Breaking your neck (literally) in rugby

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.

Br J Sports Medicine Br J Sports Med 2012;46:550-554
doi:10.1136/bjsports-2011-090360