{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:06:31Z","timestamp":1790208391590,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Cervical spine injuries are considered common in athlete populations, especially in those involved in high-contact sports. In some cases, surgical treatment can be necessary, and, therefore, return-to-play (RTP) after surgery represent a notable issue. Methods: We performed a systematic review of literature according to the PRISMA statement guidelines using the following search algorithm: ((\u201cACDF\u201d) OR (\u201ccervical spine surgery\u201d) OR (\u201cneck surgery\u201d) OR (\u201ccervical discectomy\u201d) OR (\u201cforaminotomy\u201d) OR (\u201ccervical disc replacement\u201d)) AND ((\u201creturn to play\u201d) OR (\u201cathlete\u201d) OR (\u201ccontact sports\u201d) OR (\u201cmartial arts\u201d)). The search was performed on 21 October 2022. We included only articles in which operative treatment for the cervical spine was performed and return to martial art activity was declared in the text. Results: Eight articles were selected, including 23 athletes who practice wrestling (n = 16), kickboxing (n = 1), sumo (n = 1) or other unspecified martial arts (n = 5). We also included the case of a young judoka who underwent anterior cervical discectomy and fusion (ACDF) at our hospital. About 88% (21 of 24 cases) of martial arts practitioners returned to play after cervical spine surgery, and no major complications were reported after RTP. Four patients (16.7%) returned in 0\u20133 months; 41.7% (10 of 24) returned in 3\u20136 months; 29.2% (7 of 24) returned after a period longer than 6 months. ACDF is the most used procedure. The level of evidence in the included articles is low: only case reports are available, including some single-case studies. Moreover, a small number of cases have been reported, and the examined data are very heterogeneous. Conclusions: Return to martial arts within one year after cervical spine surgery is generally safe, even if case-by-case evaluation is, however, necessary. Further studies are necessary to corroborate the present findings in a larger population.<\/jats:p>","DOI":"10.3390\/jpm13010003","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T02:31:33Z","timestamp":1671589893000},"page":"3","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Return to Martial Arts after Surgical Treatment of the Cervical Spine: Case Report and Systematic Review of the Literature for an Evidence-Based Approach"],"prefix":"10.3390","volume":"13","author":[{"given":"Giuliano","family":"Di Monaco","sequence":"first","affiliation":[{"name":"Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-0791","authenticated-orcid":false,"given":"Edoardo","family":"Mazzucchi","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Pignotti","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-4849","authenticated-orcid":false,"given":"Giuseppe","family":"La Rocca","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sabatino","sequence":"additional","affiliation":[{"name":"Unit of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy"},{"name":"Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1097\/00007632-199610010-00025","article-title":"Athletes with Cervical Spine Injury","volume":"21","author":"Maroon","year":"1996","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1093\/neuros\/nyaa308","article-title":"Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society","volume":"87","author":"Schroeder","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/BRS.0b013e3181e50651","article-title":"Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes","volume":"36","author":"Hsu","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1177\/03635465020300060601","article-title":"Catastrophic Injuries in Wrestlers","volume":"30","author":"Boden","year":"2002","journal-title":"Am. J. Sport. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1227\/01.neu.0000429843.68836.91","article-title":"Outcomes After Anterior Cervical Discectomy and Fusion in Professional Athletes","volume":"73","author":"Maroon","year":"2013","journal-title":"Neurosurgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00402-008-0609-7","article-title":"Cervical Spondylolysis in a Judo Player: A Case Report and Biomechanical Analysis","volume":"129","author":"Sasa","year":"2009","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"112","DOI":"10.2106\/00004623-200201000-00017","article-title":"Injuries to the Cervical Spine in American Football Players","volume":"84","author":"Torg","year":"2002","journal-title":"J. Bone Jt. Surg. Am. Vol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1097\/BRS.0000000000003931","article-title":"Return to Play Guidelines After Cervical Spine Injuries in American Football Athletes: A Literature-Based Review","volume":"46","author":"Swiatek","year":"2021","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E1225","DOI":"10.1097\/BRS.0000000000004230","article-title":"Letter to the Editor Regarding \u201cReturn to Play Guidelines After Cervical Spine Injuries in American Football Athletes: A Literature-Based Review\u201d","volume":"46","author":"Vaccaro","year":"2021","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1177\/0363546503258773","article-title":"Cervical Spinal Cord Injury in Sumo Wrestling: A Case Report","volume":"32","author":"Nakagawa","year":"2004","journal-title":"Am. J. Sport. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.wneu.2014.06.043","article-title":"Return to Play for Neurosurgical Patients","volume":"82","author":"Saigal","year":"2014","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1227\/NEU.0000000000000728","article-title":"Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes","volume":"77","author":"Tempel","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Narayana Kurup, J.K., Jampani, R., and Mohanty, S.P. (2017). Catastrophic Cervical Spinal Injury in an Amateur College Wrestler. BMJ Case Report., bcr-2017-220260.","DOI":"10.1136\/bcr-2017-220260"},{"key":"ref_14","first-page":"19","article-title":"Spinal Cord Injury Due to Cervical Disc Herniation without Bony Involvement Caused by Wrestling\u2014A Case Report","volume":"9","author":"Hope","year":"2019","journal-title":"J. Orthop. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"192","DOI":"10.31616\/asj.2019.0376","article-title":"Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports","volume":"15","author":"Shah","year":"2021","journal-title":"Asian Spine J"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"282","DOI":"10.35366\/102368","article-title":"Cervical Arthroplasty in a Professional Kick-Boxing Fighter, 7 Years Follow-Up","volume":"35","author":"Hartl","year":"2021","journal-title":"Acta Ortop. Mex."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1302\/0301-620X.90B5.20546","article-title":"Is Return to Professional Rugby Union Likely after Anterior Cervical Spinal Surgery?","volume":"90-B","author":"Andrews","year":"2008","journal-title":"J. Bone Jt. Surgery Br. Vol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/BRS.0b013e31827973f6","article-title":"Cervical Spinal Cord Contusion in Professional Athletes: A Case Series With Implications for Return to Play","volume":"38","author":"Brigham","year":"2013","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E80","DOI":"10.1097\/BSD.0000000000000570","article-title":"The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes","volume":"31","author":"Mai","year":"2018","journal-title":"Clin. Spine Surg. A Spine Publ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"232596711877967","DOI":"10.1177\/2325967118779672","article-title":"Return to Play After Anterior Cervical Discectomy and Fusion in Professional Athletes","volume":"6","author":"Watkins","year":"2018","journal-title":"Orthop. J. Sport. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ncl.2007.11.003","article-title":"Recognition and Management of Spinal Cord Injuries in Sports and Recreation","volume":"26","author":"Tator","year":"2008","journal-title":"Neurologic Clinics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S1529-9430(02)00202-4","article-title":"Return to Play Criteria for the Athlete with Cervical Spine Injuries Resulting in Stinger and Transient Quadriplegia\/Paresis","volume":"2","author":"Vaccaro","year":"2002","journal-title":"Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"699","DOI":"10.3928\/0147-7447-20010701-29","article-title":"Cervical Spine Injuries in Athletes: Current Return-to-Play Criteria","volume":"24","author":"Vaccaro","year":"2001","journal-title":"Orthopedics"},{"key":"ref_24","first-page":"89","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/3\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:44:43Z","timestamp":1760147083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,20]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jpm13010003"],"URL":"https:\/\/doi.org\/10.3390\/jpm13010003","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,20]]}}}