Evaluation, Management, and Return-To-Sport Guidelines for Cervical Spine Injuries in Athletes: A Narrative Review

Study DesignNarrative review.ObjectivesTo synthesize current evidence on the epidemiology, pathophysiology, classification, evaluation, and imaging of cervical spine injuries (CSI) in athletes and propose a practical framework for return-to-sport (RTS) decision-making.MethodsA review of the most recent and relevant published studies and consensus statements was performed, focusing on athletic cervical spine pathology. Key domains included on-field assessment, imaging modalities, clinical clearance criteria, and sport-specific risk considerations. All literature published in reputable journals, preferably available through well-regarded databases such as Scopus and PubMed, was eligible for inclusion, with preference given to the most recent publications related to any given topic.ResultsThe reviewed literature supports that RTS across CSI types requires resolution of symptoms, normal neurologic examination, restoration of painless cervical range of motion and strength, and radiographic evidence of healing or stability. MRI is consistently recommended for identifying high-risk features such as canal stenosis, cord signal change, or ligamentous disruption. Sport-specific risk stratification is supported by data showing higher reinjury rates in collision sports. Evidence remains heterogeneous, with substantial variation in specialist recommendations.ConclusionsSafe RTS after CSI requires comprehensive clinical and imaging assessment, recognition of sport-specific risks, and shared decision-making to prioritize athlete safety while avoiding unnecessary restrictions.