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Clinics in neurology and neurosurgery of sport: asymptomatic cervical canal stenosis and transient quadriparesis
  1. G Davis1,
  2. K Ugokwe2,
  3. E P Roger3,
  4. E C Benzel4,
  5. R C Cantu5,
  6. M Rogers6,
  7. J Dvorak7,
  8. P McCrory8
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
  3. 3
    Cleveland Clinic Spine Institute, Cleveland, OH, USA
  4. 4
    Cleveland Clinic Spine Institute, Neurosurgical Residency Program, Cleveland Clinic, Cleveland, OH, USA
  5. 5
    Sports Medicine, Emerson Hospital, Concord, MA, Boston
  6. 6
    Spinal Injuries Unit, Austin Hospital, Victoria, Australia
  7. 7
    Schultness Klinik, Zurich, Switzerland
  8. 8
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia
  1. Correspondence to Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu.au

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The cervical spine is a relatively mobile structure commencing at the base of the skull and finishing at the relatively immobile thoracic spine. The cervical spinal cord and the paired vertebral arteries are critical occupants of the cervical spine, and injury to these structures results in catastrophic quadriplegia (spinal cord injury) or stroke (vertebral artery injury). Trauma to the neck is not uncommon in sport, but only rarely results in neurovascular injury or significant spinal instability. Every physician or trainer entrusted with the care of athletes’ fears that the next neck injury seen may be a catastrophic one and endeavours to seek every opportunity possible to prevent such disaster. The question is: which athletes are at risk? Is asymptomatic spinal canal stenosis a risk factor for spinal cord injury and does an episode of transient quadriparesis predispose an athlete to the development of catastrophic spinal cord injury?

Case study: patient 1

A 26-year-old male footballer sustains a concussion with loss of consciousness lasting 30 seconds. He makes a full recovery, but as a precaution is taken to the local hospital emergency department. He is examined and found to be neurologically intact. A CT scan of the brain is reported as normal. Plain radiographs of the cervical spine suggest narrowing of the spinal canal with a Torg–Pavlov ratio of 0.76 (normal >0.8) measured at C3 (fig 1). Flexion extension radiography of the cervical spine is performed, with no evidence of instability. The managing team physician refers the patient to you for expert opinion.

Figure 1

Plain radiograph of the lateral cervical spine, showing a Torg–Pavlov ratio (b/a) of 0.76 (normal >0.8) measured at C3.

What recommendations do you make, based on the following considerations?

  1. Given that the patient is asymptomatic with respect to the cervical spine and based on these findings, will you allow him to return …

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