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Three cases seen by the author will be presented that illustrate acceptable circumstances, as well as relative and absolute contraindications for athletes to return to contact/ collision sports after an incident of transient quadriplegia. Return is deemed acceptable if the athlete has complete resolution of symptoms, full range of motion, and normal curvature of the cervical spine, as well as no evidence of spinal stenosis on magnetic resonance (MR) imaging, contrast enhanced computerized tomography (CT), or myelography. Relative contraindications, as seen in Case 2, involve a mild intervertebral disc bulge that does not obliterate the reserve of cerebrospinal fluid (CSF) around the cord and transient quadriplegia caused by minimal contact. In Case 3, true spinal stenosis documented by MR imaging illustrates an absolute contraindication for return to contact/collision sports after an episode of transient quadriplegia and what can happen if return is allowed. The author realizes that these guidelines would be difficult to prove in a scientific fashion, and that the legal and moral consequences of a controlled trial would be too serious to allow it to be done.
stenosis, stingers, return to play, catastrophic injury, assessment, quadriplegia
Director, Chief Neurosurgery Service, Service of Sports Medicine, Emerson Hospital, Concord, MA