Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Population Health Science and Policy, Institute of Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY.
Clin Spine Surg. 2020 Aug;33(7):E330-E336. doi: 10.1097/BSD.0000000000000948.
Cervical spine injuries commonly occur during athletic play, and such injuries carry significant risk for adverse sequelae if not properly managed. Although guidelines for managing return to play exist, adherence among spine surgeons has not been thoroughly examined.
Prospective analysis of survey data collected from surgeon members of the Cervical Spine Research Society (CSRS) and the International Society for the Advancement of Spine Surgery (ISASS).
The objective of this study was to characterize consensus among spine surgeons regarding decision-making on return to competitive sports and level of impact following significant cervical spine injuries from real-life scenarios.
Return to play decisions for 15 clinical cervical spine injury scenarios were compared with current guidelines. Surgeon demographic information such as orthopedic board certification status and years in practice were also analyzed. Weighted kappa analysis was utilized to determine interrater reliability in survey responses.
Survey respondents had a poor agreement with both Watkins and Torg guidelines (average weighted κ of 0.027 and 0.066, respectively). Additional kappa analysis of surgeon agreement regarding the "Types of Play" and "Level of Play" for return was still remained poor (Kendall W of 0.312 and 0.200, respectively). Responses were also significantly influenced by surgeon demographics.
There is poor consensus among spine surgeons for return to play following cervical spine injury. These results support the concept that given the gravity of cervical spine injuries, a more standardized approach to decision-making regarding return to play after cervical spine injury is necessary.
颈椎损伤在运动中很常见，如果处理不当，会有严重的不良后果。尽管有管理重返运动的指南，但脊柱外科医生的遵守情况尚未得到彻底检查。
对来自颈椎研究学会（CSRS）和脊柱外科学进步国际学会（ISASS）的脊柱外科医生成员收集的调查数据进行前瞻性分析。
本研究的目的是描述脊柱外科医生在处理现实生活中严重颈椎损伤后的重返竞技运动和影响程度的决策方面的共识。
将 15 个临床颈椎损伤场景的重返运动决策与现行指南进行比较。还分析了外科医生的人口统计学信息，如骨科委员会认证状态和从业年限。使用加权 kappa 分析来确定调查回复中的评分者间可靠性。
调查受访者对 Watkins 和 Torg 指南的一致性较差（平均加权κ值分别为 0.027 和 0.066）。对重返时“运动类型”和“运动水平”的外科医生一致性的进一步 kappa 分析仍然较差（Kendall W 值分别为 0.312 和 0.200）。回复也受到外科医生人口统计学的显著影响。
颈椎损伤后重返运动的脊柱外科医生之间存在较差的共识。这些结果支持这样一种观点，即鉴于颈椎损伤的严重性，有必要对颈椎损伤后重返运动的决策采取更标准化的方法。
