Management of thoracic spinal cord injury in a professional American football athlete: illustrative case.

Joseph C Maroon,Vikas Agarwal,David O Okonkwo,Amanda L Harrington,Andrew Faramand,Nitin Agarwal,John Norwig

doi:10.3171/case21206

Abstract

BACKGROUNDA case of catastrophic thoracic spinal cord injury (SCI) sustained by a professional American football player with severe scoliosis is presented.OBSERVATIONSA 25-year-old professional football player sustained an axial loading injury while tackling. Examination revealed a T8 American Spinal Injury Association Impairment Scale grade A complete SCI. Methylprednisolone and hypothermia protocols were initiated. Computed tomography scan of the thoracic spine demonstrated T8 and T9 facet fractures on the left at the apex of a 42° idiopathic scoliotic deformity. Magnetic resonance imaging (MRI) demonstrated T2 spinal cord hyperintensity at T9. He regained trace movement of his right lower extremity over 12 hours, which was absent on posttrauma day 2. Repeat MRI revealed interval cord compression and worsening of T2 signal change at T7-T8 secondary to hematoma. Urgent decompression and fusion from T8 to T10 were performed. Additional treatment included high-dose omega-3 fatty acids and hyperbaric oxygen therapy. A 2-month inpatient spinal cord rehabilitation program was followed by prolonged outpatient physical therapy. He currently can run and jump with minimal residual distal left lower limb spasticity.LESSONSThis is the first known football-related thoracic SCI with idiopathic scoliosis. Aggressive medical and surgical intervention with intensive rehabilitation formed the treatment protocol, with a favorable outcome achieved.

Highlights

A case of catastrophic thoracic spinal cord injury (SCI) sustained by a professional American football player with severe scoliosis is presented.OBSERVATIONS A 25-year-old professional football player sustained an axial loading injury while tackling
We present the case of a catastrophic thoracic SCI
Immediate surgery was not performed because there was no active neural element compression, and the spinal column fracture pattern was not considered unstable

Summary

BACKGROUND

A case of catastrophic thoracic spinal cord injury (SCI) sustained by a professional American football player with severe scoliosis is presented. ABBREVIATIONS AIS = American Spinal Injury Association Impairment Scale; ATA = atmopsheres absolute; DHA = docosahexaenoic acid; EPA = eicosapentaenoic acid; HBOT = hyperbaric oxygen therapy; IPR = inpatient rehabilitation; ISNCSCI = International Standards for Neurological Classification of Spinal Cord Injury; MEP =. Motor evoked potential; MRI = magnetic resonance imaging; NFL = National Football League; PT = physical therapy; SCI = spinal cord injury; SSEP = somatosensory evoked potential. On posttrauma day 1, neurological examination revealed 2/5 strength with right hip, knee, plantar flexion, and right extensor hallucis longus on the British Medical Research Council motor grading scale He regained proprioception in the right great toe. Foot orthosis to the use of an external electrical stimulation system for dorsiflexion, which was later discontinued His 1-year ISNCSCI examination revealed normal lower extremity motor scores and mild sensory impairment, graded at T10 AIS D. At 12 and 24 months after injury, longcassette scoliosis radiographs confirmed no further progression of his idiopathic thoracic dextroscoliosis

Discussion

Findings

Disclosures