title: Catastrophic cervical spine injuries in high school and college football players.
abstract: BACKGROUND
  Catastrophic cervical spine injuries in football are rare but tragic events.
  
  
  OBJECTIVE
  To update the incidence of catastrophic cervical injuries in scholastic football players and identify new injury patterns.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Orthopaedic Center, 9711 Medical Center Dr, #201, Rockville, MD 20850, USA. bboden@alum.haverford.edu
authors.forename: Barry P
authors.initials: BP
authors.lastname: Boden
authors.forename: Robin L
authors.initials: RL
authors.lastname: Tacchetti
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cantu
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Knowles
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Mueller
mesh_terms: D000293:Adolescent; D000328:Adult; D018437:Brown-Sequard Syndrome / Q000453:epidemiology / Q000209:etiology; D002574:Cervical Vertebrae / Q000293:injuries* / Q000503:physiopathology; D015986:Confounding Factors, Epidemiologic; D005500:Follow-Up Studies; D005538:Football / Q000293:injuries* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D053580:Muscle Strength; D011159:Population Surveillance; D011782:Quadriplegia / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012574:Schools; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology