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Gronfula AG, Alhaddad A, Alsharif TH, Alamri RF, Alhassan Y, Alghdali L, Kalantn AA, Abduljabbar F. The Epidemiology of Sport-Related Spinal Cord Injuries in the Gulf Region: A Systematic Review. Cureus 2024; 16:e62141. [PMID: 38993451 PMCID: PMC11238525 DOI: 10.7759/cureus.62141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Traumatic spinal cord injuries (TSCIs) can lead to life-threatening consequences and neurological deficits. Sports activities significantly contribute to the incidence of these injuries. It is important to understand the epidemiology of sport-related spinal cord injuries (SCIs) in the Gulf region to improve patient care and increase awareness among this population. While studies from Saudi Arabia and Qatar have addressed SCIs related to both cycling and diving, we believe there is still significant scope for improvement in research on this topic. Special attention should be given to conducting retrospective studies across Gulf countries to establish a well-organized database.
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Affiliation(s)
| | - Ali Alhaddad
- Orthopedic Surgery, East Jeddah General Hospital, Jeddah, SAU
| | | | - Raef F Alamri
- Orthopedics and Traumatology, Al-Noor Hospital, Makkah, SAU
| | - Yaser Alhassan
- Orthopedics, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | | | - Fahad Abduljabbar
- Orthopedic Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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2
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Hung NJ, McClellan RT, Hsu W, Hu SS, Clark AJ, Theologis AA. Timelines for Return to Different Sports Types After Eight Cervical Spine Fractures in Recreational and Elite Athletes: A Survey of the Association for Collaborative Spine Research. Clin Spine Surg 2024:01933606-990000000-00282. [PMID: 38531829 DOI: 10.1097/bsd.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Prospective cross-sectional survey. OBJECTIVE To identify timelines for when athletes may be considered safe to return to varying athletic activities after sustaining cervical spine fractures. BACKGROUND While acute management and detection of cervical spine fractures have been areas of comprehensive investigation, insight into timelines for when athletes may return to different athletic activities after sustaining such fractures is limited. METHODS A web-based survey was administered to members of the Association for Collaborative Spine Research that consisted of surgeon demographic information and questions asking when athletes (recreational vs elite) with one of 8 cervical fractures would be allowed to return to play noncontact, contact, and collision sports treated nonoperatively or operatively. The third part queried whether the decision to return to sports was influenced by the type of fixation or the presence of radiculopathy. RESULTS Thirty-three responses were included for analysis. For all 8 cervical spine fractures treated nonoperatively and operatively, significantly longer times to return to sports for athletes playing contact or collision sports compared with recreational and elite athletes playing noncontact sports, respectively (P< 0.05), were felt to be more appropriate. Comparing collision sports with contact sports for recreational and elite athletes, similar times for return to sports for nearly all fractures treated nonoperatively or operatively were noted. In the setting of associated radiculopathy, the most common responses for safe return to play were "when only motor deficits resolve completely" and "when both motor and sensory deficits resolve completely." CONCLUSIONS In this survey of spine surgeons from the Association for Collaborative Spine Research, reasonable timeframes for return to play for athletes with 8 different cervical spine fractures treated nonoperatively or operatively varied based on fracture subtype and level of sporting physicality.
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Affiliation(s)
- Nicole J Hung
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles
| | - Robert Trigg McClellan
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA
| | - Wellington Hsu
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Serena S Hu
- Department of Orthopaedic Surgery, Stanford University, Stanford
| | - Aaron J Clark
- Department of Neurological Surgery, UCSF, San Francisco, CA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), San Francisco, CA
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Obana KK, Mueller JD, Zhong JR, Saltzman BM, Lynch TS, Parisien RL, Ahmad CS, Trofa DP. Targeting rule implementation decreases neck injuries in high school football: a national injury surveillance study. PHYSICIAN SPORTSMED 2022; 50:338-342. [PMID: 34058954 DOI: 10.1080/00913847.2021.1932630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Neck injuries in football are attributed to helmet-to-helmet contact with youth players being at greatest risk. In 2014, the National Federation of State High School Associations (NFHS) implemented rules defining illegal contact against a defenseless player above the shoulders to reduce head and neck injuries in football players. This study evaluates whether rule implementation decreased rates of high school football neck injuries presenting to the emergency department (ED) pre-rule implementation (2009-2013) to post-rule implementation (2015-2019). METHODS Data were queried from the National Electronic Injury Surveillance System for high school football players 14 to 18 years old diagnosed with a neck injury from 1 January 2009 to 31 December 2019. Narratives in the data were reviewed for mechanism of injury, setting, loss of consciousness (LOC), and type of injury. RESULTS Between 2009 and 2019, an estimated 47,577 high school football neck injuries were diagnosed in EDs across the United States. 52.0% of neck injuries were sustained during competition compared to 48.0% during practice. A statistically significant (P = 0.004) decrease in neck injuries was realized from pre-rule implementation to post-rule implementation with averages of 5,278 and 3,481 injuries per year, respectively. Helmet-to-helmet neck injuries significantly (P = 0.04) decreased from pre- to post-rule implementation with averages of 851 and 508 injuries per year, respectively. Neck injuries sustained via other mechanisms were not affected by the 2014 rule implementation. CONCLUSION This study is the first to identify a decrease in overall and helmet-to-helmet related neck injuries diagnosed in the ED following the 2014 NFHS targeting rule implementation. These findings add to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related neck injuries.
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Affiliation(s)
- Kyle K Obana
- Department of Orthopaedic Surgery, John A. Burns School of Medicine, Honolulu, HI, USA.,Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - John D Mueller
- Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Jack R Zhong
- Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | | | - T Sean Lynch
- Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Christopher S Ahmad
- Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - David P Trofa
- Department of Orthopaedic Surgery, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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Patel PD, Divi SN, Canseco JA, Donnally CJ, Galetta M, Vaccaro A, Schroeder GD, Hsu WK, Hecht AC, Dossett AB, Dhanota AS, Prasad SK, Vaccaro AR. Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes. Clin Spine Surg 2022; 35:241-248. [PMID: 34379610 DOI: 10.1097/bsd.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.
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Affiliation(s)
- Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Matthew Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Wellington K Hsu
- Department of Orthopaedic Srugery, Northwestern University, Chicago, IL
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew B Dossett
- Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, TX
| | - Arsh S Dhanota
- Department of Sports Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Srivinas K Prasad
- Department of Neurosurgery, Thomas Jefferson University, Phiadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
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Canseco JA, Franks RR, Karamian BA, Divi SN, Reyes AA, Mao JZ, Al Saiegh F, Donnally CJ, Schroeder GD, Harrop JS, Pepe MD, Vaccaro AR. Overview of Traumatic Brain Injury in American Football Athletes. Clin J Sport Med 2022; 32:236-247. [PMID: 33797476 DOI: 10.1097/jsm.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. DATA SOURCES A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. RESULTS The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. CONCLUSION Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Robert Franks
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Rothman Sports Concussion Institute, Rothman Institute, Philadelphia, Pennsylvania; and
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chester J Donnally
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew D Pepe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
Elite athletes are often faced with difficult decisions when faced with a cervical spinal disorder. There are many aspects to consider such as the risk of further injury, short- and long-term effects on an athlete's life both during and after his/her career, and the options for treatment. Although there have been some recent contributions to this topic, the evidence-based literature is generally devoid of high-level clinical studies to help guide the decision-making process. This article reviews the pertinent available data/criteria and offer an algorithm for return-to-play considerations.
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Return to Play Guidelines After Cervical Spine Injuries in American Football Athletes: A Literature-Based Review. Spine (Phila Pa 1976) 2021; 46:886-892. [PMID: 34100841 DOI: 10.1097/brs.0000000000003931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature-based review. OBJECTIVE We sought to evaluate clinical and case studies related to return to play (RTP) after cervical spine injuries in elite American football athletes and to formulate guidelines to help health care practitioners manage these conditions. SUMMARY OF BACKGROUND DATA American football athletes are at unique risk of cervical spine injury and appropriate case-by-case management of cervical spine injuries is necessary for these athletes. Despite this need, no standardized guidelines exist for RTP after cervical spine injury. METHODS Observational or case-based articles relating to RTP after cervical spine injury in American football athletes were curated from PubMed/EMBASE databases. Primary literature published before December 1, 2019 involving National Football League (NFL) or National Collegiate Athletic Association (NCAA) athletes met inclusion criteria. RESULTS The data acquisition process yielded 28 studies addressing cervical spine injuries and RTP in American football athletes. Stingers/burners were the most common injury and placed athletes at higher risk of a more severe re-injury. Transient quadriplegia, cervical stenosis, cervical disc herniation (CDH), and cervical fractures have a more significant impact on the long-term health and career longevity of the American football athlete. As such, the literature offers some guidance for management of these athletes, including average time for RTP in patients treated nonoperatively, thresholds involving cervical stenosis, and postoperative recommendations after spinal decompression and/or fusion surgery. CONCLUSION Elite American football athletes are at high risk for cervical spine injury due to the nature of their sport. The decision to allow these athletes to return to play should involve an understanding of the average RTP time, the potential risks of recurrence or re-injury, and individual characteristics such as position played and pathology on imaging.Level of Evidence: 3.
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Bowles DR, Canseco JA, Alexander TD, Schroeder GD, Hecht AC, Vaccaro AR. The Prevalence and Management of Stingers in College and Professional Collision Athletes. Curr Rev Musculoskelet Med 2020; 13:651-662. [PMID: 32691363 PMCID: PMC7661678 DOI: 10.1007/s12178-020-09665-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Particularly common in collision sports such as American football or rugby, stingers are a traumatic transient neuropraxia of a cervical nerve root(s) or brachial plexus that may last anywhere from minutes to hours. This review summarizes the knowledge on the diagnosis and management of stingers in college and professional collision athletes by providing an overview of their epidemiology and pathophysiology, followed by a discussion on current treatment guidelines and return-to-play recommendations. RECENT FINDINGS Despite modifications to tackling technique, increasing awareness, and various equipment options, American football continues to have a high rate of cervical spine injuries, the majority of which occur in preseason and regular season competition settings. The incidence of stingers has slowly increased among collision athletes, and nearly half of all players report sustaining at least one stinger in their career. Recent studies have shown certain anatomical changes in the cervical spine are related to acute and reoccurring stingers. Most players who experience stingers do not miss practices or games. Despite their prevalence, literature highlighting the impact of stingers on college and professional collision athletes is limited. Advances in imaging modalities and novel radiographic parameters have provided tools for screening athletes and can guide return-to-play decisions. Future research regarding appropriate screening practices for athletes with reoccurring stingers, use of protective equipment, and rehabilitation strategies are needed to identify predisposing factors, mitigate the risk of injury, and restore full functional strength and ability.
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Affiliation(s)
- Daniel R Bowles
- Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Jose A Canseco
- Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Tyler D Alexander
- Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA
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9
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Schroeder GD, Canseco JA, Patel PD, Hilibrand AS, Kepler CK, Mirkovic SM, Watkins RG, Dossett A, Hecht AC, Vaccaro AR. Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society. Neurosurgery 2020; 87:647-654. [DOI: 10.1093/neuros/nyaa308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/31/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies.
OBJECTIVE
To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations.
METHODS
Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes.
RESULTS
Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter >10 mm (90.5%), as well as those with resolved MRI signal changes and diameter >13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of cervical spine injury (78.9%).
CONCLUSION
This study provides modified Delphi process consensus statements regarding cervical spine injury management in collision sport athletes from leading experts in spine surgery, sports injuries, and cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.
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Affiliation(s)
- Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Parthik D Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Christopher K Kepler
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srdjan M Mirkovic
- Northwestern Orthopaedic Institute, NorthShore University HealthSystem, Chicago, Illinois
| | | | - Andrew Dossett
- The Carrell Clinic Orthopedic and Sports Medicine, Dallas, Texas
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Neck and Cervical Spine Injuries in National College Athletic Association Athletes: A 5-Year Epidemiologic Study. Spine (Phila Pa 1976) 2020; 45:55-64. [PMID: 31464974 DOI: 10.1097/brs.0000000000003220] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Descriptive epidemiology study. OBJECTIVE The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period. SUMMARY OF BACKGROUND DATA The incidence and etiology of neck and cervical spine injuries in National Collegiate Athletic Association (NCAA) athletes has not been well defined in recent years. METHODS The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. RESULTS Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs. CONCLUSION The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation. LEVEL OF EVIDENCE 4.
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Lee KM, Kay MC, Kucera KL, Prentice WE, Kerr ZY. Epidemiology of Cervical Muscle Strains in Collegiate and High School Football Athletes, 2011-2012 Through 2013-2014 Academic Years. J Athl Train 2019; 54:780-786. [PMID: 31335177 DOI: 10.4085/1062-6050-229-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cervical muscle strains are an often-overlooked injury, with neck- and spine-related research typically focusing on spinal cord and vertebral injuries. OBJECTIVE To examine the rates and distributions of cervical muscle strains in collegiate and high school football athletes. DESIGN Descriptive epidemiology study. SETTING Collegiate and high school football teams. PATIENTS OR OTHER PARTICIPANTS The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) collected data from collegiate football athletes. The High School National Athletic Treatment, Injury and Outcomes Network (HS NATION) and High School Reporting Information Online (HS RIO) collected data from high school football athletes. Data from the 2011-2012 through 2013-2014 academic years were used. MAIN OUTCOME MEASURE(S) Athletic trainers collected injury and exposure data for football players. Injury counts, injury rates per 10 000 athlete-exposures (AEs), and injury rate ratios with 95% confidence intervals (CIs) were calculated. RESULTS The NCAA-ISP reported 49 cervical muscle strains (rate = 0.96/10 000 AEs), of which 28 (57.1%) were TL (time loss; rate = 0.55/10 000 AEs). High School NATION reported 184 cervical muscle strains (rate = 1.66/10 000 AEs), of which 33 (17.9%) were TL injuries (rate = 0.30/10 000 AEs). The HS RIO, which collects only TL injuries, reported 120 TL cervical muscle strains (rate = 0.51/10 000 AEs). The overall injury rate was lower in the NCAA-ISP than in HS NATION (injury rate ratio = 0.58; 95% CI = 0.42, 0.79); when restricted to TL injuries, the overall injury rate was higher in the NCAA-ISP (injury rate ratio = 1.83; 95% CI = 1.11, 3.03). No differences were found when comparing TL injuries in HS RIO and the NCAA-ISP. Cervical muscle-strain rates were higher during competitions than during practices across all 3 surveillance systems for all injuries. Most cervical muscle strains were due to player contact (NCAA-ISP = 85.7%, HS NATION = 78.8%, HS RIO = 85.8%). CONCLUSIONS The incidence of cervical muscle strains in football players was low compared with other injuries. Nonetheless, identifying and implementing interventions, particularly those aimed at reducing unsafe player contact, are essential to further decrease the risk of injury and associated adverse outcomes.
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Affiliation(s)
- Katherine M Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Kristen L Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - William E Prentice
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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12
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Bigdon SF, Gewiess J, Hoppe S, Exadaktylos AK, Benneker LM, Fairhurst PG, Albers CE. Spinal injury in alpine winter sports: a review. Scand J Trauma Resusc Emerg Med 2019; 27:69. [PMID: 31324221 PMCID: PMC6642543 DOI: 10.1186/s13049-019-0645-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/05/2019] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports. MATERIAL AND METHODS The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors. RESULTS There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population. DISCUSSION Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.
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Affiliation(s)
- Sebastian Frederick Bigdon
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Jan Gewiess
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Sven Hoppe
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Lorin M. Benneker
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Paul Gilbert Fairhurst
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Christoph E. Albers
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
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Abstract
STUDY DESIGN Descriptive epidemiology study. OBJECTIVE The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players. SUMMARY OF BACKGROUND DATA The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years. METHODS The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. RESULTS An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52-0.90) and 0.39 (95% CI 0.16-0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days. CONCLUSION Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value. LEVEL OF EVIDENCE 4.
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DePasse JM, Durand W, Palumbo MA, Daniels AH. Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities. World Neurosurg 2018; 122:e540-e545. [PMID: 30889777 DOI: 10.1016/j.wneu.2018.10.097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although several investigations have examined the epidemiology of cervical spine injuries in sports, few studies have analyzed the nationwide incidence and sex-specific epidemiology of cervical spine injuries. METHOD The National Electronic Injury Surveillance System database, which collects information on patients presenting to the emergency department at 100 hospitals across the United States, was queried for neck sprains and cervical fractures associated with sporting activities from 2000-2015. RESULT A total of 26,380 neck sprains and 1166 fractures were identified. Compared with females, the incidence for injuries in males was 1.7 times greater for neck sprains and 3.6 times greater for fractures (P < 0.0001). Football was the most common cause of cervical sprains in males, followed by cycling and weightlifting/aerobics. Females sustained most neck sprains in weightlifting/aerobics, trampoline, and cheerleading. From 2000 to 2015, the incidence of neck sprains from aerobics increased from 15.5 to 25.3 per million person-years (P < 0.0001). Similarly, the incidence of cervical fractures from cycling increased from 0.67 to 2.7 per million (P < 0.0001). For males, cycling was the most common cause of fracture, followed by diving/swimming and football. For females, horseback riding was most common, followed by cycling and diving/swimming. CONCLUSIONS Football is the leading cause of cervical sprains in the United States. The most common cause of cervical fracture in men is cycling, while in women it is horseback riding. The incidence of sport-related cervical fractures has increased by 35% from 2000 to 2015, which has been driven by an increase in cycling-related injuries.
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Affiliation(s)
- J Mason DePasse
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Wesley Durand
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mark A Palumbo
- Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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