What is spinal concussion? Spinal cord concussion is a variant of mild spinal cord injury, clinically designated as transient paraplegia or neurapraxia, and characterized by variable degrees of sensory impairment and motor weakness that typically resolve within 24–72 hours without permanent deficits (Del Bigio and Johnson, 1989; Zwimpfer and Bernstein, 1990; Torg et al., 1997). Accordingly, a grading system was developed based on the duration of symptoms, ranging from Grade I ( 24 hours) (Zwimpfer and Bernstein, 1990; Torg et al., 1997). Spinal cord concussion is predominantly a sport-related injury occurring in a wide variety of contact sports in adult and pediatric athletes including wrestling, hockey, gymnastics, and diving, but most commonly in American football, although spinal concussions can also occur after minor car accidents as “whiplash injuries” and falls (Zwimpfer and Bernstein, 1990). In contact sports, the cervical spine is particularly susceptible to injury because of axial loading forces to the head with the neck in flexion or extension. In these circumstances, injury may occur due to disc herniation, buckling of the ligamentum flavum or the posterior longitudinal ligament, or by compression of the spinal cord between vertebral bodies. There appears to be a mechanistic difference in the injury between adult and pediatric age groups. In the adult, a stenotic spinal canal or a diminished spinal canal to vertebral body diameter predispose patients to cervical concussion at the level of stenosis after hyperextension, hyperflexion, or axial loading. The pediatric spine, in contrast, has increased mobility, predisposing the spinal cord to contact with bony elements even in absence of focal stenosis (Clark et al., 2011). Guidelines regarding return to play have been developed based upon the duration of neurological symptoms, neurapraxia, and MRI analysis, but they are based on a limited number of small-scale retrospective studies (Tempel et al., 2015). Given the lack of randomized trials, medical clearance of athletes for resumption of activities is a highly controversial topic without consensus opinion (Cantu, 1998; Morganti, 2003; Mayers, 2008; Harmon et al., 2013). Furthermore, many individuals may experience multiple episodes of spinal cord concussion with recurrence of symptoms (Zwimpfer and Bernstein, 1990; Torreman et al., 1996; Clark et al., 2011). It has therefore been important to develop animal models of spinal cord concussion to elucidate the histological and functional deficits of single and repeated injuries. This perspective presents our recent efforts in developing such a model and the consequences of repetitive injury (Jin et al., 2014, 2015).
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