Cervical spine injuries can occur during non-laborious activities and high-energy trauma, so it is understandable that neck injuries can and often do occur during sports activities. Neck muscle strains, ligament sprains and disc injuries are reasonably common. However, there are two types of neck injuries that occur most frequently during sports: stingers, or burner and transient quadriplegia (TQ), or cervical cord neurapraxia. These injuries can affect athletes participating in almost any sport, but occur most often in football, wrestling and other contact sports. Stingers are the most common. Transient quadriplegia is much less common, but more dangerous.
How are they diagnosed?
Stingers and transient quadriplegia are often “diagnoses of exclusion,” meaning that other causes should be evaluated for and ruled out before these diagnoses are made. Frequently, patients will have a severe neck strain or herniated disc that will mimic some of the symptoms of a stinger or TQ. It is important for the clinician to conduct a thorough history and clinical examination prior to formulating a diagnosis so as not to misdiagnose this condition. Imaging studies such as X-rays and MRI are often essential to clarify and confirm the diagnosis.
What are the treatment options?
The treatment of stingers and transient quadriplegia is focused on regaining and improving the strength of the affected extremity(s), as well as the neck and core muscles. An athlete should generally not return to sport until the strength has returned to an adequate, pre-injury level. Patients who are noted to have spinal stenosis should be carefully evaluated by a spine specialist. Return to play criteria should be individualized. At times, surgical decompression may facilitate resolution of the stenosis, improve symptoms and prevent recurrence. General return-to-play guidelines are listed below.
* Please note – these are only guidelines; each individual athlete must be carefully evaluated by a qualified physician after an injury is sustained, and the decision to allow an athlete to return or not return to sport must be individualized and is ultimately made by the treating and/or team physician.
- Single-level Klippel-Feil deformity/congenital fusion below C2
- Spina bifida occulta
- Resolved stinger or brachial plexus neurapraxia (2 or less)
- Healed herniated disc
- Healed subaxial cervical spine fracture (C3-C7)
- Healed facet fracture
- Healed lamina fracture
- Healed spinous process fracture (clay shoveler’s fracture)
- Healed one-level anterior cervical fusion
- Healed single or multiple level posterior cervical foraminotomy
- Resolved transient quadriplegia (one episode)
- Resolved stinger or brachial plexus neurapraxia (three or more)
- Non-healed/non-resolved asymptomatic herniated disc or severe foraminal stenosis
- Healed C1 fracture
- Healed C2 or Odontoid fracture
- Any healed subaxial spine fracture with minimal or mild residual displacement, deformity or decreased range-of-motion
- Healed two-level anterior cervical fusion
- Healed one-level posterior cervical fusion
- Clinical or radiographic evidence of rheumatoid arthritis, anklosing spondylitis or diffuse idiopathic skeletal hyperostosis
- Arnold-Chiari malformation
- Os odontoidium or congenital odontoid agenesis/hypoplasia
- Klippel-Feil deformity/congenital fusion or anomaly involving C1 and/or C2
- Multiple-level Klippel-Feil deformity/congenital fusion below C2
- C1-C2 hypermobility or instability (ADI > 4 mm)
- Spear tacklers spine deformity
- Transient quadriplegia (2 or more episodes)
- Non-healed/non-resolved symptomatic herniated disc or severe foraminal stenosis
- Cervical myelopathy
- MRI evidence of spinal cord contusion, edema or abnormality
- Any healed cervical spine fracture/dislocation (lateral mass fracture with subluxation/dislocation)
- Any healed cervical spine fracture or injury with residual instability > 3.5 mm/11°
- Any healed subaxial spine fracture with residual displacement, deformity or decreased range-of-motion
- C1-C2 fusion
- Three-level (or more) anterior cervical fusion
- Two-level (or more) posterior cervical fusion
- Cervical laminectomy or laminaplasty
** Athletes who are diagnosed with conditions in category I or II should be essentially pain-free, have normal cervical range-of-motion, normal cervical lordosis and normal strength and sensation before returning to sport. Athletes diagnosed with a condition in category III should generally not be allowed to return to sport, regardless of pain or neurologic status.