Nagoshi Narihito, Tetreault Lindsay, Nakashima Hiroaki, Nouri Aria, Fehlings Michael G
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada.
Spine J. 2017 Feb;17(2):291-302. doi: 10.1016/j.spinee.2016.09.013. Epub 2016 Nov 9.
This is a systematic review.
The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).
Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial.
We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.
We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a "long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311).
There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.
这是一项系统评价。
本研究旨在评估脊髓震荡（SCC）患者能否安全重返运动，以及是否存在可预测SCC复发或脊髓损伤（SCI）发生的因素。
尽管SCC是脊髓功能的一种可逆性神经功能障碍，但其管理及对重返运动的影响仍存在争议。
我们在六个数据库中使用关键词“颈椎”“运动”和“损伤”对文献进行了系统检索。我们研究了（1）无狭窄、（2）有狭窄以及（3）接受单节段颈椎前路椎间盘切除融合术（ACDF）的患者的重返运动情况。我们还调查了SCC复发或SCI风险的预测因素。
我们共识别出3655条独特的文献引用，其中16条符合我们的纳入标准。纳入的研究为病例对照研究、病例系列研究及报告。两项研究报道了无狭窄的患者：儿科病例重返运动后未复发，而一名成年病例重返运动后出现了SCC复发。七项研究描述了有狭窄的患者。这些研究包括重返运动后有复发和无复发的病例，以及出现永久性神经功能缺损的SCI患者。三项研究报道了接受ACDF的患者。尽管一些患者术后运动未出现问题，但有几名患者因手术部位相邻节段的椎间盘突出而出现了SCC复发。关于重要的预测因素，与未出现问题的患者（11.11%；p = 0.0311）相比，重返运动后出现症状复发或SCI的患者中，症状持续“较长”时间（>24小时；36.36%）的频率更高。
关于SCC后重返运动的现行实践标准以及SCC复发或SCI的重要危险因素的证据有限。由于样本量较小今后需要开展前瞻性多中心研究，以确定SCC后重返运动不良结局的重要预测因素。
