Management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine.

OBJECTIVE: Conditions involving the cervical spine in athletes requiring a management decision are numerous. This report presents appropriate guidelines for return to collision activities in those with congenital, developmental, or postinjury lesions.

DATA SOURCES: Information was compiled from > 1,200 cervical spine lesions documented by the National Football Head and Neck Injury Registry and an extensive literature review.

DATA SYNTHESIS: Available data as well as a clinical understanding of injury mechanisms have resulted in the development of reasonable management guidelines. Each of the congenital, developmental, and posttraumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindication to sport participation on the basis of a variety of parameters. Conditions included in the discussion are odontoid anomalies; spina bifida occulta; atlanto-occipital fusion; Klippel-Feil anomalies; cervical canal stenosis; spear tackler's spine; traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuries and fractures; intervertebral disc injuries; and postcervical spine fusion.

CONCLUSION: The proposed guidelines should be used in the decision-making process in conjunction with other such factors as the age, experience, ability of the individual, level of participation, and position played, as well as the attitude and desires of the athlete and his or her parents following an informed discussion of the problem with particular regard to potential risk.