Spinal Injuries in Athletes

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Spinal Injuries in Athletes

• Kim Walpert, M.D.
• Georgia Neurological Surgery

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Objectives

• To understand basic epidemiology
• To understand mechanisms of injury
• To recognize potentially serious injuries
• To initiate treatment in the field
• To prevent any injury possible

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Cervical Spine Injury

• Approximately 1000 spinal cord injuries per year
  in athletic events
• Most not related to team sportsdiving, surfing,
  skiing
• Football most common team sport for cervical
  injury

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Spinal Injuries in Football

• Spine injuries 1.3 per 100,000
• Permanent quadriplegia 0.4 per 100,000

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Classification

• Type I permanent spinal cord damage
• Type II transient neurologic deficit with
  normal exam and imaging
• Type III radiographic abnormality

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Primary Mechanism

• Axial loading
• Flexion
• High velocity impact

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Axial Loading
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Axial Loading
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Axial Loading

• normal cervical spine has a curve, allowing it to
  absorb shock
• when the neck is flexed slightly forward, the
  cervical spine becomes straight
• when a force is applied to the top of the head in
  this position, the energy is transmitted along
  the axis of the cervical spine axial loading

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Flexion MOI
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Type I Injuries

• Permanent spinal cord injury
• Bilateral symptoms
• Early recognition to prevent secondary injury
• Contraindication to return to sports

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Type II Injuries

• Transient neurologic deficit
• Exam and radiographic studies normal
• Important to differentiate spinal cord vs
  peripheral nerve symptoms

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Spinal Cord Peripheral

• Bilateral
• Upper and lower extremities
• Sphincter or sexual dysfunction

• Unilateral
• Burner or Stinger

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Type III Injuries

• Fractures
• Fracture/dislocation
• Ligamentous injury
• Spinal stenosis (Torg ratio canalbody less than
  0.80)

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Spear Tacklers Spine

• Absolute contraindication to contact sports
• High risk for quadriplegia
• Straight spine with cervical stenosis
• Pre-existing traumatic change on radiographic
  studies
• Known use of spear-tackling techniques

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Diagnosis

• Be suspicious!
• Pain
• Neurologic complaints and/or deficit
• Assume the worst

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Management of Spinal Injuries

• Any head injury should be treated as cervical
  spine injury
• Immobilize with neck in neutral position
• Helmet in place until immobilized

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Return to Play

• Complex
• Radiographic and clinical decision

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Thoracolumbar Spine Injury

• Spinal cord not usually at risk
• Peripheral nerve symptoms most common
• Soft tissue
• Fractures
• Disc herniation

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Soft Tissue Injury

• Usually related to direct contact
• Improper body mechanics
• Pain in the paraspinous muscles
• No nerve root findings or abnormalities on
  neurologic exam

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Treatment

• Ice and rest
• Therapeutic modalities
• Gradual rehabilitation

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Fractures

• Compression fractures
• Fracture/dislocation
• Treatment depends on fracture type

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Disc Herniation

• Conservative treatment
• Surgery if pain refractory or weakness

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Return to Play

• Heavily dependent on stability of spine
• Clinical and radiographic
• Surgical treatment not automatic contraindication
  to return to play

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Prevention of Secondary Injury

• ABCs of emergency care
• Standardized protocols for head and neck injuries
  in the field
• Every unconscious athlete should be treated as
  cervical injury

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Be Suspicious

• Pay attention to pain
• Pay attention to mechanism of injury

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Case Study One

• 120 lb. Female with 120 lb weight on shoulders
• Doing step-ups
• Fell backwards, landed seated
• Complained of thoracolumbar pain

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Case Study One
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Case Study One
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Case Study Two

• College football player
• Face mask to face mask contact
• No LOC
• No neurologic complaints
• Neck pain

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Case Study Two
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Case Study Two
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Case Study Two
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Prevention

• We can make a difference.
• 1976 NCAA football rule change to eliminate the
  use of the head as a weapon
• Incidence of spine injuries from 4.1 to 1.3 per
  100,000
• Incidence of quadriplegia from 1.58 to 0.4 per
  100,000

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Hockey

• 2nd most common sport for SCI
• 1977-1983 injuries studied by the Canadian
  Committee on the Prevention of Spine and Head
  Injuries Due to Hockey
• Common mechanismvertex blow to the head against
  uncushioned boards

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Hockey Case Study

• Travis Roy
• hockey player for Boston University sustained
  permanent quadriplegia injury in the first 11
  seconds of the first game of collegiate his
  career when he crashed headfirst into the boards,
  forever changing his life

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Hockey

• Enforced rules against boarding and crosschecking
• New rules against checking from behind
• Development of neck conditioning programs
• Helmet redesign
• Since 1984, 50 decrease in spine injuries

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Spinal Injuries in Athletes

• Fundamental understanding of what the body can
  and cannot withstand

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Spinal Injuries in Athletes

• Basic knowledge of anatomy of spine and nervous
  system

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Spinal Injuries in Athletes

• Know what kind of injury to suspect with specific
  mechanism

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Spinal Injuries in Athletes

• Know your athletes

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Commitment to Education
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Thank You!