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


Study design

Systematic review


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 development of a spinal cord injury (SCI).

Summary of background data

Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play controversial.


We conducted a systematic search of the literature using 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 decompression and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.


We identified 3655 unique citations, 16 of which met our inclusion criteria. Included studies were case-control studies or case series/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 neurological deficits. Three studies reported on patients who underwent an ACDF. Although some patients who 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 RTP had a “long” duration of symptoms (>24 hours; 36.36%) compared to those who were problem-free (11.11%; p=0.0311).


There is limited evidence regarding current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Due to small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following RTP after SCC.


  • Spinal cord concussion
  • Neurapraxia
  • Cervical stenosis
  • Surgical treatment
  • Return to play
  • systematic review

Acknowledgements: Dr. Fehlings is supported by the Gerry and Tootsie Halbert Chair in Neural Repair and Regeneration and the DeZwirek Family Foundation

Name and address for correspondence: Krembil Neuroscience Center, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Suite 4W-449, Toronto, ON M5T 2S8, Canada, Institutes of Medical Science, University of Toronto, University Health Network, Toronto, ON M5S 1A8, Canada, Tel: +1 416 603 5229, Fax: +1 416 603 6274,

Autor / Fonte:Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Aria Nouri, Michael G Fehlings Spine Journal: Official Journal of the North American Spine Society 2016 November 8