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Clinics in neurology and neurosurgery of sport: cervical disc prolapse
  1. G Davis1,
  2. P Hamlyn2,
  3. W R Sears3,
  4. P McCrory4
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    Barts and London Hospital Trust, London, UK
  3. 3
    Spinal Injuries Unit, Royal Northshore Hospital and Department of Neurosurgery, Royal Northshore Hospital and Dalcross Private Hospital, Sydney, Australia
  4. 4
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
  1. 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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A cervical intervertebral disc can prolapse (hernia or rupture) asymptomatically or may produce neck pain, nerve root compression (radiculopathy) or spinal cord compression (myelopathy). Surgery is indicated in cases of cervical myelopathy. In cases of symptomatic cervical radiculopathy, surgery is indicated in cases that fail to respond to conservative treatment. Surgical approaches to the cervical spine are usually anterior or posterior. Currently, anterior cervical discectomy is the most common procedure used. This may be performed alone or with the addition of fusion (insertion of a bone graft) and with or without instrumentation (an intervertebral prosthesis or use of plates or screws). An alternative to fusion (arthrodesis) is a disc replacement (arthroplasty). There is extensive debate among spinal surgeons as to the most appropriate technique, and as the literature lacks absolute clarity regarding the superiority of one technique over another, most spinal surgeons use the technique that works well in their hands.

CASE STUDY: POSTACCIDENT SURGERY FOR SINGLE LEVEL DISC

A 25-year-old professional soccer player is involved in a motor vehicle crash, sustaining an acute C6–7 disc prolapse with radiculopathy (figs 1 and 2). He undergoes C6–7 anterior cervical discectomy and fusion. Postoperatively he is neurologically intact. Three months have now passed and you are asked to provide your expert opinion. What recommendations do you make, based on the following considerations?

  1. Can the patient return to play?

  2. If so, when? Do you place any restrictions on him and is there any further follow-up that you require?

  3. If you determine that he may not return to play, please explain your reasons for this) If you review him 12 months after surgery and plain x-ray of the cervical spine shows solid fusion, with stable flexion extension x-rays of the cervical spine, would this alter your decision? Are there any other factors that would alter your decision?

Figure 1

Sagittal T2-weighted MRI scan of …

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