Joaquim Andrei F, Hsu Wellington K, Patel Alpesh A
Department of Neurology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; and.
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Neurosurg Focus. 2016 Apr;40(4):E10. doi: 10.3171/2016.1.FOCUS15560.
Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population. A search of the MEDLINE database using the search terms "cervical spine" AND "surgery" AND "athletes" yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia. The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation. Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended.
颈椎手术是全球最常见的脊柱外科手术之一。作者对有关高水平运动员颈椎手术结果的文献进行了系统综述，以便更好地了解该人群颈椎病理的细微差别。使用搜索词“颈椎”“手术”和“运动员”在MEDLINE数据库中进行搜索，共得到54篇摘要。在排除不符合纳入标准的出版物后，共有8篇报告了因颈椎病理（主要是退行性疾病）症状接受治疗的职业或精英运动员颈椎手术结果的论文留待分析。其中5篇涉及颈椎间盘突出症的治疗，3篇专门关于创伤性神经失用症。本综述纳入的大多数患者是美国橄榄球运动员。前路颈椎间盘切除融合术（ACDF）常用于高水平运动员治疗颈椎间盘突出症。大多数研究表明，因椎间盘突出症导致神经根病的运动员在接受ACDF手术后无症状，恢复比赛是安全的。手术治疗可能比非手术治疗为这些运动员提供更高的恢复比赛率。无症状患者颈椎脊髓挫伤后可能恢复比赛。一些作者认为，MRI上的颈髓信号改变在神经功能完好的患者中可能不是恢复比赛的绝对禁忌证。颈椎管狭窄继发的颈椎挫伤可能比椎间盘突出继发的挫伤预后更差、复发率更高。证据质量较低（四级），必须推荐个体化治疗。
