spine sports injuries - utosm · spine sports injuries michael h. ford md frcsc integrated spine...
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Spine Sports Injuries
Michael H. Ford MD FRCSC
Integrated Spine Unit
Sunnybrook Health Sciences Centre
Objectives
• Establish the extent of the problem.
• Review of etiologies.
• Pre-and post hospital care.
• Assessment routine.
• Appropriate choice of investigations.
• Appropriate care
Extent of the Problem
• There is very little data on non-spinal cord
injuries.
• American football, rugby, ice hockey,
gymnastics ,wrestling, diving, cheerleading
• In Ontario, snowmobiling, cycling,ice
hockey, skiing
Etiology
• Muscular strain.
• Degenerative
• Stress fracture.
• Fractures/dislocations.
• Spondylolysis/spondylolisthesis.
• Cord/root contusion.
• Non-spondylotic (renal contusion etc.)
Etiology
• Muscular strain.
Probably over diagnosed.
Most cases are in fact, degenerative
etiology mechanical low back pain.
Tends to be self-limiting.
Etiology
• Degenerative
Most often spontaneous in onset or initiated
by a very minor event.
Diagnosis is made by history and physical
examination.
“ Pattern of pain” is very important here in
establishing a diagnosis.
Significant variance from the established
patterns of pain should prompt aggressive
investigation.
Athletes have tumors too!
Back Dominant Leg Dominant
Pain Patterns
I II III IV
Constant Intermittent Constant Intermittent
Flexion:
-Discogenic
Extension:
-Facet OA
-Spondy
Radicular:
-HNP
Neurogenic:
-Stenosis
Individualized Treatment
Etiology
• Stress fracture.
Most commonly sacral or sacral facet.
More common in females.
Especially triathletes
Fractures/Dislocations
• This is the most feared category of spinal
injury.these are the injuries most commonly
associated with a spinal cord injury.
Prehospital stabilization avoiding secondary
injury is the key. It is particularly
problematic in the athlete in full equipment.
Early facemask removal is strongly
recommended for airway access. Removal
of the helmet and shoulder pads is required
prior to CT/ MRI imaging.
Spondylolysis
• Acute pars defect in the pediatric population
is typically associated with a positive
SPECT scan and has a CT scan
appearance of an acute fracture. This can
be dealt with conservatively with bracing.
The incidence of failure, however, is high. A
negative bone scan and the CT appearance
of a chronic defect in the absence of a slip
can be treated with a direct repair.
Spondylolysis
• A pars defect can be unilateral. It is usually
associated with sclerosis of the contralateral
pars and can with time going on to become
a bilateral defect.
Spondylolisthesis
• Low-grade slips can be asymptomatic.
High-grade slips tend to be more
symptomatic. Maintaining a high level of
physical fitness has been demonstrated to
be an effective conservative treatment for
spondylolisthesis. Surgical management is
elective and typically entails a posterior
instrumented fusion with an interbody cage.
Cord/RootContusion
Central cord syndrome.
This is typically associated with a contusion to
the spinal cord in the setting of cervical
canal stenosis. The cord injury picture is
one of a partial or incomplete injury with
greater involvement of the upper extremities
than the lower extremities. It is associated
with subsequent neurologic improvement of
varying degrees.
Stingers
• This phenomenon is characterized by
transient radicular symptoms typically after
significant contact. It is felt that they
represent a contusive injury to roots/brachial
plexus. They are typically associated with a
good prognosis and do not represent a
significant barrier to return to play. Imaging
to rule out significant cervical canal stenosis
is recommended. In the presence of
significant canal stenosis than caution with
respect to recommendations to return to
play is strongly indicated.
Special Olympics Athletes
• Down syndrome has a high incidence of C1-
C2 instability secondary to incomplete
formation of the odontoid (10-40%). Despite
this, however, progression to gross
instability and subsequent neurologic deficit
is extremely rare. It’s felt that they do not
need to be excluded from sport.
Return to Play
• There is strong evidence to suggest that
return to play after a lumbar disc herniation
treated either surgically or conservatively is
associated with a good long-term outcome.
Similar findings have been noted in those
individuals who have had a cervical disc
herniation. There is even strong evidence to
suggest that return to play after an anterior
cervical decompression and fusion is within
reason. Those individuals, however, with a
history of cord contusion with significant
canal stenosis should be excluded from
return to contact sports.