Introduction Cervical stenosis may be congenital acquired (traumatic, degenerative) Associated conditions Spear tackler's spine a syndrome of cervical stenosis caused by repetitive microtrauma and improper tackling techniques is considered a contraindication to return to play Prognosis cervical stenosis places a patient at increased risk for radiculopathy/myelopathy/SCI even from minor trauma or cervical spondylosis therefore congenital cervical stenosis is an important consideration in the athlete Classification Absolute cervical stenosis defined as canal diameter < 10mm Relative cervical stenosis defined as canal diameter of 10-13mm Imaging Radiographs recommended views ap, lateral, flexion/extension views of cervical spine radiographic risk factors for neurologic involvement on lateral radiograph include canal diameter of < 13mm (normal is ~17mm) Torg-Pavlov ratio (canal/vertebral body width) of < 0.8 (normal is 1.0) Torg ratio is technique dependent, not predictive, and not accurate in large athletes MRI study of choice to evaluate soft tissue anatomy and neural impingement Evaluation Somatosensory evoked potentials may help identify cord compromise in absolute stenosis Treatment Nonoperative observation with possible activity restrictions indications patients without neurologic symptoms contraindications to return to play (controversial) loss of the CSF around the cord or deformation of the spinal cord documented by MRI especially with history of multiple episodes of transient quadriparesis bilateral extremity symptoms spear tackler's spine Torg ratio of <0.8 alone is not considered a contraindication to return to play Operative surgical decompression and stabilization indications radiculopathy myelopathy in some cases surgery may be indicated as a prophylactic measure