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Cervical Spinal Cord Contusion in Professional Athletes: A Case Series With Implications for Return to Play

Brigham, Craig D. MD; Capo, Jason MD

doi: 10.1097/BRS.0b013e31827973f6
Cervical Spine

Study Design. Retrospective case series.

Objective. This report provides long-term follow-up on athletes who have sustained a cervical spinal cord contusion. Their magnetic resonance (MR) image is correlated with clinical signs and symptoms. Mechanism of injury and a hypothesis of etiology are reported.

Summary of Background Data. Current return-to-play criteria for athletes who sustain a cervical cord contusion are based on expert opinion only. Decision making for this clinical situation in athletes carries significant clinical, legal, and economic ramifications. The natural history, clinical correlation, and effect of surgery for athletic cervical cord contusions have not been established. The mechanism of injury for this entity has historically emphasized axial loading.

Methods. The case histories, physical examination, and MR images were reviewed for 4 professional athletes. All athletes had documented cervical cord contusions. None of the athletes had an acute disc herniation, fracture, instability, or focal cord compression. All athletes were contacted by telephone to assess symptoms at a minimum follow-up of 2 years after injury.

Results. All 4 athletes had congenital stenosis, defined as lack of CSF signal around the cord on an MR image. All underwent anterior fusions at the level of their contusion. In follow-up, 2 athletes developed new contusions: one more than 5 years later, adjacent to a fusion; and 1, 2 years later, not adjacent to his previous fusion. No athlete developed permanent neurological sequelae. The presence of a contusion did not correlate with athletes' signs and symptoms. The mechanism of injury was hyperextension.

Conclusion. It is hypothesized that the horizontal facet orientation of the C3–C4 level, congenital stenosis, and relative hypermobility in extension are the contributing factors in the cause of this clinical entity. An anterior fusion at the C3–C4 level seems to be the most reliable method of preventing or delaying the return of symptoms. Return-to-play guidelines should emphasize the athletes' history of symptoms in context with their MR image because there is poor correlation between the finding of a contusion and the clinical presentation. Recurrence of symptoms is common and the long-term consequences of repeated episodes remain unknown.

Four professional athletes with cervical spinal cord contusions were followed for a minimum of 2 years after injury. All the 4 underwent magnetic resonance imaging of injury at the C3–C4 level and all had fusions. The magnetic resonance imaging did not correlate well with their clinical presentations, but all had hyperextension as the mechanism of injury. None had acute disc herniations or instability, but all had congenital stenosis. It is hypothesized that the horizontal facet orientation of C3–C4 and its relative hypermobility contribute to this problem.

From the OrthoCarolina, PA Spine Center, Charlotte, NC.

Address correspondence and reprint requests to Craig D. Brigham, MD, OrthoCarolina, PA Spine Center, 2001 Randolph Rd, Charlotte, NC 28207; E-mail:

Acknowledgment date: January 26, 2012. First revision date: April 12, 2012. Second revision date: June 20, 2012. Third revision date: July 16, 2012. Acceptance date: July 23, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.