Updated: 5/30/2019

[Blocked from Release] Cervical Stenosis

Topic
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https://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
 

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