• Stephan Werle, Kais Abu Nahleh, and Heinrich Boehm.
• From the Department of Spinal Surgery and Paraplegiology, Zentralklinik Bad Berka, Germany.
• Spine. 2015 Mar 1;40(5):E317-20.

Study DesignCase report and literature review.ObjectiveTo report a unique case of atlantoaxial instability after a header in a 37-year-old amateur soccer player and to discuss the injury pattern in relation to the impact of heading.Summary Of Background DataAlthough there is potential for cervical spine injuries, the rates in soccer are low compared with other contact or even noncontact sports. No cases of acute post-traumatic atlantoaxial instability after heading have ever been reported in a MEDLINE-listed article.MethodsA 37-year-old male soccer player experienced acute upper neck pain and transient quadriplegia after heading a long-distance ball on 2 occasions during a match. Imaging revealed atlantoaxial instability. Persistent neurological symptoms on conservative treatment led to his referral to our department. The considerable instability required surgical intervention.ResultsTransarticular C1-C2 fixation and posterior fusion with structural iliac crest grafting were performed. The procedure immediately led to complete relief of the neurological symptoms. After an uneventful postoperative recovery, follow-up at 9 months revealed solid fusion. The patient remained symptom free.ConclusionHeading the ball in soccer can potentially lead to atlantoaxial instability. Ligamentous damage can theoretically be caused by anteriorly directed and rotational overload. However, the causative mechanism remains unclear. Diagnostic workup should consider dynamic imaging in players with transient neurological symptoms after minor trauma to the cervical spine.Level Of EvidenceN/A.

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