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Cervical myelopathy is a progressive degenerative condition affecting the cervical spinal cord that results from compression of the spinal cord in the cervical region. The most common cause is cervical spondylosis, though it can also be caused by disc herniation, ossification of posterior longitudinal ligament, spinal stenosis, trauma, and tumors.
Patients typically present with neck pain, upper extremity numbness and paresthesias, weakness in arms and legs, and gait disturbances. They may also experience balance problems, fine motor skill deterioration, hand clumsiness, hyperreflexia, positive Hoffman’s sign, and positive Babinski sign. Bowel and bladder dysfunction is usually a late finding.
Diagnostic evaluation primarily relies on MRI of the cervical spine as the gold standard. Additional imaging may include CT scan for bone detail and X-rays to evaluate alignment and stability. EMG/NCS can help rule out peripheral nerve conditions, and somatosensory evoked potentials may be utilized. Classification systems include the Modified Japanese Orthopedic Association (mJOA) score and Nurick grade.
Treatment options range from conservative management to surgical intervention. Conservative management includes activity modification, physical therapy, cervical collar use, pain management, and close monitoring for progression. Surgical options include anterior cervical discectomy and fusion (ACDF), cervical corpectomy, posterior laminectomy with or without fusion, and laminoplasty. Surgery is indicated for progressive neurological decline, severe symptoms, significant cord compression, or failed conservative management.
Prognostic factors include age at presentation, duration of symptoms, severity of cord compression, presence of signal changes on MRI, and timing of surgical intervention. Post-operative care involves early mobilization, physical therapy, regular neurological monitoring, and prevention of adjacent segment disease.
1. Definition:
– Progressive degenerative condition of the cervical spine
– Compression of the spinal cord due to age-related changes
2. Pathophysiology:
– Disc degeneration
– Osteophyte formation
– Ligamentum flavum hypertrophy
– Facet joint arthropathy
3. Risk Factors in Athletes:
– Repetitive cervical trauma (e.g., in football, rugby)
– Genetic predisposition
– Previous cervical injuries
4. Clinical Presentation:
– Neck pain and stiffness
– Upper extremity numbness or weakness
– Gait disturbances
– Fine motor skill impairment
– Lhermitte’s sign (electric shock-like sensation down the spine)
5. Diagnosis:
– MRI: Gold standard for visualizing cord compression
– CT: Evaluates bony structures
– X-rays: Assesses alignment and degenerative changes
– Electromyography (EMG): Differentiates myelopathy from peripheral nerve disorders
6. Management:
– Conservative:
• Activity modification
• Physical therapy
• NSAIDs
• Cervical traction
– Surgical:
• Anterior cervical discectomy and fusion (ACDF)
• Laminoplasty
• Laminectomy with fusion
7. Return to Play Considerations:
– Individualized approach based on:
• Severity of symptoms
• Surgical vs. non-surgical management
• Sport-specific demands
– Generally, no return to contact sports post-surgery
1. Mechanism:
– Axial loading
– Hyperflexion or hyperextension
– Rotation combined with compression
2. Common Sports:
– American football
– Rugby
– Diving
– Gymnastics
3. Classification:
– Complete vs. Incomplete injury
– ASIA Impairment Scale (A-E)
4. Clinical Syndromes:
– Central cord syndrome
– Brown-Séquard syndrome
– Anterior cord syndrome
– Posterior cord syndrome
5. Immediate Management:
– On-field assessment (ABCDE approach)
– Immobilization
– Rapid transport to trauma center
6. Acute Treatment:
– High-dose methylprednisolone (controversial)
– Surgical decompression if indicated
– Blood pressure management to maintain spinal cord perfusion
7. Rehabilitation:
– Early mobilization
– Multidisciplinary approach
– Focus on functional outcomes
8. Prevention Strategies:
– Proper tackling techniques
– Strengthening of neck muscles
– Rule changes in contact sports
1. Pathophysiology:
– Acute or chronic disc herniation compressing the spinal cord
2. Risk Factors:
– Repetitive cervical flexion/extension
– Poor posture during training
– Genetic predisposition
3. Clinical Presentation:
– Neck pain with radicular symptoms
– Myelopathic signs (e.g., hyperreflexia, clonus)
– Possible acute onset after traumatic event
4. Diagnosis:
– MRI: Shows disc herniation and cord compression
– CT myelography: Alternative if MRI contraindicated
5. Management:
– Conservative treatment for mild cases:
• Rest
• Physical therapy
• Epidural steroid injections
– Surgical intervention for severe or progressive cases:
• ACDF
• Artificial disc replacement
6. Return to Play:
– Depends on level of herniation and degree of cord compression
– Generally, 3-6 months post-conservative treatment
– 6-12 months post-surgery, if cleared by surgeon
1. Definition:
– Calcification of the posterior longitudinal ligament
– More common in Asian populations
2. Relevance to Sports:
– Can cause acute myelopathy with minor trauma
– Increased risk in contact sports
3. Diagnosis:
– CT: Best for visualizing ossification
– MRI: Assesses cord compression and signal changes
4. Management:
– Surgical decompression often necessary
– Anterior vs. posterior approach based on extent of ossification
5. Sports Participation:
– Generally advised against contact sports
– Individual assessment for non-contact sports
1. Definition:
– Fluid-filled cavity within the spinal cord
2. Relevance to Sports:
– Can be exacerbated by Valsalva maneuvers
– Risk of sudden neurological deterioration
3. Diagnosis:
– MRI: Diagnostic modality of choice
4. Management:
– Surgical intervention if symptomatic:
• Syrinx drainage
• Posterior fossa decompression (if associated with Chiari malformation)
5. Sports Participation:
– Generally contraindicated in contact sports
– Careful evaluation for non-contact sports
Myelopathy in sports medicine presents unique challenges due to the potential for acute onset and the high-impact nature of many athletic activities. Early recognition, appropriate imaging, and timely intervention are crucial to prevent long-term neurological deficits. The decision to return to play must be individualized, considering the specific myelopathy condition, the athlete’s recovery, and the demands of their sport.
For sports medicine specialists, a thorough understanding of these myelopathy conditions is essential for: 1. Accurate diagnosis and management 2. Providing appropriate return-to-play guidelines 3. Implementing preventive strategies to reduce the risk of spinal cord injuries
As research in this field continues to evolve, staying updated with the latest diagnostic techniques, treatment modalities, and rehabilitation protocols is paramount for optimal patient care in sports-related myelopathy conditions.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
