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Excerpt
Because the consequences of cervical spine injury (csi) are potentially catastrophic, return to play (rtp) decisions can be agonizing, especially if an athlete is reluctant to modify his activity. We attempted to elucidate the current thinking amongst orthopedists in making these rtp decisions. Ten cases of athletes who had sustained csi and presented to their orthopedist requesting advice on the safety of returning to their sport were selected and mailed to 346 physicians. They were asked to select, of 6 categories, the type of play (top) that they would feel comfortable recommending for each situation. Analysis was completed using basic descriptive statistics, chi-square, and ANOVA where appropriate. Of 113(33% response rate) responders, 72 were spine sub-specialists(spi), 22 were sports medicine subspecialists(spo), 13 were interested in both, and 3 were not specialists in either. There was a wide disparity in the top recommended for each of the cases. For most of the cases, there was no relationship between yrs in practice, spi, spo, referral to a published guideline, nor sports participation of the physician and the top selected. For the 2 cases of upper cervical lesions and the case of a healed burst fracture, spi was significantly related to the top chosen (p<0.05). For the cases of females with 1 level fusions and the case of recurrent neurapraxia, yrs in practice was inversely related to the top chosen (p<0.05). For the cases of the 2 level fusion and the healed burst fracture, spo was related to the top chosen (p<0.05). Use of a guide was significant only for 1 of the cases (p=0.04).
We found no consensus as to the post-injury management of many csi patients, even amongst those who use presently published guidelines. Further research and education in the area of sports participation following csi is warranted.
