Overview
Cervical spine disorders encompass a range of conditions affecting the vertebrae, intervertebral discs, and surrounding structures, often presenting unique challenges in diagnosis and management, particularly in elite athletes 1.Diagnosis
Posteriorly tilted dens: Recognize as a normal anatomical variation that can mimic a fracture; differentiation requires ruling out fracture presence via plain films or laminography 2.
Imaging: Plain radiographs are initial diagnostic tools; advanced imaging like MRI or CT may be necessary for detailed assessment 1.
Clinical evaluation: Includes neurological examination to assess motor and sensory functions 1.Management
Single-level anterior cervical diskectomy and fusion: Often considered safe for return to play in elite athletes 1.
Cervical disk arthroplasty: Return to play remains controversial; individualized risk assessment advised 1.
Multilevel fusion: Management and return to play criteria are unclear and require cautious evaluation 1.
Cervical stenosis: Specific treatment guidelines for return to play are lacking; individualized patient assessment is crucial 1.Special Populations
Elite athletes: Return to play protocols vary significantly based on injury type and severity; individualized decision-making frameworks recommended 1.Key Recommendations
Return to play after single-level anterior cervical diskectomy and fusion should be considered feasible for elite athletes (Evidence: Moderate 1).
Multilevel cervical fusion and cervical disk arthroplasty require individualized risk assessment before allowing return to play due to insufficient evidence supporting routine return (Evidence: Weak 1).
Posteriorly tilted dens should be differentiated from fractures using imaging techniques, with plain films often sufficient but laminography reserved for unclear cases (Evidence: Expert opinion 2).References
1 Pahapill RR, Hsu WK. Controversies in the Management of Cervical Spine Conditions in Elite Athletes. Orthopedics 2019. link
2 Swischuk LE, Hayden CK, Sarwar M. The posteriorly tilted dens. A normal variation mimicking a fractured dens. Pediatric radiology 1979. link