Degenerative disease of the cervical spine and its relationship to athletes.

Each sport presents with unique risk factors and different mechanisms of injury, and therefore extrapolation of the data from one sport to another makes comparison difficult. The current evidence exploring the relationship of athletes and degenerative changes of the cervical spine leaves much to be debated, and future prospective longitudinal studies will be needed to clarify our understanding further. Such research will help structure clinical recommendations and improve sports safety and the care of athletes of all ages. Currently, there is evidence to suggest that participation in collision sports is implicated in premature degeneration of the cervical spine. There is some evidence to suggest that the same is true with noncollision sports and activities that result in direct and indirect repetitive loads to the cervical spine over time. The risk factors have yet to be clearly identified. The natural history and sequelae of premature degeneration have yet to be elucidated. Cervical spondylosis also appears to increase the severity, but not the frequency, of irreversible neurologic injury during collision sport participation. Prudence dictates that we not ignore the present evidence suggesting a link between neuropraxia and cervical stenosis. Proper screening for cervical stenosis in patients with transient neuropraxia with subsequent cessation of participation in collision sports if severe stenosis is present is suggested. There is no consensus for RTP guidelines in the setting of transient neurologic injuries in the athlete when severe degeneration is present, and each case must be considered individually with regard to the sport involved.