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Cervical Stenosis

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Topic updated on 10/08/13 7:32pm
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-Pavlo 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

 

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(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? Topic Review Topic

1. Anterior cervical diskectomy and fusion for one level disk herniation
2. Torg ratio of less than 0.8 with no other neurologic symptoms
3. Cord signal changes in the MRI
4. Frequent episodes of stingers when he was in high school
5. Chronic neck and back pain

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