High-energy contact sports and cervical spine neuropraxia injuries: what are the criteria for return to participation?
METHODS
Clinically based systematic review.


OBJECTIVE
To define optimal clinical care for patients after sport-related neuropraxic injuries using a systematic review supported with expert opinion.


BACKGROUND
Athletes who participate in contact sports may experience cervical cord neuropraxia, with bilateral motor or sensory symptoms such as burning, numbness, or loss of sensation referable to the cervical spinal cord. The symptoms last from minutes to hours, but recovery is usually believed to be complete. The underlying condition is cervical spinal stenosis that predisposes the athlete to a transient compression or concussive injury to the spinal cord.


METHODS
Focused questions on the treatment of cervical spine sport-related injuries resulting in transient neuropraxia were refined by a panel of spine traumatology surgeons consisting of fellowship-trained neurologic and orthopedic surgeons. Medical subject heading keywords were searched through MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify pertinent English-language abstracts and articles whose focus was human subjects. The quality of literature was rated as high, moderate, low, or very low. The proposed questions were answered using the Grading of Recommendations Assessment, Development and Evaluation evidence-based review system. These treatment recommendations were rated as either strong or weak based on the quality of evidence and clinical expertise.


RESULTS
The literature searches revealed low and very low quality evidence with no prospective or randomized studies. One hundred fifty-three pertinent articles were identified; these were supplemented with additional articles to form an evidentiary table with 17 original articles containing unique patient data.


CONCLUSIONS
Literature regarding the optimal treatment of patients with transient neuropraxia is of low quality. On the basis of expert opinion, there was a recommendation that a return to full participation in high-energy contact sports could be based on radiographic findings: patients with transient neuropraxia without stenosis could return as a strong recommendation, whereas stenotic patients could not return as a weak recommendation. Furthermore, a strong recommendation was made to permit players to return to full participation after decompression with a single-level anterior cervical fusion.
Dailey
Andrew
A
Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Harrop
James S
JS
France
John C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002574:Cervical Vertebrae; D002648:Child; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011859:Radiography; D020127:Recovery of Function; D012677:Sensation; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult