Spine Surgeons at Rothman Orthopaedics Provide Updated Return-to-Play Recommendations for Collision Athletes after Cervical Spine Injury

A recent survey study led by Dr. Alex Vaccaro and Dr. Gregory Schroeder—spine surgeons at Rothman Orthopaedic Institute—provides updated guidelines for clinicians regarding return-to-play decisions for athletes in collision sports after an injury to the cervical spine. The study was performed using the Delphi survey methodology and involved attendees to the 2019 Cervical Spine Research Society (CSRS) meeting in New York City, ultimately including over 100 spine surgeons with the goal of establishing an updated consensus on return-to-play decisions.

“Professional team physicians have tried to institute guidelines for players to safely return to the field after neck injuries but there is a lack of high-quality studies, and most surveys on the topic are informal,” said Alexander R. Vaccaro, MD, PhD, MBA, President of Rothman Orthopaedic Institute, Richard H. Rothman Professor and Chairman of the Department of Orthopaedics, and Professor of Neurosurgery at Thomas Jefferson University and Hospitals. “Our study provides the consensus expert opinion of spine surgeons with experience treating neck injuries in collision athletes, especially American football. The topic is controversial, and randomized trials are impractical. Our results deliver updated recommendations from over 100 surgeons, and also highlights persistent areas of controversy.”

The survey involved three rounds of questions with participation of NFL team physicians. The study, published as
“Updated Return-to-Play Recommendations for Collision Athletes after Cervical Spine Injury: A Modified Delphi Consensus Study with the Cervical Spine Research Society" in Neurosurgery, the official journal of the Congress of Neurological Surgeons, found strong consensus regarding the ability of athletes without symptoms to return-to-play, as long as their cervical spinal canal did not have evidence of abnormal narrowing and an MRI showed no signal changes. In addition, athletes with adequate healing after certain neck fractures can return to play if there is no neck instability. Return-to-play for athletes who do not have symptoms and do not have MRI spinal cord changes after a one-level anterior neck fusion procedure are also allowed to return to play. The study was published online ahead of print on Tuesday, July 28th, 2020  and can be accessed using the following link: doi.org/10.1093/neuros/nyaa308. It will subsequently appear in the October issue of Neurosurgery, Volume 87, Issue 4.

“It is a strong step in the right direction. Additional formal studies that evaluate the most effective treatment plan for these injuries, and optimal timing for return-to-play are still necessary, said Gregory D. Schroeder, M.D. “I believe the value of our study comes not only from the update of guidelines, but also from the thorough and formal survey methodology used to reach consensus on a complex topic.”

Although cervical spine injuries are rare in sports, long-term and life-altering consequences demand a thorough clinical evaluation and effective management. While previous studies have provided limited guidelines for athletes to return to the field, this study applies a more formal approach to establish consensus on how to manage football athletes with traumatic neck injuries.