Neck Injury - Rugby

Abstract

HISTORY: A 19-year-old rugby player sustained a neck injury while tackling. The mechanism of injury involved axial compression followed by lateral flexion of the neck. He suffered no loss of consciousness and immediately reported bilateral parasthesia of the upper limbs with no associated neck pain. His cervical spine was stabilised and the player was removed from the field in a spine board. PHYSICAL EXAMINATION: His symptoms lasted approximately 45 seconds and by the time he arrived in the medical room for secondary examination, he had no residual symptoms of parasthesia. The athlete was non tender on palpation of the cervical spinous processes, his neck movements were within normal range and no specific neurological symptoms were noted on flexion, extension or lateral rotation. He had normal sensation, reflexes and strength of his upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Cervical Spinal Cord Injury 2. Cervical Disc Lesion 3. Cervical Spondylosis TESTS AND RESULTS: XRAY showed no obvious structural lesions, no fractures, subluxations, or displaced vertebrae. MRI and myelogram confirmed bulging intervertabrael discs at C3/4, C4/5 and C5/6 level. Central disc herniation and an annular tear was noted at C4/5. There was no CSF anteriorly over C4-C6. Measurement of his spinal canal diameter on these levels indicated a width of 8-10mm. He had a reduced TORG ratio of 0.6. FINAL/WORKING DIAGNOSIS: Congenital Cervical Stenosis TREATMENT AND OUTCOMES: The player consulted two orthopedic spine specialists for opinion and was advised to discontinue rugby and refrain from any future participation in contact sport. Although the athlete experienced no further symptoms, athletes who have cervical spine stenosis are at increased risk for serious nerve injuries. On further enquiry, the athlete reported a 2 year history of intermittent symptoms following rugby-related neck trauma. A history of recurrent episodes of temporary paraplegia or quadriplegia is an ominous sign and justifies the decision to withdraw the athlete from future participation in contact sport.