Return to play after cervical spine injury

Study Design. A questionnaire survey was mailed to members of the Cervical Spine Research Society, the Herodiuus Sports Medicine Society, and to membe rs of the authors' Department of Orthopaedics. Objectives. The purpose of our study was to evaluate what influence, if any , factors such as published guidelines, type of sport of the patient, numbe r of years in practice, subspecialty interest, and sports participation of the respondent held in the "return to play" decision-making process after a cervical spine injury. Summary of Background Data. The consequences of cervical spine injury are p otentially catastrophic, and return to play decisions in athletes with a hi story of neck injury can be agonizing. Although recent publications have ad dressed some of the concerns regarding cervical spine injuries in the athle tic population, many questions remain unanswered. Factors such as published guidelines, type of sport of the patient, number of years in practice, sub specialty interest, and sports participation of the respondent have all bee n suggested as having a possible role in return to play decisions. Methods. Representative radiographs and case histories of 10 athletes who h ad sustained neck injury were mailed to 346 physicians. For each case physi cians selected every type of play (of six categories) that they felt comfor table recommending. Type of play was divided into six categories: Type 1, c ollision sports; Type 2, contact sports; Type 3, noncontact, high velocity sports; Type 4, noncontact, repetitive load sports (e.g., running); Type 5, noncontact, low impact sports; Type 6, no sports. In addition, demographic data regarding board certification, subspecialty interest, number of years in practice, use of guidelines in return to play decisions, and personal p articipation in sports were queried from all respondents. Statistical analy sis was completed with Statview (Berkeley, CA). Basic descriptive statistic s, chi (2), and ANOVA were used where appropriate. Results. Three hundred forty-six questionnaires were mailed and 113 were re turned (response rate 32.7%). One hundred ten (97%) of the respondents who completed the questionnaire were board certified. Seventy-five were subspec ialists in spine, 22 were subspecialists in sports-medicine, and 13 reporte d interests in both sports medicine and spine. Use of Published Guidelines. Although 49% of respondents: reported using gu idelines in decision-making, the use of guidelines was statistically signif icant in only one case (P = 0.04). Hierarchy of Risk. In general, those physicians:who participated in the stu dy followed the hierarchy of risk that we established in this study (Type 1 [collision sports; highest level of risk] through Type 6 [no sports; lowes t level of risk]). Twelve (10.6%) respondents, however, deviated from it in one or more cases. Years in Practice. In three cases there was a statistically significant ass ociation between the number of years a physician was in practice and the ty pe of play selected (P < 0.05). In each case a lower-level of play tended t o be recommended by more senior physicians. Subspecialty Interest. In three Cases those respondents with a spine subspe cialty interest recommended returned to a higher level of play (P < 0.05). Conclusions. There is no consensus on the postinjury management of many cer vical spine-injured patients. Further research, education, and discussion o n this topic are needed.