SPINAL CORD CONCUSSION - Calgary...
Transcript of SPINAL CORD CONCUSSION - Calgary...
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SPINAL CORD CONCUSSION
Stephan du Plessis MD
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CASE PRESENTATION
• 23 yo Varsity Defensive Back• Tackled with neck in extension• Unable to walk from field
• No movement in arms or legs• No sensation below neck
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CASE PRESENTATION
2 hours later• Reports mild neck stiffness• Denies weakness, mild parasthesias left in
fingers and toesO/E• Tone, power, coordination, reflexes normal• Sensation and gait normal, full neck ROM
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CASE PRESENTATION
• Honors student – 4.0 grade point average• Excellent athlete – pro football career likely• Desperately wants to play football
• Coach and team bring him in for an opinion
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Spinal Cord Concussion
• Aka Cervical Cord Neurapraxia, Transient quadra- or para-plegia
Clinical Presentation• Neck injury in an athlete• Abrupt onset of transient neurological
deficit localized to the spinal cord
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Spinal Cord Concussion
Clinical Presentation• Symptoms may involve:
both armsboth legsall four extremitiesipsilateral arm and leg
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Spinal Cord Concussion
Clinical Presentation• Sensory symptoms
burning painnumbnesstingling
• Motor changes (+/-)weaknessparalysis
• Durationmost < 15 minutessome < 48 hours
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Spinal Cord Concussion
KEY FEATURE• Complete return of motor function,
resolution of sensory symptoms, and full, pain-free spinal range of motion
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Spinal Cord Concussion
CLASSIFICATIONPattern• Quadri-• Para-• Hemi –
Grade• I <15 minutes• II 15 minutes – 24
hours• III >24 hours
Type• Plegic > Paresthetic > Paretic
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Spinal Cord Concussion
PATHOPHYSIOLOGY
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Spinal Cord Concussion
PATHOPHYSIOLOGY - mechanicalClinical Structural
Compression + +Deceleration -Shear -Distraction -Laceration -Contusion -
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Cervical cord neurapraxia: classification, patho-mechanics, morbidity, and management guidelines
Joseph S. Torg, M.D., Thomas A. Corcoran, M.D., Lawrence E. Thibault, Sc.D., Helen Pavlov, M.D., Brian J. Sennett, M.D., R. John Naranja, Jr., M.D.,and Steven Priano, M.D.
Departments of Orthopedic Surgery and Neurosurgery, Allegheny University for the Health Sciences, Philadelphia, Pennsylvania; and Department of Radiology, The Hospital for Special Surgery, New York, New York
J Neurosurg 87:843-850, 1997
Key words: cervical spine, neurapraxia, transient quadriplegia, spinal stenosis
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Materials and Methods
Study Population• 110 patients (1
female)• Average Age 21 (13-
33)• All injuries during
sports related activities
Sports Activities87% football5% basketball2% hockey2% wrestling4% other
Torg et al., J Neurosurg 87:843-850, 1997
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Materials and Methods
Follow-Up• 105 of 110 patients (95%)• Range 12 months – 19 years
for those returning to sports(including min 1 athletic season)
Torg et al., J Neurosurg 87:843-850, 1997
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Results
Patient Outcome• No permanent or catastrophic neurological
injuries• 1 Patient suffered a neurological deficit as a
result of surgical intervention
Torg et al., J Neurosurg 87:843-850, 1997
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Results
Radiographic Workup – Plain X-Rays• Cervical Stenosis 86%• Osteophyte Ridging 50%• Degenerative Disc(s) 28%• Loss of Lordosis 21%
• Normal 7%
104/110 patientsAge 13-33, mean 21
Torg et al., J Neurosurg 87:843-850, 1997
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Results
Radiographic Workup – MRI (53/110)
• Disc Bulge 81%• Osteophyte Ridging 55%• Foraminal Compromise 47%• Disc Protrusion 36%
• Normal 8%
53/110 patientsAge 13-33, mean 21
Torg et al., J Neurosurg 87:843-850, 1997
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Inci
denc
e (%
)
0
20
40
60
80
100
Arm
s
Legs
Ipsi
late
ral
Arm
+ L
eg
Spinal Cord Concussion - Presentation
Torg et al., J Neurosurg87:843-850, 1997
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grade 3grade 2
grade 1total
0102030405060708090
100
Torg et al.,J Neurosurg 87:843-850, 1997
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RETURN TO PLAY
• 38% retired after 1st episode (42/110)
• 15% retired after 2nd episode (17/110)
• 23% returned with no recurrence (25/110 – mean f/u 43 mo)
• 14% continued despite recurrence (15/110 – mean f/u 35 mo)
• 57% returned to contact activities (63/110)
• 56% experienced a recurrent episode (35/63)Torg et al., J Neurosurg 87:843-850, 1997
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PREDICTORS OF RECURRENCE
• Return to Football• Narrow Spinal Canal (SC/VB ratio and MRI Space Available
for Cord)
Non-Predictive• Age, level of participation, radiographic
and MRI pathology, clinical presentation
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CONCLUSIONS
SPINAL CORD CONCUSSION• By definition Spinal Cord Concussion is a
completely reversible neurological event• SCC tends to happen in athletes,
particularly those involved with high impact sports
• SCC correlates with radiographic canal stenosis
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CONCLUSIONS
RETURN TO PLAY• Decision based on individual circumstances
and best available (Class III) evidence• Approximate 56% incidence of SCC
recurrence• No known incidence of permanent
neurological deficit
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