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 requiri ng a management decision are numerous. This report presents appropriat e guidelines for return to collision activities in those with congenit al, developmental, or postinjury lesions. Data sources: Information wa s compiled from >1,200 cervical spine lesions documented by the Nation al Football Head and Neck Injury Registry and an extensive literature review. Data synthesis: Available data as well as a clinical understan ding of injury mechanisms have resulted in the development of reasonab le management guidelines. Each of the congenital, developmental, and p osttraumatic conditions presented are determined to present either no contraindication, relative contraindication, or an absolute contraindi cation to sport participation on the basis of a variety of parameters. Conditions included in the discussion are odontoid anomalies; spina b ifida occulta; atlanto-occipital fusion; Klippel-Feil anomalies; cervi cal canal stenosis; spear tackler's spine; traumatic conditions of the upper, middle, and lower cervical spine, including ligamentous injuri es and fractures; intervertebral disc injuries; and postcervical spine fusion. Conclusion: The proposed guidelines should be used in the dec ision-making process in conjunction with other such factors as the age , experience, ability of the individual, level of participation, and p osition played, as well as the attitude and desires of the athlete and his or her parents following an informed discussion of the problem wi th particular regard to potential risk.