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SPINE Injuries in Sport

SPINE Injuries in Sport

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Published by Surgicalgown
SPINE



Update 2008:

Surgeons are now more aggressive in managing vertebral fractures rather than accepting compressed fractures as newer forms of ORIF allow more stable fixation.

MIS kyphoplasty/vertebroplasty are now being used for the reduction and fixation of vertebral fractures. The current filler is cement but newer bone substitutes are also being trialed.

Introduction

Evaluation

history
Physical examination
Soft Tissue Injuries

sprains
ligamentous injuries
stinger/burner syndrome
intervertebral disc lesions
transient quadriplegia
spear/tackler’s spine
Fractures and Dislocations

cervical
thoracic-lumbar
Spondylolysis/Spondylolisthesis

Vertebral apophysitis

Congenital/Developmental Disorders

Prevention of Cervical Spine Injuries

Return to Play Guidelines



Introduction

During the past 20 years, there has been a significant increase in participation in competitive and recreational sporting activities. This has led to an increased incidence of injury. Fortunately, injuries to the spine occur infrequently. Less than 10% of reported sports-related muscular-skeletal injuries involve the spine. However, these injuries are potentially devastating to the sportsperson (Fig. 1). Football, water sports (particularly diving), and trampolining are the commonest causes of sporting-related spinal injuries (Fig. 2).

Correct evaluation and diagnosis is the key to appropriate treatment and prevention of potentially devastating consequences of spinal column injuries.

1

Evaluation

The evaluation of an injured spine in a sportsperson requires that a detailed history and physical examination be performed (Fig.).

History

Mechanism of injury
Pain profile
Site
Character and severity of pain
Frequency
Radiation
Exacerbating/relieving factors
Symptoms of nerve root/spinal cord compression
Recent alteration in activity level, training technique or equipment
Systemic symptoms
Disability


Clinical Examination

Key: Examine and look for areas of tenderness as sign of injury.

The spine should be examined posteriorly, to evaluate the posture and structural deformities. Cutaneous lesions such as midline dimple or neurofibroma should be noted as they may be associated with underlying spinal abnormality. Palpation will determine local tenderness and is helpful in the assessment of muscle spasm and spinal alignment. The range of motion of the spine and its rhythm and any pain reduction should be noted. In the lumbar spine, the neural tension signs (straight leg raising test, Lasegue test, crossed straight leg raising test and femoral nerve stretch test) should be elicited. In the cervical spine, extension combined with rotation may precipitate radicular pain or symptoms in patients with cervical disc protrusion or spondylosis. Complete neurological examination is mandatory as is assessment of gait. In suspected lumbar spinal injuries, examination of the abdomen and hips is essential, as symptoms arising from these regions can be misinterpreted as arising from the lumbar spine.

Radiological Investigation

Major advances have occurred in the radiological evaluation of spinal disorders with imaging modalities such as computed tomography and magnetic resonance imaging. To gain maximum information, the imaging techniques must be used appropriately.

Plain Radiographs

A very useful tool in the initial. Imaging of spinal trauma. Assessment of vertebral alignment, fractures and ligamentous injury. Adequate cervical spine radiographs must include C1 – T1. Spinal canal narrowing and congenital fusions can be assessed.

Flexion and extension views will reveal instability,

Congenital Cervical Spinal Canal Stenosis

Athletes with congenital canal narrowing are more susceptible to spinal cord injury, even in the presence of minor disc protrusion or subluxation. Assessment of canal dimensions with Torg’s canal to vertebral body with
SPINE



Update 2008:

Surgeons are now more aggressive in managing vertebral fractures rather than accepting compressed fractures as newer forms of ORIF allow more stable fixation.

MIS kyphoplasty/vertebroplasty are now being used for the reduction and fixation of vertebral fractures. The current filler is cement but newer bone substitutes are also being trialed.

Introduction

Evaluation

history
Physical examination
Soft Tissue Injuries

sprains
ligamentous injuries
stinger/burner syndrome
intervertebral disc lesions
transient quadriplegia
spear/tackler’s spine
Fractures and Dislocations

cervical
thoracic-lumbar
Spondylolysis/Spondylolisthesis

Vertebral apophysitis

Congenital/Developmental Disorders

Prevention of Cervical Spine Injuries

Return to Play Guidelines



Introduction

During the past 20 years, there has been a significant increase in participation in competitive and recreational sporting activities. This has led to an increased incidence of injury. Fortunately, injuries to the spine occur infrequently. Less than 10% of reported sports-related muscular-skeletal injuries involve the spine. However, these injuries are potentially devastating to the sportsperson (Fig. 1). Football, water sports (particularly diving), and trampolining are the commonest causes of sporting-related spinal injuries (Fig. 2).

Correct evaluation and diagnosis is the key to appropriate treatment and prevention of potentially devastating consequences of spinal column injuries.

1

Evaluation

The evaluation of an injured spine in a sportsperson requires that a detailed history and physical examination be performed (Fig.).

History

Mechanism of injury
Pain profile
Site
Character and severity of pain
Frequency
Radiation
Exacerbating/relieving factors
Symptoms of nerve root/spinal cord compression
Recent alteration in activity level, training technique or equipment
Systemic symptoms
Disability


Clinical Examination

Key: Examine and look for areas of tenderness as sign of injury.

The spine should be examined posteriorly, to evaluate the posture and structural deformities. Cutaneous lesions such as midline dimple or neurofibroma should be noted as they may be associated with underlying spinal abnormality. Palpation will determine local tenderness and is helpful in the assessment of muscle spasm and spinal alignment. The range of motion of the spine and its rhythm and any pain reduction should be noted. In the lumbar spine, the neural tension signs (straight leg raising test, Lasegue test, crossed straight leg raising test and femoral nerve stretch test) should be elicited. In the cervical spine, extension combined with rotation may precipitate radicular pain or symptoms in patients with cervical disc protrusion or spondylosis. Complete neurological examination is mandatory as is assessment of gait. In suspected lumbar spinal injuries, examination of the abdomen and hips is essential, as symptoms arising from these regions can be misinterpreted as arising from the lumbar spine.

Radiological Investigation

Major advances have occurred in the radiological evaluation of spinal disorders with imaging modalities such as computed tomography and magnetic resonance imaging. To gain maximum information, the imaging techniques must be used appropriately.

Plain Radiographs

A very useful tool in the initial. Imaging of spinal trauma. Assessment of vertebral alignment, fractures and ligamentous injury. Adequate cervical spine radiographs must include C1 – T1. Spinal canal narrowing and congenital fusions can be assessed.

Flexion and extension views will reveal instability,

Congenital Cervical Spinal Canal Stenosis

Athletes with congenital canal narrowing are more susceptible to spinal cord injury, even in the presence of minor disc protrusion or subluxation. Assessment of canal dimensions with Torg’s canal to vertebral body with

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Published by: Surgicalgown on Jun 06, 2009
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02/03/2013

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SPINE
 
Update 2008:Surgeons are now more aggressive in managing vertebral fractures rather thanaccepting compressed fractures as newer forms of ORIF allow more stablefixation.MIS kyphoplasty/vertebroplasty are now being used for the reduction and fixationof vertebral fractures. The current filler is cement but newer bone substitutes arealso being trialed.
IntroductionEvaluation
history
 
Physical examination
 
Soft Tissue Injuries
sprains
 
ligamentous injuries
 
stinger/burner syndrome
 
intervertebral disc lesions
 
transient quadriplegia
 
spear/tackler’s spine
 
Fractures and Dislocations
cervical
 
thoracic-lumbar
 
Spondylolysis/SpondylolisthesisVertebral apophysitisCongenital/Developmental DisordersPrevention of Cervical Spine InjuriesReturn to Play Guidelines
 
Introduction
During the past 20 years, there has been a significant increase in participation incompetitive and recreational sporting activities. This has led to an increased incidence of injury. Fortunately, injuries to the spine occur infrequently. Less than 10% of reportedsports-related muscular-skeletal injuries involve the spine. However, these injuries are
 
potentially devastating to the sportsperson (Fig. 1). Football, water sports (particularlydiving), and trampolining are the commonest causes of sporting-related spinal injuries (Fig.2).Correct evaluation and diagnosis is the key to appropriate treatment and prevention of potentially devastating consequences of spinal column injuries.1
Evaluation
The evaluation of an injured spine in a sportsperson requires that a detailed history andphysical examination be performed (Fig.).
History
Mechanism of injury
 
Pain profile
 
Site
 
Character and severity of pain
 
Frequency
 
Radiation
 
Exacerbating/relieving factors
 
Symptoms of nerve root/spinal cord compression
 
Recent alteration in activity level, training technique or equipment
 
Systemic symptoms
 
Disability
 
Clinical ExaminationKey: Examine and look for areas of tenderness as sign of injury.
The spine should be examined posteriorly, to evaluate the posture and structuraldeformities. Cutaneous lesions such as midline dimple or neurofibroma should be noted asthey may be associated with underlying spinal abnormality. Palpation will determine localtenderness and is helpful in the assessment of muscle spasm and spinal alignment. Therange of motion of the spine and its rhythm and any pain reduction should be noted. In thelumbar spine, the neural tension signs (straight leg raising test, Lasegue test, crossedstraight leg raising test and femoral nerve stretch test) should be elicited. In the cervicalspine, extension combined with rotation may precipitate radicular pain or symptoms inpatients with cervical disc protrusion or spondylosis. Complete neurological examination ismandatory as is assessment of gait. In suspected lumbar spinal injuries, examination of the
 
abdomen and hips is essential, as symptoms arising from these regions can bemisinterpreted as arising from the lumbar spine.
Radiological Investigation
Major advances have occurred in the radiological evaluation of spinal disorders with imagingmodalities such as computed tomography and magnetic resonance imaging. To gainmaximum information, the imaging techniques must be used appropriately.
Plain Radiographs
A very useful tool in the initial. Imaging of spinal trauma. Assessment of vertebralalignment, fractures and ligamentous injury. Adequate cervical spine radiographs mustinclude C1 – T1. Spinal canal narrowing and congenital fusions can be assessed.Flexion and extension views will reveal instability,
Congenital Cervical Spinal Canal Stenosis
Athletes with congenital canal narrowing are more susceptible to spinal cord injury, even inthe presence of minor disc protrusion or subluxation. Assessment of canal dimensions withTorg’s canal to vertebral body with ratio eliminates magnification effect. The normal ratio is1:1.A spinal canal is narrow if this ratio is less than 0.8 at C3-C6 (Figs. 4 and 5).
Computed tomography
Provides useful assessment of fractures/dislocations including number, size and position of bony fragments. Aids in surgical planning. Spinal canal contents are poorly visualized. CRrarely depicts disc protrusion in the cervical spine. CT/myelography may be used tovisualize compressive lesions when MRI is unavailable.
 
MRI
MRI with its multi-planar capabilities and superb soft tissue contrast is the modality of choice to investigate suspected spinal cord, disc or ligamentous injuries. Assessment withMRI for disc protrusion is essential in bilateral facet joint dislocations to prevent possiblecord compression by disc material prolapsed behind the vertebral body following reductionof the dislocation.
Bone Scan
This investigation may be useful in cases of unexplained pain – occult fracture, infection,tumour. However, bone scanning lacks specificity.
Injury Classification
The majority of sports-related injuries to the spine occur in the cervical region. Injuries maybe classified as follows:1. Soft tissue injuries
sprains
 

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