Lower Cervical Posterior Element Fractures in the National Football League: A Report of 2 Cases and a Review of the Literature

Abstract BACKGROUND AND IMPORTANCE: Injuries in professional football players are common because of the nature of the collisions and the frequency of axial loading to the cervical spine. These injuries should be thoroughly evaluated because they can put the player at risk of future injury and even paralysis. The focus of this report is to present 2 cases of this injury and review the current body of literature. CLINICAL PRESENTATION: We present 2 cases of professional football players who experienced injuries to the lower posterior elements of their cervical spine simultaneously on a kickoff during a game. Both players described transient symptoms consistent with a “stinger,” which is commonly encountered. Workup revealed fractures of the lower cervical spine in both patients. One patient was able to be managed conservatively and returned to football the following season. The second patient had an unstable fracture that ultimately required operative intervention, and the patient retired from professional football. CONCLUSION: Cervical spine injuries in football players need to be adequately evaluated, and in many cases can be career threatening. We recommend that players with persistent pain after a transient neurapraxia undergo radiography and computed tomography of the cervical spine to evaluate for a fracture.

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Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00085 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Bram P Verhofste ◽

Daniel J Hedequist ◽

Craig M Birch ◽

Emily S Rademacher ◽

Michael P Glotzbecker ◽

...

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Trauma Center ◽

Youth Sports ◽

Axial Loading ◽

Permanent Disability ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Level 1

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]

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Catastrophic Cervical Spine Injuries in High School and College Football Players

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(08)70037-0 ◽

2007 ◽

Vol 2007 ◽

pp. 32-33

Author(s):

D.E. Feldman

Keyword(s):

High School ◽

Cervical Spine ◽

College Football ◽

Football Players ◽

Cervical Spine Injuries ◽

Spine Injuries

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Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

MedPulse International Journal of Radiology ◽

10.26611/101312210 ◽

2021 ◽

Vol 12 (2) ◽

pp. 92-97

Author(s):

Sushant H Bhadane ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spine ◽

Mr Imaging ◽

Neurological Deficit ◽

Spine Injury ◽

Cervical Spine Injuries ◽

Cord Injury ◽

Spine Injuries ◽

Posterior Element

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

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Cervical Spine Injuries in Football Players

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/00124635-199909000-00006 ◽

1999 ◽

Vol 7 (5) ◽

pp. 338-347 ◽

Cited By ~ 31

Author(s):

Bruce E. Thomas ◽

Geoffrey M. McCullen ◽

Hansen A. Yuan

Keyword(s):

Cervical Spine ◽

Football Players ◽

Cervical Spine Injuries ◽

Spine Injuries

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Helmet Fit and Cervical Spine Motion in Collegiate Men's Lacrosse Athletes Secured to a Spine Board

Journal of Athletic Training ◽

10.4085/1062-6050-45.3.215 ◽

2010 ◽

Vol 45 (3) ◽

pp. 215-221 ◽

Cited By ~ 9

Author(s):

Meredith A. Petschauer ◽

Randy Schmitz ◽

Diane L. Gill

Keyword(s):

Cervical Spine ◽

Range Of Motion ◽

Sports Medicine ◽

Sagittal Plane ◽

Football Players ◽

Cervical Spine Injuries ◽

Medicine Research ◽

Spine Injuries ◽

Spine Motion ◽

Spine Board

Abstract Context: Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head. Objective: To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. Design: Crossover study. Setting: Sports medicine research laboratory. Patients or Other Participants: Eighteen healthy collegiate men's lacrosse players. Intervention(s): Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. Main Outcome Measure(s): Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). Results: Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). Conclusions: Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.

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Cervical Spine Injuries in Children, Part I: Mechanism of Injury, Clinical Presentation, and Imaging

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2009.11.034 ◽

2011 ◽

Vol 41 (2) ◽

pp. 142-150 ◽

Cited By ~ 21

Author(s):

Joshua S. Easter ◽

Roger Barkin ◽

Carlo L. Rosen ◽

Kevin Ban

Keyword(s):

Cervical Spine ◽

Clinical Presentation ◽

Mechanism Of Injury ◽

Cervical Spine Injuries ◽

Spine Injuries

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Helmet and Shoulder Pad Removal in Football Players with Unstable Cervical Spine Injuries

Journal of Applied Biomechanics ◽

10.1123/jab.25.2.119 ◽

2009 ◽

Vol 25 (2) ◽

pp. 119-132 ◽

Cited By ~ 11

Author(s):

Michael C. Dahl ◽

Dheera Ananthakrishnan ◽

Gregg Nicandri ◽

Jens R. Chapman ◽

Randal P. Ching

Keyword(s):

Cervical Spine ◽

Team Sports ◽

The United States ◽

Football Players ◽

Patient Handling ◽

Lateral Direction ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Unstable Cervical Spine ◽

The Right

Football, one of the country’s most popular team sports, is associated with the largest overall number of sports-related, catastrophic, cervical spine injuries in the United States (Mueller, 2007). Patient handling can be hindered by the protective sports equipment worn by the athlete. Improper stabilization of these patients can exacerbate neurologic injury. Because of the lack of consensus on the best method for equipment removal, a study was performed comparing three techniques: full body levitation, upper torso tilt, and log roll. These techniques were performed on an intact and lesioned cervical spine cadaveric model simulating conditions in the emergency department. The levitation technique was found to produce motion in the anterior and right lateral directions. The tilt technique resulted in motions in the posterior left lateral directions, and the log roll technique generated motions in the right lateral direction and had the largest amount of increased instability when comparing the intact and lesioned specimen. These findings suggest that each method of equipment removal displays unique weaknesses that the practitioner should take into account, possibly on a patient-by-patient basis.

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