Torg et al identified diagnostic findings seen in football players who spear tackle. This can help identify those football players who should avoid all collision sports in order to avoid quadraplegia or other catastrophic neurologic injury.


Diagnostic findings:

(1) vertebral body ratio (Pavlov or Torg ratio) <= 0.8 in 1 or more cervical vertebrae (C3 to C7)

(2) persistent reversal of the normal cervical lordosis on erect lateral radiographs obtained in neutral

(3) radiographic evidence of previous traumatic injury in the cervical spine

(4) documented evidence that the player has spear tackled opponents



• Feinberg and Spielholz stated that these athletes may keep the head and neck in a slightly flexed position. This may correlate with the loss of lordosis seen on X-ray.


If the patient has all of the diagnostic findings, then the athlete is at risk of permanent neurologic sequelae and should avoid all collision sports (football, rugby, hockey, etc.).


An athlete may be considered for return to collision activities if:

(1) the lordosis of the cervical spine returns

(2) there is no evidence of cervical disc disease and

(3) there is no evidence of cervical vertebral instability


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