Return to play in athletes with spinal cord concussion: a systematic literature review.
This is a systematic review.



The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).



Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial.



We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.



We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a "long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311).



There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Narihito
N
Nagoshi
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada.
Lindsay
L
Tetreault
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
Hiroaki
H
Nakashima
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada.
Aria
A
Nouri
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building 1 King's College Circle, Room 2374, Toronto M5S 1A8, Ontario, Canada. Electronic address: Michael.Fehlings@uhn.ca.
Michael G
MG
Fehlings
D000293:Adolescent; D000328:Adult; D056352:Athletes; D002574:Cervical Vertebrae / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D000068958:Return to Sport; D013119:Spinal Cord Injuries / Q000534:rehabilitation* / Q000601:surgery
Cervical stenosis; Neurapraxia; Return to play; Spinal cord concussion; Surgical treatment; Systematic review