Cervical Spine & Spinal Cord Injuries in Athletes

Cervical spine and spinal cord injuries (SCI) are uncommon in athletes but carry significant risk of morbidity and mortality as well as implications for the athletes future. The most commonly implicated sports include football, hockey, wrestling, gymnastics, and rugby however they can occur during any athletic event. Between the years 1977 and 2004, an average of 40 vertebral column injuries and 7 spinal cord injuries were reported annually [1]. Approximately 2.4% of athletic-related hospitalizations are related to SCI [2] and 9.2% of all SCIs in the United States are sustained during athletic activity [3]. Most of these occur in athletes younger than 30 years of age and the majority occur in high school athletes [4, 5]. In American football, these injuries speaked in the 1960s when new, harder helmets were introduced and spear tackling was still legal [6]. The majority of these injuries among football players occur during tackling and most cervical spine and spinal cord injuries involve an axial load on the neck with some degree of flexion or extension. Although the differential diagnosis of neck pain in athletes is broad, this review will focus on limb and life threatening cervical spine and spinal cord injuries.

On Field Management

One challenge in managing these potential injuries is rapidly identifying these athletes and applying the proper treatment. The sideline physician and athletic trainer should work together as a team to identify these potential injuries. A thorough neck and neurological exam should be performed. Any objective or subjective neurological deficits, altered mental status, or cervical spine tenderness should raise suspicion of an injury. Furthermore, any co-occurring injuries can be a painful distraction. If any injury of the cervical spine is suspected other than a stinger, a cervical collar should be immediately applied and the athlete should be placed in the supine position. In most cases, a rigid backboard is used (although the evidence favoring a backboard is lacking [7]) and the athlete should be transferred to the nearest trauma center. The sports medicine team on the field should accompany the athlete to the emergency department to assist in removal of the helmet if this is not done on the sideline.