A 27-year-old male professional player presented with a 4-month history of neck pain and stiffness. He could not recall a clear precipitant for these symptoms. On examination he was found to have a global, mild restriction in all cervical movements. He had no focal neurological signs and no other clear abnormalities.
X-ray images show a congenital fusion and dysplasia of the C2 to C4 vertebral bodies and posterior elements. This is further demonstrated on the MRI sequences. There is no significant canal stenosis associated with this. There was some modest foraminal narrowing (not shown here) at C4-5 and C5-6.
At the time of diagnosis this player had been competing at a professional level for more than seven years. The potential significance of his x-ray findings and neck anatomy was discussed with him. After obtaining opinions from his club doctor, a spinal surgeon and a neurologist this player elected to retire as he was concerned about the possibility of sustaining a more significant spinal injury. His neck pain was well managed with a short period of rest and physiotherapy. He is now employed in a coaching role at the same club.
Making decisions about fitness to play are challenging. They generally require a good understanding of the available literature, opinions from various medical experts and careful counselling. There are a number of clinical guidelines that have been published to help guide return to play decisions after cervical spine injury. These are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. As a general rule there is consensus that players should be pain free, have no focal neurology and have a normal range of motion before returning to play. Based on these criteria this player would have been able to return to football. Most clinical guidelines advise caution about returning players to contact sport following the diagnosis of, or surgery to create, a cervical fusion. The guidelines largely permit a return to play after a single level fusion. A two-level fusion is considered to be a relative contraindication for a return to contact sport while a three-level fusion (as seen in this case) is considered by some to be an absolute contraindication. It was based on these recommendations that this player decided to retire.
To learn more about contraindications to playing contact sport review or complete the ‘spine’ module in the FIFA Diploma in Football Medicine.
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