PT  - JOURNAL ARTICLE
AU  - Daniel Kuster
AU  - Alastair Gibson
AU  - Rami Abboud
AU  - Tim Drew
TI  - Mechanisms of cervical spine injury in rugby union: a systematic review of the literature
AID  - 10.1136/bjsports-2011-090360
DP  - 2012 Jun 01
TA  - British Journal of Sports Medicine
PG  - 550--554
VI  - 46
IP  - 8
4099  - http://bjsm.bmj.com/content/46/8/550.short
4100  - http://bjsm.bmj.com/content/46/8/550.full
SO  - Br J Sports Med2012 Jun 01; 46
AB  - 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.