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Patel PD, Divi SN, Canseco JA, Donnally CJ, Galetta M, Vaccaro A, Schroeder GD, Hsu WK, Hecht AC, Dossett AB, Dhanota AS, Prasad SK, Vaccaro AR. Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes. Clin Spine Surg 2022; 35:241-248. [PMID: 34379610 DOI: 10.1097/bsd.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.
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Affiliation(s)
- Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Matthew Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Wellington K Hsu
- Department of Orthopaedic Srugery, Northwestern University, Chicago, IL
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew B Dossett
- Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, TX
| | - Arsh S Dhanota
- Department of Sports Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Srivinas K Prasad
- Department of Neurosurgery, Thomas Jefferson University, Phiadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
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Self M, Mooney JH, Amburgy J, Houston JT, Hadley MN, Sicking D, Walters BC. Chasing the Cup: A Comprehensive Review of Spinal Cord Injuries in Hockey. Cureus 2022; 14:e24314. [PMID: 35602828 PMCID: PMC9122105 DOI: 10.7759/cureus.24314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/05/2022] Open
Abstract
Ice hockey is a high-speed sport with a high rate of associated injury, including spinal cord injury (SCI). The incidence of hockey-related SCI has increased significantly in more recent years. A comprehensive literature search was conducted with the PubMed, Medline, Google Scholar, and Web of Science databases using the phrases “hockey AND spinal cord injuries” to identify relevant studies pertaining to hockey-related SCIs, equipment use, anatomy, and biomechanics of SCI, injury recognition, and return-to-play guidelines. Fifty-three abstracts and full texts were reviewed and included, ranging from 1983 to 2021. The proportion of catastrophic SCIs is high when compared to other sports. SCIs in hockey occur most commonly from a collision with the boards due to intentional contact resulting in axial compression, as well as flexion-related teardrop fractures that lead to spinal canal compromise and neurologic injury. Public awareness programs, improvements in equipment, and rule changes can all serve to minimize the risk of SCI. Hockey has a relatively high rate of associated SCIs occurring most commonly due to flexion-distraction injuries from intentional contact. Further investigation into equipment and hockey arena characteristics as well as future research into injury recognition and removal from and return to play is necessary.
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Giannuzzi AP, De Simone A, Ricciardi M. Spontaneous nervous system concussion in dogs: a description of two cases and a review of terminology in veterinary medicine. Open Vet J 2017; 7:306-312. [PMID: 29138745 PMCID: PMC5681728 DOI: 10.4314/ovj.v7i4.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
In human medicine, central nervous system (CNS) concussion is defined as a transient neurological dysfunction following a traumatic event, without evidence of structural abnormalities of the affected region on advanced diagnostic imaging. Depending on the anatomical region involved, three forms of concussive syndromes are described: brain concussion, spinal concussion and cerebellar concussion. Although major textbooks of veterinary neurology admit the existence of canine brain concussion, spontaneous cases of this pathological condition have not been reported in small animals so far. This report describes two cases of concussion in dogs: a 9-month-old, intact male, shih-tzu with brain concussion; and a 10-month-old, intact male, poodle with cerebellar concussion. In addition, a brief review of the definition of the term “concussion” in the veterinary medical literature is provided, in comparison to its meaning in the human medical literature. Finally, this paper proposes an appropriate definition of “concussion” in dogs, that may facilitate clinicians in the recognition of such an elusive syndrome.
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Affiliation(s)
| | | | - Mario Ricciardi
- "Pingry" Veterinary Hospital, via Medaglie d'Oro 5, Bari, Italy
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Abstract
Cervical spine trauma in the athlete is not an insignificant occurrence with possibly catastrophic results. Football remains one of the most common and most well studied sporting activities associated with spine injuries. Transient spinal cord and peripheral nerve injuries may manifest as quadriparesis or burners/stingers with symptoms that resolve completely. More severe spinal cord injuries, typically from axial loading on the cervical spine, will cause bilateral symptoms with residual neurological deficit. Acute Trauma Life Support principles must always be applied to the player with a potential spine injury. Recent positional statements by National Athletic Trainers' Association advocate equipment removal on the field by 3 individuals with appropriate training, a shift from previous recommendations. This recommendation is still under debate, but equipment removal in the field is an option depending on staff training. The use of steroids in acute spinal cord injury remains controversial. Moderate systemic hypothermia has theoretical benefits for reducing spinal cord damage in the setting of an acute injury. Although it has been studied in the laboratory, only a few clinical trials have been performed and further research is necessary before routine implementation of hypothermia protocols.
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Nagoshi N, Tetreault L, Nakashima H, Nouri A, Fehlings MG. Return to play in athletes with spinal cord concussion: a systematic literature review. Spine J 2017; 17:291-302. [PMID: 27836772 DOI: 10.1016/j.spinee.2016.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/05/2016] [Accepted: 09/12/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a systematic review. PURPOSE The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI). BACKGROUND CONTEXT Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. METHODS We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI. RESULTS We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a "long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311). CONCLUSIONS There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.
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Affiliation(s)
- Narihito Nagoshi
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Lindsay Tetreault
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada
| | - Hiroaki Nakashima
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Aria Nouri
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building 1 King's College Circle, Room 2374, Toronto M5S 1A8, Ontario, Canada.
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Jin Y, Bouyer J, Haas C, Fischer I. Evaluation of the anatomical and functional consequences of repetitive mild cervical contusion using a model of spinal concussion. Exp Neurol 2015; 271:175-88. [PMID: 26070306 DOI: 10.1016/j.expneurol.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
Spinal cord concussion is characterized by a transient loss of motor and sensory function that generally resolves without permanent deficits. Spinal cord concussions usually occur during vehicular accidents, falls, and sport activity, but unlike brain concussions, have received much less attention despite the potential for repeated injury leading to permanent neurological sequelae. Consequently, there is no consensus regarding decisions related to return to play following an episode of spinal concussion, nor an understanding of the short- and long-term consequences of repeated injury. Importantly, there are no models of spinal concussion to study the anatomical and functional sequelae of single or repeated injury. We have developed a new model of spinal cord concussion focusing on the anatomical and behavioral outcomes of single and repeated injury. Rats received a very mild (50 kdyn, IH impactor) spinal contusion at C5 and were separated into two groups three weeks after the initial injury--C1, which received a second, sham surgery, and C2, which received a second contusion at the same site. To track motor function and recovery, animals received weekly behavioral tests--BBB, CatWalk™, cylinder, and Von Frey. Analysis of locomotor activity by BBB demonstrated that rats rapidly recovered, regaining near-normal function by one week after the first and second injury, which was confirmed using the more detailed CatWalk™ analysis. The cylinder test showed that a single contusion did not induce significant deficits of the affected limb, but that repeated injury resulted in significant alteration in paw preference, with animals favoring the unaffected limb. Intriguingly, Von Frey analysis demonstrated an increased sensitivity in the contralateral hindlimb in the C2 group vs. the C1 group. Anatomical analyses revealed that while the lesion volume of both groups was minimal, the area of spared white matter in the C2 group was significantly reduced 1 and 2mm rostral to the lesion epicenter. Reactive astrocytes were present in both groups, with the majority found at the lesion epicenter in the C1 group, whereas the C2 group demonstrated increased reactive astrocytes extending 1mm caudal to the lesion epicenter. Macrophages accumulated within the injured, dorsal and ipsilateral spinal cord, with significant increases at 2 and 3mm rostral to the epicenter in the C2 group. Our model is designed to represent the clinical presentation of spinal cord concussion, and highlight the susceptibility and functional sequelae of repeated injury. Future experiments will examine the temporal and spatial windows of vulnerability for repeated injuries.
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Affiliation(s)
- Ying Jin
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Julien Bouyer
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Christopher Haas
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Itzhak Fischer
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States.
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Tan LA, Kasliwal MK, Fontes RBV, Fessler RG. Local cooling for traumatic spinal cord injury. J Neurosurg Spine 2014; 21:845-7. [PMID: 25170650 DOI: 10.3171/2014.5.spine14472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lee A Tan
- Rush University Medical Center, Chicago, IL
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Behavioral and anatomical consequences of repetitive mild thoracic spinal cord contusion injury in the rat. Exp Neurol 2014; 257:57-69. [PMID: 24786492 DOI: 10.1016/j.expneurol.2014.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/19/2014] [Accepted: 04/20/2014] [Indexed: 01/21/2023]
Abstract
Moderate and severe spinal cord contusion injuries have been extensively studied, yet much less is known about mild injuries. Mild contusions result in transient functional deficits, proceeding to near-complete recovery, but they may render the spinal cord vulnerable to future injuries. However, to date there have been no appropriate models to study the behavioral consequences, anatomical changes, and susceptibility of a mild contusion to repeated injuries, which may occur in children as well as adults during competitive sport activities. We have developed a novel mild spinal cord contusion injury model characterized by a sequence of transient functional deficits after the first injury and restoration to near-complete motor and sensory function, which is then followed up by a second injury. This model can serve not only to study the effects of repeated injuries on behavioral and anatomical changes, but also to examine the relationship between successive tissue damage and recovery of function. In the present study, we confirmed that mild thoracic spinal cord contusion, utilizing the NYU impactor device, resulted in localized tissue damage, characterized by a cystic cavity and peripheral rim of spared white matter at the injury epicenter, and rapid functional recovery to near-normal levels utilizing several behavioral tests. Repeated injury after 3weeks, when functional recovery has been completed, resulted in worsening of both motor and sensory function, which did not recover to prior levels. Anatomical analyses showed no differences in the volumes of spared white matter, lesion, or cyst, but revealed modest extension of lesion area rostral to the injury epicenter as well as an increase in inflammation and apoptosis. These studies demonstrate that a mild injury model can be used to test efficacy of treatments for repeated injuries and may serve to assist in the formulation of policies and clinical practice regarding mild SCI injury and spinal concussion.
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