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.

中文翻译：

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颈椎损伤后碰撞运动员重新上场建议的更新：与颈椎研究协会的改良德尔福共识研究

背景 先前的研究试图为碰撞运动运动员在颈椎损伤后建立重返赛场 (RTP) 指南。然而，由于缺乏高质量的证据和基本的共识调查方法，建议受到了限制。目的 制定有关颈椎损伤后碰撞运动运动员管理的相关临床声明，并建立共识 RTP 建议。方法遵循改良的德尔福方法，与颈椎研究协会的脊柱外科医生和美国国家橄榄球联盟的队医进行了 3 轮调查研究，以建立共识指南并制定碰撞运动运动员颈椎损伤管理的建议。结果 我们的研究显示强烈共识，无症状的运动员在 1/2 节段颈椎前路椎间盘切除融合术 (ACDF) 后没有增强的磁共振成像 (MRI) T2 信号变化可能是 RTP，但在 3 节节 ACDF 后不会 (84.4%) . 尽管在各种情况下注意到 1-/2-level ACDF 后允许 RTP，但该决定是有争议的。没有注意到 2 级 ACDF 后碰撞运动员的共识 RTP。无症状运动员的 RTP 达成了强烈的共识，没有增加信号变化和椎管直径 >10 毫米（90.5%），以及那些 MRI 信号改变和直径 >13 毫米（81.3%）。对于 ACDF 后假关节的病例，RTP 尚未达成共识。强烈共识支持有颈椎损伤史的运动员（78.9%）在参加运动前进行筛查 MRI。结论 本研究提供了来自脊柱外科、运动损伤和颈椎创伤领域的领先专家的关于碰撞运动运动员颈椎损伤管理的修正德尔福过程共识声明。未来的研究应旨在阐明 RTP 的最佳时间表，并关注伤害预防。