Adult Spine Trauma
Anatomy & Science
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Low Back Pain - Introduction
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DISH (Diffuse Idiopathic Skeletal Hyperostosis)
Pediatric Cervical Spine
Pediatric Cervical Trauma Overview
Pseudosubluxation of the Cervical Spine
Pediatric Spinal Cord Injury
Atlantoaxial Rotatory Displacement (AARD)
Congenital Muscular Torticollis
Adolescent Idiopathic Scoliosis
King Classification of AIS
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Cerebral Palsy - Spinal Disorders
Pediatric Spondylolisthesis & Spondylolysis
Disk Space Infection - Pediatric
Topic updated on
Cervical stenosis may be
acquired (traumatic, degenerative)
Spear tackler's spine
a syndrome of cervical stenosis caused by repetitive microtrauma and
improper tackling techniques
is considered a
contraindication to return to play
cervical stenosis places a patient at increased risk for radiculopathy/myelopathy/SCI even from minor trauma or cervical spondylosis
therefore congenital cervical stenosis is an
important consideration in the athlete
Absolute cervical stenosis
defined as canal diameter < 10mm
Relative cervical stenosis
defined as canal diameter of 10-13mm
ap, lateral, flexion/extension views of cervical spine
radiographic risk factors for neurologic involvement on lateral radiograph include
canal diameter of < 13mm (normal is ~17mm)
(canal/vertebral body width) of < 0.8
(normal is 1.0)
Torg ratio is technique dependent, not predictive, and not accurate in large athletes
study of choice to evaluate soft tissue anatomy and neural impingement
Somatosensory evoked potentials
may help identify cord compromise in absolute stenosis
observation with possible activity restrictions
patients without neurologic symptoms
contraindications to return to play (controversial)
loss of the CSF around the cord or deformation of the spinal cord documented by MRI
history of multiple episodes of transient quadriparesis
bilateral extremity symptoms
spear tackler's spine
Torg ratio of <0.8 alone is not considered a contraindication
to return to play
surgical decompression and stabilization
in some cases surgery may be indicated as a prophylactic measure
Please Rate Educational Value!
Qbank (3 Questions)
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
Select Answer to see Preferred Response
PREFERRED RESPONSE ▶
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.
The cervical spinal stenosis controversy.
Clin Sports Med. 1998 Jan;17(1):121-6.
PMID: 9475976 (Link to Pubmed)
Cervical spine injuries in athletes: current return-to-play criteria.
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 Pubmed)
Acute sports-related spinal cord injury: contemporary management principles.
Kim DH, Vaccaro AR, Berta SC.
Clin Sports Med. 2003 Jul;22(3):501-12.
PMID: 12852683 (Link to Pubmed)
Sam Cho MD
Derek Moore MD
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