Return to play in athletes with spinal cord concussion: a systematic literature review

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• 作者：Narihito Nagoshi ; MD ; PhD^a ; ^b ; Lindsay Tetreault ; PhD^a ; Hiroaki Nakashima ; MD^a ; ^c ; Aria Nouri ; MD ; MSc^a ; Michael G. Fehlings ; MD ; PhD ; FRCS ; FACS^a ; ^d ; ^{Michael.Fehlings@uhn.ca}
• 关键词：Cervical stenosis ; Neurapraxia ; Return to play ; Spinal cord concussion ; Surgical treatment ; Systematic review
• 刊名：The Spine Journal
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：17
• 期：2
• 页码：291-302
• 全文大小：739 K
• 卷排序：17

文摘

This is a systematic review.PurposeThe study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).Background ContextAlthough SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial.MethodsWe conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.ResultsWe identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a “long” duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311).ConclusionsThere is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.