Introduction Injuries to the cervical spine can occur in all sports and range from soft tissue injuries to quadriplegia spectrum of injuries include ligament sprains in cervical spine burners / stingers spear tackler's spine definition developmental narrowing (stenosis) of the cervical canal persistent straightening or reversal of the normal cervical lordotic curve concomitant posttraumatic roentgenographic abnormalities of the cervical spine documentation of having employed spear tackling techniques treatment contraindication to play in contact sports cervical fxs transient quadriplegia neuropraxia of the cervical cord bilateral upper and lower extremity pain, parasthesias, and weakness symptoms resolve within minutes to hours quadriplegia Epidemiology Demographics Injuries to the cervical spine are primarily seen in contact sports common among football and rugby players evolution of protective gear has decreased incidence Etiology Mechanism axial load (compression) with flexion of the spine most injuries in contact sports occur during tackling of another player "spear tackling" is the most common mechanism of neck injury in football can lead to gradual cervical stenosis and loss of cervical lordosis Associated conditions underlying conditions of the cervical spine can increase the severity of neck injuries and be contraindications to play. They include previous trauma to cervical spine (fractures, ligamentous injuries) cervical stenosis congenital odontoid hypoplasia os odontoideum Klippel-Feil anomalies Anatomy Cervical spine Presentation History evaluate mental status spinal injuries should be assumed in the athlete with loss of or altered consciousness Symptoms neck pain neurological symptoms such as numbness, tingling or weakness Physical exam (on-field evaluation) when cervical spine injury is suspected in the field stabilize the head and neck log roll to supine position remove facemask to protect airway as needed recent NATA guidelines allow remove of both helmet and shoulder pads if it can be done safely CPR as indicated log roll place on backboard transport to location to perform complete physical exam inspection look for deformities of cervical spine palpate spinous processes for step off or pain neurological exam muscle testing of all 4 extremities test sensation throughout extremities test reflexes Imaging Radiographs indications burner / stingers with recurring symptoms neurologic symptoms and transient quadriplegia recommended views cervical spine trauma series findings canal diameter of < 13mm (normal is ~17mm) Torg-Pavlo ratio (canal/vertebral body width) of < 0.8 (normal is 1.0) Torg ratio is technique dependent, not predictive, and not accurate in large athletes MRI indications bilateral neurologic symptoms findings look for spinal stenosis or loss of CSF around the spinal cord Treatment Nonoperative return to play criteria indications burners/stingers complete resolution of symptoms normal strength and range of motion transient quadriplegia with normal MRI findings congenital stenosis (Torg-Pavlov ratio <0.8) without instability (but patients should be counseled regarding the risks) NO return to play (contraindications to RTP) transient quadriplegia with severe stenosis spear tackler's spine cervical neuropraxia with ligamentous instability upper C spine abnormalities (C0 to C2) are absolute contraindications for RTP odontoid hypoplasia os odontoideum atlantooccipital fusion Torg 1 Klippel-Feil anomaly (long fusion mass) absolute contraindication to play Torg 2 Klippel-Feil (only 1 or 2 segments) with limited motion, secondary degenerative changes or instability Torg 2 Klippel-Feil below C3, asymptomatic, is a relative contraindication to RTP Operative treatment is the same as for other traumatic injuries to the spine