Return-to-Sport Recommendations for Athletes With Congenital Cervical Spine Pathology: A Modified Delphi Consensus Survey of Expert Opinion
Scott L. Zuckerman, Jacob Jo, Grant H. Rigney, Julian E. Bailes, Christopher M. Bonfield, Robert C. Cantu, Patrick C. H. Chan, Andrew M. Cordover, Domagoj Coric, Hank Feuer, Raymond J. Gardocki, Andrew C. Hecht, Wellington K. Hsu, Jacob R. Joseph, Ronald A. Lehman, Allan D. Levi, Susan M. Liew, Philip K. Louie, Steven C. Ludwig, Joseph Maroon, Vincent J. Miele, Jeff Mullin, Venu M. Nemani, Frank M. Phillips, Sheeraz Qureshi, K. Daniel Riew, Myron A. Rogers, Rick C. Sasso, Gabriel A. Smith, Jay D. Turner, Alexander R. Vaccaro, Robert G. Watkins, Nicholas Theodore, David O. Okonkwo, Allen K. Sills, Gavin A. DavisBACKGROUND AND OBJECTIVES:
Recommendations guiding participation in sports for athletes with congenital cervical spine pathology are lacking, and management of these athletes remains challenging. Thus, the objective was to perform a modified Delphi consensus survey of expert opinion on return-to-sport (RTS) decisions in athletes with congenital cervical spine pathologies.
METHODS:
A cross-sectional, modified Delphi consensus survey investigating RTS decisions in athletes with various types of congenital cervical spine pathology was undertaken. An international panel of neurosurgery/orthopedic spine surgeons with sport expertise was identified. The cervical spine pathologies studied were craniocervical anomalies, Klippel-Feil syndrome, os odontoideum, Chiari malformation, and congenital cervical stenosis. A 2 × 2 scheme was used to classify sport risk based on
RESULTS:
Of the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons), survey completion was 100%. The following scenarios achieved ≥70% consensus to recommend athletes to return-to-play high impact/high frequency sports: C1 ring anomaly and no prior neurapraxic event, occipitalized C1, Klippel-Feil of 1 motion segment with/without kyphosis, and asymptomatic Chiari malformation without syrinx. Consensus was also achieved that an athlete with congenital stenosis who has experienced at least 2 neurapraxic events should be advised not to RTS. Although consensus was not achieved in other areas, notable findings are discussed.
CONCLUSION:
The following scenarios reached ≥70% consensus recommending athletes to return to high impact/high frequency sports: C1 ring anomaly without a prior neurapraxic event, occipitalized C1, Klippel-Feil syndrome involving 1 motion segment, and asymptomatic Chiari malformation without a syrinx. In addition, consensus was reached advising athletes with congenital stenosis with 2 or more neurapraxic events not to RTS. Although consensus was not obtained in other areas, notable findings are discussed.