Cervical spine injuries in the pediatric and adolescent athlete

Injuries of the cervical spine in the pediatric and adolescent athlete are less common than other musculoskeletal injuries. Although many of these injuries are relatively minor, serious and potentially unstable or progressive spinal injury must be excluded. Important anatomic differences between the child younger than 10 years and older children and adolescents influence the types of injuries sustained and make assessment of the child's cervical spine sometimes difficult for practitioners accustomed to treating adolescent and adult athletes. Stable soft-tissue injuries of the cervical spine are the most common injuries that occur in all athletes. These injuries are responsive to symptomatic treatment and aggressive rehabilitation. Stingers are injuries of the brachial plexus and upper cervical roots that result from stretching or compressive forces associated with collision sports. Rapid return of sensory and motor dysfunction of a single upper extremity characterizes this entity; long-term disability is rare. Cervical cord neurapraxia (CCN) with transient quadriplegia is most commonly seen in football players. Most athletes fully recover. Cervical canal stenosis as defined by a Pavlov/Torg ratio of less than or equal to 0.8 is predictive of recurrent CCN. Young athletes sustain CCN secondary to hypermobility of the immature cervical spine. Return to play after these injuries is controversial. The athlete with Down syndrome and potential cervical hypermobility requires a careful cervical and neurologic evaluation prior to clearance for participation in sports.