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 login to view 7 more bullets cervical fxs transient quadriplegia login to view 3 more bullets 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" login to view 2 more bullets 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 login to view 1 more bullet 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) login to view 1 more bullet 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 login to view 5 more bullets NO return to play (contraindications to RTP) transient quadriplegia with severe stenosis login to view 9 more bullets asymptomatic athletes with no T2-signal change following a 3-level ACDF login to view 2 more bullets Operative treatment is the same as for other traumatic injuries to the spine