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21-year-old college football player sustains transient loss of motor function in his arms after a collision. Which of the following is an absolute contraindication to return to play?
Anterior cervical diskectomy and fusion for one level disk herniation
Torg ratio of less than 0.8 with no other neurologic symptoms
Cord signal changes in the MRI
Frequent episodes of stingers when he was in high school
Chronic neck and back pain
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The Torg ratio is the ratio of the spinal canal/vertebral body. Torg and Pavlov stated that a ratio under 0.8 corresponded to severe spinal stenosis. However, subsequent studies have shown the incidence of spinal stenosis (using a Torg ratio of 0.8 as a definition) to be 49% in asymptomatic professional football players. Kim et al also found that the presence of an abnormal Torg ratio does not appear to be predictive of future spinal cord injury.
Ladd and Scranton argue that spinal stenosis cannot be defined by bone measurements alone; they claim “functional” spinal stenosis is more accurately defined as a loss of the CSF around the cord or deformation of the spinal cord documented by CT myelography or MRI. Cantu advises that in the setting of “functional” spinal stenosis, a return to contact or collision sports should be contraindicated. Kim et al argue that athletes sustaining multiple episodes of transient quadriparesis or bilateral extremity symptoms with MRI evidence of cord injury should be advised to avoid contact/collision sports.
Clin Sports Med. 1998 Jan;17(1):121-6. PMID: 9475976 (Link to Abstract)
Vaccaro AR, Watkins B, Albert TJ, Pfaff WL, Klein GR, Silber JS.
Orthopedics. 2001 Jul;24(7):699-703; quiz 704-5. PMID: 11478562 (Link to Abstract)
Kim DH, Vaccaro AR, Berta SC.
Clin Sports Med. 2003 Jul;22(3):501-12. PMID: 12852683 (Link to Abstract)
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