To The Editor: In the Current Concepts Review article Injuries to the Cervical Spine in American Football Players (2002;84:112-22), by Torg et al., the authors represented the spear tackler's spine as being an absolute contraindication to participation in collision sports. We acknowledge the contributions of Dr. Torg and his colleagues to the understanding of cervical spine injuries in football players, and we generally agree with, and advocate, the guidelines that they have presented. The authors defined the characteristics of spear tackler's spine as (1) a canal-vertebral body ratio (Pavlov ratio) of <0.8, (2) a straight or kyphotic alignment of the neck on a neutral lateral radiograph, (3) a posttraumatic radiographic abnormality, and (4) documentation of the patient's use of the spear-tackling technique. The authors' conclusion that spear tackler's spine is an absolute contraindication for return to play is based on their previously published retrospective review of fifteen football players who had sustained trauma to the cervical spine during play 1. The patients had either been referred to the lead author (J.S.T.) or identified through the National Football Head and Neck Injury Registry, from 1987 to 1990. All fifteen players were retrospectively found to meet the criteria of spear tackler's spine. Eleven of the fifteen patients had full neurological recovery, while four had a permanent neurological deficit. All four of these players had antecedent cervical or neurological symptoms prior to the sentinel injury, and three had sustained fracture-dislocations and/or disc herniations of the cervical spine. The remaining eleven patients had anatomical abnormalities, including disc herniations (six patients) and congenital anomalies (two patients). The authors' conclusion that spear tackler's spine is an absolute contraindication to participation in contact sports and collision activities is well intended but based on anecdotal evidence. The case reports of the four patients with spear tackler's spine …