Cervical Spine Injuries in Sport - Dr Jonathon Ball
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At the recent Neurosurgical Society of Australia's Annual Scientific Meeting, Dr Ball was asked to speak on Cervical Spine Injuries in Sport. Given the high profile of these injuries and Dr Ball's experience in managing spinal injuries, he joined a panel to present on up to date knowledge on this spectrum of injury. For more information about Dr Ball see http://www.neurospine.com.au
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Cervical Spine Injuries in Sport - Dr Jonathon Ball
- 1. RNSH Cervical Spine Injuries in Sport “Its All in the Game” Dr Jonathon R. Ball FRACS BMed BMedSc(Hons) GradDipBiomedE Neurosurgeon and Spinal Surgeon Royal North Shore Hospital North Shore Private Hospital Sydney, Australia Head of Department, Neurosurgery Royal North Shore Hospital Sydney, Australia
- 2. RNSH
- 3. RNSH Cervical Fractures @ RNSH n = 389
- 5. RNSH source : www. trove.nla.gov.au
- 6. RNSH Outline • Acute spinal cord injury • Cervical cord neurapraxia • Burners/Stingers • Cervical disc protrusions & fractures
- 7. RNSH SCI in Australia (2007-2008) • 285 traumatic SCIs • 25 (9%) “struck by, or collision with another person or object” • 10 participating in sporting or leisure activities (excludes water actives) source : AIHW: Norton L 2010. Spinal cord injury, Australia 2007–08. Injury research and statistics series no. 52. Cat. no. INJCAT 128. Canberra: AIHW.
- 8. RNSH source : http://irbplayerwelfare.com/pdfs/CI_Risk_Assessment_EN.pdf
- 9. RNSH source : http://irbplayerwelfare.com/pdfs/CI_Risk_Assessment_EN.pdf
- 10. RNSH Outline • Acute spinal cord injury • Cervical cord neurapraxia • Burners/Stingers • Cervical disc protrusions & fractures
- 11. RNSH
- 12. RNSH Classification of CCN • type (neurologic deficit) • plegia • paresis • parasthesia • grade (duration) • 1 : < 15 mins • 2 : 15 mins - 24 hrs • 3 : > 24 hrs • pattern • quad : all 4 limbs • upper : both upper limbs • lower : both lower limbs • hemi : ipsilateral upper/lower limbs
- 13. RNSH ‘Pincer Mechanism’ after Penning (1962) source : Torg JS et al. J Bone Joint Surg Am. 84(1):112-122 (2002).
- 14. RNSH Pathophysiology source : Torg JS et al. Clin Orthop Relat Res. (321):259-69 (1995).
- 15. RNSH Pathophysiology source : Torg JS et al. Clin Orthop Relat Res. (321):259-69 (1995).
- 16. RNSH Torg/Pavlov Ratio source : Chao S et al. Sports Med. 40(1):59-75 (2010).
- 17. RNSH source : Torg JS et al. J Bone Joint Surg Am. 78(9):1308-14 (1996).
- 18. RNSH
- 19. RNSH source : Meredith DS et al. Am J Sports Med. 78(9):1308-14 (2013).
- 20. RNSH Outline • Acute spinal cord injury • Cervical spinal cord neurapraxia • Burners/Stingers • Cervical disc protrusions & fractures
- 21. RNSH ‘Burners/Stingers’ • temporary episode of unilateral upper extremity dysaesthesia +/- motor weakness source : Chang D & Bosco J. Bull NYU Hosp Jt Dis. 64(3-4): 119-129 (2006).
- 22. RNSH Outline • Acute spinal cord injury • Cervical spinal cord neurapraxia • Burners/Stingers • Cervical disc protrusions & fractures
- 23. RNSH To Operate or Not ? • acute patent safety • need for acute neurologic decompression • need for acute stabilisation • future RTP considerations • higher functional demand - prevent further injuries • potential for ‘timely’ healing op vs non-op based on : C. Prusmack, NASS 2013.
- 24. RNSH Neurologic Decompression • Clinical • neuro exam : normal, improving, worsening, fixed • radicular vs cord vs plexus • Radiographic • SC compression : disc, fracture, haematoma • Functional Reserve : ?? how much • Stenosis : focal, diffuse, congenital, degenerative • Foraminal stenosis • Contusion based on : C. Prusmack, NASS 2013.
- 25. RNSH Future RTP Considerations • safety issues • prevent further SCI • prevent further neurologic symptoms • consequence of surgical intervention • professional issues • level of player • sport & position • livelihood • timing based on : C. Prusmack, NASS 2013.
- 26. RNSH • 99 x NFL players • 53 x operative • 32 x ACDF, 3 x foraminotomy, 16 not known • RTP 72 % (29.3 games, 2.8 years) • ASD 5.3% • 46 x non-operative • RTP 46 % (14.7 games, 1.5 years)
- 27. RNSH • 16 x NFL players • 9 x radicular Sx, 3 x CCN • initial non-operative Mx • 3 x ACDF - 1 x RTP • 13 non-operative - 8 x RTP
- 28. RNSH source : Burnett MG JS & Sonntag V Neurosurg Focus. 15;21(4):E5 (2006).
- 29. RNSH • 15 subjects (7 x NFL, 8 x WWE) • RTP 13/15 • adjacent disc herniation - 1 subject after 2 years
- 30. RNSH • 19 professional rugby players (1998-2003) • 17 x single level ACDF, 2 x double level • 13 x RTP same level, 1 x RTP lower level • 5 did not RTP • 2 x recurrent neck/radicular symptoms
- 31. RNSH Return to Play Criteria • Clinical • no neck pain, normal cervical range of motion, normal neurologic exam • no prohibitive history • Radiographic • flex-ext XR - no instability • CT : no significant fracture • MR : no cord compression (? functional reserve, contusion, foraminal stenosis) based on : C. Prusmack, NASS 2013.
- 32. RNSH Outline • Acute spinal cord injury • Cervical cord neurapraxia • Burners/Stingers • Cervical disc protrusions & fractures
- 33. RNSH
- 34. RNSH