chi-square test. A subset of 100 consecutive tackles at each level of play were reviewed by two blinded reviewers to assess intra- and interrater reliabilities using Cohen's Kappa calculations. RESULTS (1) In all groups, coaches instructed players to use the “head across the bow” tackling technique: 83%, YL; 81%, MS; 75%, HS. Coaches instructed players to “keep your head up” 89%, in the YL; 100%, MS; and 81%, in HS. (2, 3) During games, players used head-up, inside shoulder tackles more successfully across all groups: 97.5%, YL; 99.5%, MS; 98.8%, HS. While intra- and interrater reliabilities were in the good reliability range, these scores were lower in the youth group. CONCLUSIONS Our study supports the effectiveness of tackling with the head up and with making the initial contact with the inside shoulder. Lower reliability ratings for the youth group were likely due to lower video quality and lack of players’ tackling experience. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

At-Risk Tackling Techniques in American Football.

Background:In American football, fewer fatalities and severe injuries have been seen annually since 1976, after data from 1971 through 1975 were retrospectively reviewed to better understand the mechanisms involved in catastrophic cervical spine injury and rules were enacted to prohibit certain types of aggressive tackling. The National Football Head and Neck Injury Registry was established in 1975.Purpose:To assess (1) tackling techniques that coaches were teaching at 3 levels—youth level (YL; 4th to 5th grades), middle school (MS; 6th to 8th grades), and high school (HS; 9th to 12th grades); (2) tackling techniques used during games; and (3) the successful tackle rates of these techniques.Study Design:Descriptive epidemiology study.Methods:Surveys were distributed via email to 500 coaches of YL, MS, and HS football teams in Texas. Coaches provided video recordings of football games, and all tackle attempts were graded by a single reviewer who watched game videos; 1000 consecutive tackles were observed for each group. Survey data included how coaches instructed their players to tackle, the types of tackles, the number of tackles versus missed tackles, the head position, and the initial contact. Data were analyzed with the chi-square test. A subset of 100 consecutive tackles at each level of play was reviewed by 2 blinded reviewers to assess intra- and interrater reliabilities.Results:In all groups, coaches responded that they preferred to teach the at-risk “head across the bow” tackling technique (83% YL, 81% MS, 75% HS). Coaches stated that they instructed players to “keep your head up,” as currently recommended, 89% in YL, 100% in MS, and 81% in HS. During games, players used head-up, inside-shoulder tackles more successfully across all groups (97.5% YL, 99.5% MS, 98.8% HS). While intra- and interrater reliabilities were in the good range, these scores were lower in the youth group.Conclusion:Our study supports the effectiveness of tackling with the head up and making the initial contact with the inside shoulder. Lower reliability ratings for the youth group were likely due to lower video quality and the lack of players’ tackling experience.

Direct competitive wrestling-related catastrophic lower cervical spine injuries

Direct competitive wrestling-related catastrophic lower cervical spine injuries

Epidemiology of Cervical Spine Injuries in High School Athletes Over a Ten-Year Period

BackgroundMore than 7 million athletes participate in high school sports annually, with both the benefits of physical activity and risks of injury. Although catastrophic cervical spine injuries have been studied, limited data are available that characterize less-severe cervical spine injuries in high school athletes. ObjectiveTo describe and compare cervical spine injury rates and patterns among U.S. high school athletes across 24 sports over a 10-year period. DesignDescriptive epidemiology study. SettingNational sample of high schools participating in the High School Reporting Information Online injury surveillance system. ParticipantsAthletes from participating schools injured in a school sanctioned practice, competition, or performance during the 2005–2006 through 2014–2015 academic years. MethodsCervical spine injury data captured by the High School Reporting Information Online system during the 10-year study period were examined. Cervical spine injury was defined as any injury to the cervical spinal cord, bones, nerves, or supporting structures of the cervical spine including muscles, ligaments, and tendons. Main Outcome MeasurementsCervical spine injury rates, diagnoses, mechanisms, and severities. ResultsDuring the study period, 1080 cervical spine injuries were reported during 35,581,036 athlete exposures for an injury rate of 3.04 per 100,000 athlete exposures. Injury rates were highest in football (10.10), wrestling (7.42), and girls’ gymnastics (4.95). Muscle injuries were most common (63.1%), followed by nerve injuries (20.5%). A larger proportion of football injuries were nerve injuries compared with all other sports (injury proportion ratio 3.31; confidence interval 2.33-4.72), whereas in boys’ ice hockey fractures represented a greater proportion of injuries compared with all other sports (injury proportion ratio 7.64; confidence interval 2.10-27.83). Overall, the most common mechanisms of injury were contact with another player (70.7%) and contact with playing surface (16.1%). ConclusionsCervical spine injury rates and patterns vary by sport and gender. Characterizing these differences is the first step in developing effective, evidence-based prevention guidelines. Level of EvidenceIV

Catastrophic Cervical Spine Injuries in Contact Sports.

Study Design Systematic review. Objectives To determine the incidence of catastrophic cervical spine injuries (CCSIs) among elite athletes participating in contact team sports and whether the incidence varies depending on the use of protective gear or by player position. Methods Electronic databases and reference lists of key articles published from January 1, 2000, to January 29, 2016, were searched. Results Fourteen studies were included that reported CCSI in rugby (n = 10), American football (n = 3), and Irish hurling (n = 1). Among Rugby Union players, incidence of CCSI was 4.1 per 100,000 player-hours. Among National Football League players, the CCSI rate was 0.6 per 100,000 player-exposures. At the collegiate level, the CCSI rate ranged from 1.1 to 4.7 per 100,000 player-years. Mixed populations of elite and recreational rugby players in four studies report a CCSI rate of 1.4 to 7.2 per 100,000 player-years. In this same population, the scrum accounted for 30 to 51% of total reported CCSIs in Rugby Union versus 0 to 4% in Rugby League. The tackle accounted for 29 to 39% of injuries in Rugby Union and 78 to 100% of injuries in Rugby League. Making a tackle was responsible for 29 to 80% of injuries in American football. Conclusion CCSIs are infrequent among elite athletes. There is insufficient evidence to determine the effect of protective gear (e.g., helmets, padding) on CCSI incidence. Scrum and tackle in rugby and tackling in American football account for the majority of CCSIs in each respective sport.

Impact of the national prevention policy and scrum law changes on the incidence of rugby-related catastrophic cervical spine injuries in French Rugby Union

Background and aimsCatastrophic cervical spine injuries are rare in rugby union but require close monitoring. The aim of this study was to analyse the incidence of severe cervical spine injuries...

Return to Play After Cervical Spine Injury in Sports

Spinal cord injuries (SCIs) resulting from sports now represent 8.9% of the total causes of SCI. Regardless of cause, there are bound to be return-to-play decisions to be made for athletes. Since catastrophic cervical spine injuries are among the most devastating injuries in all of sports, returning from a cervical spine injury is one of the most difficult decisions in sports medicine. Axial loading is the primary mechanism for catastrophic cervical spine injuries. Axial loading occurs as a result of intentional or unintentional head-down contact and spearing. Most would agree that the athlete returning to a contact or collision sport after a cervical spine injury must be asymptomatic, have full strength, and have full active range of motion; however, each situation is unique. The following review discusses the pathophysiology of these conditions and suggests guidelines for return to contact sports after traumatic cervical SCI.

Cervical Spine Injury Management in the Helmeted Athlete

The relative incidence of catastrophic cervical spine injury in sports is low compared to other injuries. However, the potential catastrophic and life-altering consequences of spine injury cause understandable concern regarding the prehospital management and care of the cervical-spine-injured athlete. This is complicated when injured athletes participate in equipment-intensive sports, such as football, where helmets and facemasks are potential barriers to obtaining immediate access to the athlete's airway. Cervical spine injuries in these cases necessitate delicate and precise management, often involving the combined efforts of multiple health-care providers. The outcome of a catastrophic cervical spine injury is dependent on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment.

Declining Incidence of Catastrophic Cervical Spine Injuries in French Rugby: 1996-2006

Declining Incidence of Catastrophic Cervical Spine Injuries in French Rugby: 1996-2006

Summary of the National Athletic Trainers' Association Position Statement on the Acute Management of the Cervical Spine-Injured Athlete

The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment. The objective of the National Athletic Trainers' Association (NATA) position statement on the acute care of the cervical spine-injured athlete is to provide the certified athletic trainer, team physician, emergency responder, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in an athlete. Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport such as football, hockey, or lacrosse; and imaging considerations in the emergency department.

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

Declining Incidence of Catastrophic Cervical Spine Injuries in French Rugby: 1996-2006

Purpose To investigate the incidence and the risk factors of catastrophic cervical spine injuries in French rugby. Study Design Descriptive epidemiology study. Methods The patients included had cervical spine injuries causing neurological disorder classified from the ASIA scale, grade A to D. A retrospective review of all cases that occurred between the 1996-1997 and the 2005-2006 seasons was made. Circumstances of the injuries and of the clinical outcome were collected by interview. Results There were 37 cases of catastrophic cervical spine injuries in French rugby for the last 10 years. The incidence of the cervical spine injuries decreased during this period. The rates of injury were 2.1 per 100 000 players per year during the 1996-1997 season and 1.4 during the 2005-2006 season (P <. 01). The scrum was a major cause of injury, accounting for 51.3% (19/37). The forwards represented 89.2% (33/37) of the injured players. The hookers were involved in 37.8% (14/37) of the cases. The measures of prevention with the modification of the rules of scrum and the creation of a medical certificate required for players to play in the front row must have been successful. Conclusion The incidence of disabling cervical spine injuries in French rugby has decreased for the last 10 years, which is linked to the decreasing incidence of injuries in the scrum. This epidemiological study shows the effectiveness of the preventive measures on cervical spine injuries in French rugby players. A national register of catastrophic cervical spine injuries extends our epidemiological observations.

Screening for catastrophic neck injuries in sports

The cervical spine is prone to injury due to the structure of the articulating vertebrae at the level of C4-C6, where the spinal cord occupies more of the spinal canal. Cervical spine injuries can occur in all sports and all ages. Participation in contact sports certainly increases the possibility of cervical spine injuries. In screening for catastrophic neck injuries it is vital to examine incidence and injury surveillance statistics in sports. These data can help determine sport-specific preponderance of catastrophic injury. Screening methods for predisposition to catastrophic cervical spine injuries include a concise history, physical examination, and radiographic methods. There is currently no universal classification system utilizing imaging of the cervical spine that has been validated as a screening method for catastrophic neck injuries.

Catastrophic Cervical Spine Injuries in High School and College Football Players

Catastrophic Cervical Spine Injuries in High School and College Football Players

Catastrophic Cervical Spine Injuries in High School and College Football Players

Background Catastrophic cervical spine injuries in football are rare but tragic events. Purpose To update the incidence of catastrophic cervical injuries in scholastic football players and identify new injury patterns. Study Design Descriptive epidemiology study. Methods The authors retrospectively reviewed 196 incidents of catastrophic high school and collegiate football injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). Results There were 15.08 direct catastrophic cervical spine injuries in scholastic football participants per year, an incidence of 1.10 and 4.72 injuries per 100 000 high school and 100 000 college participants, respectively. Seventy-six athletes had quadriplegia (5.85 per year), 0.50 per 100 000 high school players and 0.82 per 100 000 college players. Spear tackling by players on defense continued to be the predominant mechanism of injury causing quadriplegia. Five athletes had a Brown-Séquard–like syndrome; only 1 made a full recovery. One athlete with Brown-Séquard–like syndrome and permanent neurologic symptoms reported a cervical cord neurapraxia event before the study period. Forty-three athletes (3.31 per year) had diagnosed cervical cord neurapraxia. In addition to hyperflexion and hyperextension injuries, axial forces were found to cause cervical cord neurapraxia. Sixteen of the 43 athletes returned to football after a cervical cord neurapraxia episode, and none of the 16 suffered a permanent quadriplegic event. Nine athletes sustained an isolated injury at the C1 or C2 level, and 7 sustained a combined injury at the C1, or C2 level and at a subaxial level. Conclusion The total number of quadriplegic events for high school and college football players is approximately 6 per year, with a higher incidence at the college level. Cervical cord neurapraxia can be caused by hyperflexion, hyperextension, and axial compression forces. Upper level cervical injuries involving the atlas and axis can occur in football players and may be associated with noncontiguous subaxial injuries.

Catastrophic spine injuries in American football, 1977-2001.

Cervical spinal cord injuries have been the most common catastrophic football injury and the second leading direct cause of death attributable to football skills. This study looks at the 25-year (1977-2001) experience with catastrophic neck injuries and examines not only the incidence but also the cause of injury and variables that have either increased or decreased these injuries. Data were collected on a national level from all organized football programs, including public school, college, professional, and youth programs, through personal contact and questionnaires on each catastrophic football injury. Funded by the National Collegiate Athletic Association, the National Federation of State High School Associations, and the American Football Coaches Association, data were collected by the National Center for Catastrophic Sports Injury Research, University of North Carolina at Chapel Hill (Frederick O. Mueller, Director, and Robert C. Cantu, Medical Director). Teaching the fundamental techniques of the game, equipment standards, and improved medical care both on and off the playing field have led to a 270% reduction in permanent spinal cord injury from a peak of 20 per year during the period 1971 to 1975 to 7.2 per year during the past 10 years. The type of injury, activity at the time of injury, level of play, and whether the injury was incurred in a game or practice are presented. On the basis of the data, recommendations are given for reducing catastrophic cervical spine injury in football.

Trampolines in New Zealand: a decade of injuries.

Despite international concern about the safety of trampolines, they have become increasingly popular in New Zealand. While internationally attention has centred on a relatively few cases of catastrophic cervical spine injury, little research effort has been directed at placing these incidents in a wider context. To redress this, a descriptive epidemiological study of trampoline-related injury in New Zealand was undertaken. National hospitalization and mortality data for a 10-year period revealed 2098 hospitalizations and two deaths. The incidence rate for hospitalizations increased from 3.1 per 100,000 population per year in 1979 to 9.3 in 1988. Of the hospitalized victims, 71% were injured on home trampolines and 80% fell from the trampoline to the surrounding surface. Fractures were the commonest type of injury (68%), and the body site most frequently involved was the upper limb (53%). There was no evidence of a high incidence of severe head and neck injuries. It was concluded that, although existing trampoline standards addressed many of the issues raised by this research, measures to reduce the impact of falls from trampolines to the ground and to prohibit the provision of trampolines as 'play equipment' are required.

Catastrophic Spine Injuries in Football (1977???1989)

Funded by the National Collegiate Athletes Association, the purpose of the National Center for Catastrophic Sports Injury Research is to reduce catastrophic injuries of the head and neck by analyzing the epidemiologic and medical data, and then recommending appropriate rules, conditioning, and medical changes. Catastrophic cervical spine injuries are defined as those that result in spinal cord injury. All cases result in disability. Deaths are excluded from this report. A total of 128 players incurred permanent cervical cord injuries from 1977 through 1989. Defensive players are at greater risk for quadriplegia than offensive players are, and most are injured while tackling. To further reduce catastrophic spine injuries, players must stop using the head as a battering ram, and use the shoulder for blocking and tackling instead. Other recommendations for reducing catastrophic spine injuries are presented.