Cervical disc injury

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Case

A 26-year-old male professional football player presented with severe left arm pain. He was initially aware of some neck discomfort immediately following a match. Over the subsequent 48 hours he then developed severe left arm pain.

On examination the player appeared distressed. He had a global restriction in cervical movements and a positive Spurling’s test. He had 4/5 weakness of elbow flexion and wrist extension and had an absent biceps reflex on the left side.

Findings

The lateral x-ray image of the cervical spine shows a loss of the normal cervical lordosis. There is also equivocal narrowing of the C5/6 disc. The MRI images show a large left paracentral disc protrusion (9mmAP x 7mmW x 8mmH) that fills the left lateral angle of the canal and impinges on the left C6 nerve root at the inner margin of the neural foramen. A central annular tear and broad disc bulge mildly narrow the central canal, slightly indenting the ventral surface of the cord. The cord signal remains normal.

Discussion

This player was initially managed with a trial of conservative treatment. They had a short period of rest, physiotherapy treatments and used regular analgesics. A foraminal steroid injection provided temporary relief however the symptoms recurred. He eventually underwent an anterior cervical discectomy and fusion (ACDF) and returned to football approximately six months following surgery.

Cervical radiculopathy typically resolves spontaneously (90% have a resolution of symptoms at three months compared with six weeks in the lumbar spine). Adequate analgesia is needed initially as the pain can be severe. It is not uncommon for patients to require a number of different analgesics. Physiotherapy treatments can also provide symptomatic relief. A nerve root injection can also be effective, however this must be done by experienced specialists and using an image intensifier.

Surgery, usually in the form of an ACDF, is an option when there is focal neurology or persisting symptoms and failed conservative treatment. A partial discectomy and laminectomy can also be considered where there is a single-level pathology and no underlying degenerative disease. There is a faster return to sport in this situation, however, the final decision should be made by a neurologist and spinal surgeon.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Dr. Matthew Durham
02 October 2018 16:23

There should be a mandatory two week (6 treatments) trial of chiropractic care that would be discontinued if no measurable results were achieved or continued as long as improvement is present before any surgery is considered.

In 30 years of practice I have seen more than a few cases ( Cervical and Lumbar) that “needed surgery “ completely recover. If they are stable and their pain is manageable what would the downside be?

Speaking strictly financially, can you imagine what the savings would be if it were only 5% successful?

Bangoura
11 October 2018 15:07

Devant un cas de trauma cervical qu’ il soit grave ou bénin la prise en charge doit être prompte et efficace. Orienter le blessé dans un centre spécialisé. Faire une RADIOGRAPHIE NUMÉRISÉE ensuite l IRM. SI la cervicalgie n est pas grave(sans lésion osteo articulaire et neurologique).le traitement médical plus la physiothérapie peux nous aider dans le pronostic. Le trauma de la colonne cervicale est L apanage des sports de combat des accidents de la circulation du footbal SI la cervicalgie est associée de lésions osseuses et neurologiques il faut recourir a la chirurgie. Certaines lésions neurologiques sont irreverssibles(HEMIPLEGIE TETRAPLEGIE)… Read more »

Dr. Matthew Durham
02 October 2018 16:23

There should be a mandatory two week (6 treatments) trial of chiropractic care that would be discontinued if no measurable results were achieved or continued as long as improvement is present before any surgery is considered.

In 30 years of practice I have seen more than a few cases ( Cervical and Lumbar) that “needed surgery “ completely recover. If they are stable and their pain is manageable what would the downside be?

Speaking strictly financially, can you imagine what the savings would be if it were only 5% successful?

Mark Fulcher
09 October 2018 9:35

Hey Matt. Good comment. Are there enough chiropractors out there to manage that..??!! I think that the kiwi workforce would be overwhelmed! I think that it is really important to remember that the vast majority of patients with radicular pain (in both the cervical and lumbar spine) get better spontaneously over 6-12 weeks. Surgery should be reserved for those who are either in severe pain (despite treatment), have significant or evolving neurological signs or those who do not get better. This guy waited three months before he even saw a surgeon! He really wanted this to resolve and did not… Read more »

Hannan Ahmad
01 June 2020 17:48

Back pain is an extremely common fact of life. With at least 80% of Americans experiencing back pain at one time or another, chances are good that if you haven’t felt back pain yourself, you know someone who has.