Return-to-Sport Recommendations for Athletes With Congenital Cervical Spine Pathology: A Modified Delphi Consensus Survey of Expert Opinion

BACKGROUND AND OBJECTIVES: Recommendations guiding participation in sports for athletes with congenital cervical spine pathology are lacking, and management of these athletes remains challenging. Thus, the objective was to perform a modified Delphi consensus survey of expert opinion on return-to-sport (RTS) decisions in athletes with congenital cervical spine pathologies. METHODS: A cross-sectional, modified Delphi consensus survey investigating RTS decisions in athletes with various types of congenital cervical spine pathology was undertaken. An international panel of neurosurgery/orthopedic spine surgeons with sport expertise was identified. The cervical spine pathologies studied were craniocervical anomalies, Klippel-Feil syndrome, os odontoideum, Chiari malformation, and congenital cervical stenosis. A 2 × 2 scheme was used to classify sport risk based on impact forces and frequency : low impact/low frequency, low impact/high frequency, high impact/low frequency, and high impact/high frequency. Consensus was a-priori defined at ≥70%. Descriptive statistics were performed. RESULTS: Of the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons), survey completion was 100%. The following scenarios achieved ≥70% consensus to recommend athletes to return-to-play high impact/high frequency sports: C1 ring anomaly and no prior neurapraxic event, occipitalized C1, Klippel-Feil of 1 motion segment with/without kyphosis, and asymptomatic Chiari malformation without syrinx. Consensus was also achieved that an athlete with congenital stenosis who has experienced at least 2 neurapraxic events should be advised not to RTS. Although consensus was not achieved in other areas, notable findings are discussed. CONCLUSION: The following scenarios reached ≥70% consensus recommending athletes to return to high impact/high frequency sports: C1 ring anomaly without a prior neurapraxic event, occipitalized C1, Klippel-Feil syndrome involving 1 motion segment, and asymptomatic Chiari malformation without a syrinx. In addition, consensus was reached advising athletes with congenital stenosis with 2 or more neurapraxic events not to RTS. Although consensus was not obtained in other areas, notable findings are discussed.