Article Text

Download PDFPDF

Mechanisms of cervical spine injury in rugby union: a systematic review of the literature
  1. Daniel Kuster1,
  2. Alastair Gibson2,
  3. Rami Abboud1,
  4. Tim Drew1
  1. 1Department of Orthopaedic & Trauma Surgery, University of Dundee, Dundee, UK
  2. 2Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Daniel Kuster, Department of Orthopaedic & Trauma Surgery, Institute of Motion Analysis & Research, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK; d.kuster{at}


Background Severe cervical spine injury in rugby union (rugby) exerts a major impact on the individual who sustains the injury and on the broader society. Since the late 1970s, authors of rugby case report studies have postulated that the underlying mechanism of cervical spine injury is hyperflexion of the neck. However, this is in conflict with findings from more recent experimental studies. These have shown that it is more likely that the majority of cervical spine injuries occur due to buckling of the cervical spinal column.

Objective To investigate the primary mechanism of cervical spine injury in rugby.

Methods A comprehensive and systematic review of the literature was undertaken. Six key factors were identified and subsequently used to investigate the two principally postulated mechanisms of cervical spine injury: hyperflexion and buckling.

Results Facet dislocations, in particular bilateral facet dislocations, were identified as the most common types of cervical spine injury in rugby. Trauma occurred most often at lower cervical spinal levels, notably the C4/5 and C5/6 motion segments. Experimental studies demonstrate that bilateral facet dislocations occurring at the lower cervical spinal levels are primarily produced via buckling.

Conclusion Our analysis of key factors for cervical spine injury in rugby shows that it is unlikely that the majority of injuries occur after hyperflexion of the neck. It appears more likely that they are the result of buckling of the cervical spinal column.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Funding DK is a MBPhD student funded by the University of Dundee.

  • Competing interests None.