Cervical spine trauma evaluation

Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes

“…Initial management of cervical trauma in contact athletes should focus on a systematic clinical evaluation. Primary assessment begins with evaluation of the patient’s airway, respiration, and circulation as outlined by the Advanced Trauma Life Support algorithm (ATLS) 5. In patients with suspected cervical spine injury, a thorough clinical examination is performed, including: visual examination of the spine, posterior cervical palpation identifying pain/tenderness or step-offs, and a comprehensive neurological examination of bilateral upper/lower extremities.…”

“…Initial points of consideration in the setting of ACT should include changes in an athlete's level of consciousness, cervical spine tenderness, severe neck stiffness, transient loss of motor function, parasthesias, and complete loss of motor and or sensory function. 2,5 Patients may report numbness or weakness of the upper or lower extremities, as well as associated episodes of transient parasthesias or quadriparesis. 2,16 Commonly, professional collision athletes may experience burners/stingers (a unilateral constellation of symptoms because of irritation of either the brachial plexus or peripheral nerve root) or cord neuropraxia (injury to the spinal cord with symptoms in a bilateral distribution with variable severity).…”

“…ACT may result in rapid neurological deterioration; hence quick recognition by the sideline medical staff is essential. 5,18,20 In patients with a suspicion for ACT, the cervical spine should be placed in a neutral position and immobilized in a rigid cervical collar to prevent any possibility of further injury to the spinal cord. 20 Contraindications for mobilizing the spine into a neutral position include: increased pain, worsening neurological symptoms, worsening muscle spasms, airway compromise, inability to physically reposition the spine, and patient-expressed trepidation.…”

“…Patients with apparent ACT injury should be assumed to have a SCI until it is confirmed otherwise. Initial points of consideration in the setting of ACT should include changes in an athlete’s level of consciousness, cervical spine tenderness, severe neck stiffness, transient loss of motor function, parasthesias, and complete loss of motor and or sensory function 2,5. Patients may report numbness or weakness of the upper or lower extremities, as well as associated episodes of transient parasthesias or quadriparesis 2,16.…”

“…To reduce or avoid irreversible injury, prompt and appropriate medical care is essential. This includes rehearsing emergency action plans and role identification before an episode 5. The purpose of this review is to provide an overview of the epidemiology, pathophysiology, clinical presentation, immediate, and long-term management, with particular attention to return-to-play (RTP) recommendations of ACT and cervical spinal cord injury (SCI) in collision sport athletes with a special focus on professional American football athletes.…”