Management of cervical spine injuries in athletes

Abstract

Objective: Although the incidence of catastrophic cervical spine injury in sport has been significantly reduced over the past 3 decades, the injury warrants continued attention because of the altered quality of life that often accompanies such an injury. The purpose of our literature review was to provide athletic trainers with an understanding of the mechanisms, anatomical structures, and complications often associated with sport-related cervical spine injury. We also present the most current recommendations for management and treatment of these potentially catastrophic injuries.

Data sources: A review of the most pertinent literature between 1970 and 2005 was conducted using MEDLINE and the search terms spinal cord injury, cervical spine injury, neurosurgical trauma, cervical spinal stenosis, and catastrophic spine injury.

Data synthesis: Flexion of the head places the cervical spine into a straight line and prevents the neck musculature from assisting in force absorption. This mechanism is the primary cause of cervical fracture, dislocation, and quadriplegia. The most serious of the syndromes described in the literature involves a complete spinal cord injury with transverse myelopathy. This injury typically results in total loss of spinal function below the level of the lesion.

Conclusions/recommendations: Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the impact and bony displacement, as well as subsequent secondary insults such as hemorrhage, ischemia, and edema. Athletic trainers should be prepared to promptly recognize these potentially catastrophic injuries and follow the recommendations of the Inter-Association Task Force for the Appropriate Care of the Spine Injured Athlete in managing such injuries.

Figure 1. C6-C7 fracture-dislocation with cord edema, typical of complete quadriplegic injuries.

Figure 2. C6-C7 acute, traumatic herniated nucleus pulposus with a fracture-dislocation and spinal cord edema.

Figure 3. C5-C6 herniated nucleus pulposus.

Figure 4. Sagittal view on magnetic resonance imaging showing congenital spinal stenosis in a collegiate gymnast with transient spinal cord injury and a focal lesion at C3-C4. Because of recurrent symptoms and the focal lesion superimposed on the widespread stenosis, the athlete was medically disqualified from further contact sport participation

Figure 5. Axial view on magnetic resonance imaging of the same gymnast shown in Figure 4, demonstrating severe spinal canal narrowing with spinal cord compromise

Figure 6. Sagittal view on magnetic resonance imaging of a collegiate football player with a single episode of transient spinal cord injury but smooth, nonfocal stenosis and preservation of the cerebrospinal fluid signal throughout. This player was permitted to return to competition and experienced no recurrent symptoms