http://upload.orthobullets.com/topic/2032/images/xray-cervical-lateral - shows torg ratio small.jpg
Introduction
  • Cervical stenosis may be 
    • congenital
    • acquired (traumatic, degenerative)
  • Associated conditions
    • 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
  • Prognosis
    • 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
Classification
  • Absolute cervical stenosis
    • defined as canal diameter < 10mm
  • Relative cervical stenosis
    • defined as canal diameter of 10-13mm
Imaging
  • Radiographs
    • recommended views
      • 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)
      • Torg-Pavlov ratio (canal/vertebral body width) of < 0.8 (normal is 1.0)  
        • Torg ratio is technique dependent, not predictive, and not accurate in large athletes
  • MRI
    • study of choice to evaluate soft tissue anatomy and neural impingement
Evaluation
  • Somatosensory evoked potentials
    • may help identify cord compromise in absolute stenosis
Treatment
  • Nonoperative
    • observation with possible activity restrictions
      • indications
        • 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
          • especially with
            • 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 
  • Operative
    • surgical decompression and stabilization
      • indications
        • radiculopathy
        • myelopathy
        • in some cases surgery may be indicated as a prophylactic measure
 

Please rate topic.

Average 3.2 of 23 Ratings

Questions (1)

(OBQ05.81) 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? Review Topic

QID:967
1

Anterior cervical diskectomy and fusion for one level disk herniation

3%

(51/1719)

2

Torg ratio of less than 0.8 with no other neurologic symptoms

12%

(206/1719)

3

Cord signal changes in the MRI

79%

(1360/1719)

4

Frequent episodes of stingers when he was in high school

4%

(67/1719)

5

Chronic neck and back pain

2%

(30/1719)

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

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.


Please rate question.

Average 2.0 of 43 Ratings

Question COMMENTS (1)
Sorry, this question is available to Virtual Curriculum members only.

Click HERE to learn more and purchase the Virtual Curriculum today!


GROUPS (1)
EVIDENCE & REFERENCES (4)
Topic COMMENTS (2)