Sports related spine injuries

General

Permanent SCI
May be complete or may have features of any of the incomplete SCI syndromes (often in mixed or partial forms)

Football players with suspected C-spine injury should not have their helmet removed in the field

The following terms probably originated as locker-room jargon for various cervical spine-related injuries usually sustained in playing football.

Medical definitions have subsequently been retro-fitted to them. As a result, the precise definitions may not be uniformly agreed upon.
Although the semantics may differ, it is more important from a diagnostic and therapeutic standpoint to distinguish nerve root injuries, brachial plexus injuries, and spinal cord injuries.

Sensory changes that may involve numbness, tingling or burning. May or may not be associated with motor symptoms of weakness or complete paralysis.
Typically lasts < 15mins (although may persist up to 48 hrs),
Involves all 4 extremities in 80% of cases.
Narrowing of the sagittal diameter of the cervical spinal canal is felt to be a contributory factor.
With resumption of contact activities, recurrence rate is ≈ 56%, with higher risks of recurrence among those with narrower canal diameters.
Evaluation should include cervical MRI.
Uncomplicated cases of CCN (no spinal instability and no MRI evidence of cord defect or edema) have a low risk of permanent injury and does not recommend activity restrictions

Distinct from the burning hands syndrome.
Unilateral, burning dysesthetic pain radiating down one arm from the shoulder, sometimes associated with weakness involving the C5 or C6 nerve roots.
Usually follows a tackle.
May result from

Downward traction on the upper trunk of the brachial plexus (when the shoulder is forcefully depressed with the neck flexed to the contralateral side) or
By direct nerve root compression in the neural foramina (not an SCI)

Vascular injury to carotid or vertebral arteries.
Usually related to intimal dissection following a direct blow to the neck or by extreme movements.
Symptoms are those of a TIA or stroke

Rule changes in 1976 banned spearing (the practice of using the football helmet as a battering ram to tackle an opponent) and resulted in a reduction of the number of football-related occurrences of cervical spine fractures and quadriplegia.
Four characteristics of spear tackler’s spine

Cervical spinal stenosis
Loss of normal cervical lordosis: as a result, the stress of axial loading is more likely to be imparted to the vertebral bodies, rather than being absorbed by the cervical musculature and ligaments, increasing the risk of burst fractures and quadriplegia
Evidence of pre-existing traumatic abnormalities
Documented spear tackler’s technique

The athlete is removed from competition until the cervical lordosis returns and the player learns to use other tackling techniques.
This tackling technique has been banned since 1976.

Most injuries can be visualized with the helmet in place.
A neurological exam can be performed with the helmet in place.
The patient may be immobilized on a spine board with the helmet in place.
The facemask can be removed with special tools to access the airway.
Hyperextension must be avoided following removal of the helmet and shoulder pads.

In a controlled setting (usually after X-rays) the helmet and shoulder pads are removed together as a unit to avoid neck flexion or extension.
Possible indications for removal of helmet

The facemask cannot be removed in a reasonable amount of time.
An airway cannot be established even with the facemask removed.
There is life-threatening hemorrhage under the helmet that can only be controlled by removal.
The helmet and strap do not hold the head securely, so immobilizing the helmet does not adequately immobilize the spine (e.g., a poorly fitting or damaged helmet).
The helmet prevents immobilization for transportation in an appropriate position.
Certain situations where the patient is unstable (M.D. decision).