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Unusual High Risk College Football Injury: What The Heck? It Was The Neck? - Page #4
 

Working Diagnosis:
1. Ligamentous injury involving right alar ligament, transverse ligament, and posterior interspinous ligament at C1-C2.
2. Traumatic left disc extrusion at C2-C3.

Treatment:
He was treated non-operatively and placed in a cervical collar, which was to be worn at all times.

Outcome:
The patient returned for follow-up neurosurgical evaluation two weeks after being placed in the collar. He reported complete resolution of neck pain and continued to deny any neurologic symptoms. The follow up plain films showed loss of normal lordosis; however, no further C1-C2 subluxation was noted on neutral lateral x-ray. Case Photo #8 Conservative management with cervical collar was continued on discharge.

Author's Comments:
The craniocervical junction (CCJ) is stabilized by several ligaments, the strongest of which include the transverse and alar ligaments. Injury to these ligaments can result in CCJ instability. The athlete also sustained a C2-C3 disc extrusion, causing cord impingement. Herniation at this level is rare, especially in young patients. High c-spine instability and herniation can result in paralysis and cardiorespiratory compromise, so prompt diagnosis is key. CT and dynamic XR can assess for C1-C2 stability. MRI can evaluate for spinal cord pathology. Immediate c-spine immobilization is imperative. The degree of stability and cord injury determine whether management is surgical or conservative.

Editor's Comments:
As sports medicine physicians is important to be ready to identify c-spine injuries on the field and have a team approach for management and transport, however this case is a reminder that significant c-spine injuries will not always present acutely on the field and a high level of suspicion can be important even days later. In the office Xrays are usually available and may be able to identify cervical spine instability, however if concern remains very high more advanced imaging with CT and/or MRI is recommended.

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