C- Spine Related Contraindications for Participation in Contact Sports

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Condition Contraindications
CONGENITAL CONGENITAL
1. odontoid abnormalities (serious injury may result from atlanto- axial instability)
  • Complete aplasia (rare)
absolute
  • hypoplasia (conjunction with achondroplasia and spondyloepiphyseal dysplasia)
absolute
  • os odontoideum (traumatic origin probably)
absolute
2. atlanto- occipital fusion (partial or complete fusion of atlas to occiput): sudden onset of symptoms & sudden death have been reported absolute
3. Klippel- Feil Anomaly (congenital fusion of 2 or more cervical vertebrae)
  • Type I: mass fusion of C- spine to upper T- Spine
absolute
  • Type II: fusion of only 1 or 2 interspaces

1. Assocaited with limited ROM, occipitocervical anomalies, instability, disc disease or degenerative changes

absolute

2. Associated with full ROM and none of the above

none
ACQUIRED ACQUIRED
1. Cervical spine steonosis
  • assymptomatic
  • with one episode of cord neuropraxia
  • cord neuropraxia + MRI evidence of cord defect or edema
  • cord neuropraxia + ligamentous instability, symptoms or neurologic findings > 36 hours or multiple episodes.
  • none
  • relative
  • absolute
  • absolute
2. Spear Tackler's Spine absolute
3. spina bifida occulta: rare, incidental x-ray finding none
POST- TRAUMATIC UPPER CERVICAL SPINE POST- TRAUMATIC UPPER CERVICAL SPINE
1. Atlantoaxial instability (ADI > 3mm adults, >4 mm peds) absoluate
2. atlantoaxial rotatory fixation (may be associated with disruption of transverse ligament) absolute

3. fractures

  • healed, pain free, full ROM and no neurologic findings with any of the folowing fractures: nondisplaced Jefferson fracture; odontoid fracture; or lateral mass fracture of axis
  • all others
  • None
  • Absolute
4. post- surgical atlantoaxial fusion absolute
POST- TRAUMATIC SUBAXIAL CERVICAL SPINE POST- TRAUMATIC SUBAXIAL CERVICLA SPINE
1. ligamentous injuries: >3.5 mm subluxation or > 11 degrees angulation on flexion-extension views. absolute

2. fractures

  • healed, stable fractures listed here with normal exam: VB compression fracture without posterior involvement; spinous process fractures.
  • VB fractures with sagittal component or posterior bony or ligamentous involvement.
  • comminuted fracture with displacement into spinal canal.
  • lateral mass fracture producing facet incongruity.
  • none
  • absolute
  • absolute
  • absolute
3. Intervertebral Disc Injury
  • healed herniated disc treated conservatively
  • s/p ACDF with solid fusion, no symptoms, normal exam and full pain-free ROM
  • chronic herniated disc with pain, neuro findings or decreased ROM, or acute herniated disc.
  • none
  • none
  • absolute
4. s/p Fusion
  • stable one- level fusion
  • stable two- level fusion
  • fusion > 2 levels
  • none
  • relative
  • absolute

1. Torg JS, Ramsey- Emrhein JA: Management guidelines for participation in collison activities with congenital, developmental, or post- injury lesions involving the cervical spine. Clin Sports Med 16: 501-31. 1997.

-edaks

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