Return-to-Sport Recommendations for Athletes With Cervical Spine Trauma: A Modified Delphi Consensus Survey of Expert Opinion.

Background and objectives: Recommendations regarding return to sport (RTS) for athletes who have experienced cervical spine trauma are lacking, and management of these athletes remains challenging. The objective of this article was to perform a modified Delphi consensus survey of expert opinion on RTS in athletes who have suffered a traumatic injury to the cervical spine.

Methods: A cross-sectional, modified Delphi consensus survey examining RTS decisions in athletes with a history of a traumatic injury to the cervical spine was undertaken. A panel of international neurosurgery and orthopedic spine surgeons with expertise in sport was identified. Sport risk was classified through a 2 × 2 scheme based on impact forces and frequency: 1 = low impact/low frequency; 2 = low impact/high frequency; 3 = high impact/low frequency; and 4 = high impact/high frequency. Consensus was set a priori at ≥70%. Descriptive statistics were performed.

Results: Survey completion was 100% among the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons). The following scenarios achieved ≥70% consensus to recommend advising athletes to return to play high impact /high frequency forces sport: healed fractures of C1, C2; subaxial facet/laminar/body fractures; fibrous union of a prior laminar fracture; and cervical disk abutting cord without compression. Notable findings, including areas that did not reach consensus, are discussed.

Conclusion: Following a modified Delphi survey on RTS in athletes with spine pathology, the following scenarios reached consensus to RTS to high impact/high frequency forces sports: healed fractures of C1, C2; fractures of the subaxial facet/lamina/body; fibrous union of a prior laminar fracture; and cervical disk abutting the cord without compression. However, many scenarios of unhealed cervical spine fractures with fibrous union did not reach consensus.