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

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

Extent of the Problem

Extent of the Problem

Extent of the Problem

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

Etiology

• Fractures/dislocations

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.

Etiology

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.

Spondylolysis

Spondylolysis

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.

Spondylolisthesis

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.

Non-Spondylotic Causes

• Renal contusion.

• Visceral injury i.e., spleen, adrenals

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.

Return to Play

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