The Journal of Bone and Joint Surgery, Vol 68, Issue 9 1354-1370, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Neurapraxia of the cervical spinal cord with transient quadriplegia

JS Torg, H Pavlov, SE Genuario, B Sennett, RJ Wisneski, BH Robie and C Jahre

The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				G Clewer, M Carmont, and D Jaffray Spontaneous tetraplegia during weight training Br. J. Sports Med., December 1, 2006; 40(12): 1011 - 1012. [Abstract] [Full Text] [PDF]

				B. P. Boden, R. L. Tacchetti, R. C. Cantu, S. B. Knowles, and F. O. Mueller Catastrophic Cervical Spine Injuries in High School and College Football Players Am. J. Sports Med., August 1, 2006; 34(8): 1223 - 1232. [Abstract] [Full Text] [PDF]

				B. P. Boden Direct Catastrophic Injury in Sports J. Am. Acad. Ortho. Surg., November 1, 2005; 13(7): 445 - 454. [Abstract] [Full Text] [PDF]

				T. Cochrane and J. D. Schmahmann Compressive myelopathy presenting as cervical cord neurapraxia: A differential diagnosis of TIA Neurology, October 11, 2005; 65(7): 1140 - 1141. [Full Text] [PDF]

				F J Andrews Transient cervical neurapraxia associated with cervical spine stenosis Emerg. Med. J., March 1, 2002; 19(2): 172 - 173. [Abstract] [Full Text] [PDF]

				J. T. Guille and H. H. Sherk Congenital Osseous Anomalies of the Upper and Lower Cervical Spine in Children J. Bone Joint Surg. Am., February 1, 2002; 84(2): 277 - 288. [Full Text] [PDF]

				J. S. Torg, J. T. Guille, and S. Jaffe Injuries to the Cervical Spine in American Football Players J. Bone Joint Surg. Am., January 1, 2002; 84(1): 112 - 122. [Full Text]

				J. C. Wang, S. L. Nuccion, J. E. Feighan, B. Cohen, F. J. Dorey, and P. V. Scoles Growth and Development of the Pediatric Cervical Spine Documented Radiographically J. Bone Joint Surg. Am., August 1, 2001; 83(8): 1212 - 1218. [Abstract] [Full Text]

				J. Berge, B. Marque, J.-M. Vital, J. Senegas, and J.-M. Caille Age-Related Changes in the Cervical Spines of Front-Line Rugby Players Am. J. Sports Med., July 1, 1999; 27(4): 422 - 429. [Abstract] [Full Text] [PDF]

				F. P. Castro Jr, J. Ricciardi, M. E. Brunet, M. T. Busch, and T. S. Whitecloud Stingers, the Torg Ratio, and the Cervical Spine Am. J. Sports Med., September 1, 1997; 25(5): 603 - 608. [Abstract] [PDF]

				J. S. TORG, R. J. NARANJA JR., H. PAVLOV, B. J. GALINAT, R. WARREN, and R. A. STINE The Relationship of Developmental Narrowing of the Cervical Spinal Canal to Reversible and Irreversible Injury of the Cervical Spinal Cord in Football Players. An Epidemiological Study J. Bone Joint Surg. Am., September 1, 1996; 78(9): 1308 - 14. [Abstract] [Full Text]

				S. A. Meyer, K. R. Schulte, J. J. Callaghan, J. P. Albright, J. W. Powell, E. T. Crowley, and G. Y. El-Khoury Cervical Spinal Stenosis and Stingers in Collegiate Football Players Am. J. Sports Med., March 1, 1994; 22(2): 158 - 166. [Abstract] [PDF]

				J. S. Torg, B. Sennett, H. Pavlov, M. R. Leventhal, and S. G. Glasgow Spear tackler's spine: An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs Am. J. Sports Med., September 1, 1993; 21(5): 640 - 649. [Abstract] [PDF]

				A. T. Scher Spinal cord concussion in rugby players Am. J. Sports Med., September 1, 1991; 19(5): 485 - 488. [Abstract] [PDF]

				J. M. Odor, R. G. Watkins, W. H. Dillin, S. Dennis, and M. Saberi Incidence of cervical spinal stenosis in professional and rookie football players Am. J. Sports Med., September 1, 1990; 18(5): 507 - 509. [Abstract] [PDF]