Cervical neurapraxia in elite athletes: evaluation and surgical treatment. Report of five cases.
OBJECTIVE
Neurapraxia, transient posttraumatic paralysis of the motor and/or sensory tracts in the spinal cord, may be a career-ending event in an athlete. Management, rehabilitation, and return-to-play decisions remain controversial.


METHODS
Five elite football players were evaluated after experiencing episodes of neurapraxia. All patients experienced bilateral paresthesias--three in all four extremities and two in the upper extremities--lasting a few minutes to more than 24 hours. Transient motor deficits occurred in two individuals but caused no permanent sequelae. Neuroimaging confirmed the presence of herniated discs, focal cord compression, and no parenchymal changes in all cases. All patients underwent anterior cervical microdiscectomy and fusion, and cervical plates were placed in four. After aggressive rehabilitation and confirmation of fusion ranging from 9 weeks to 8 months postoperatively, the players were allowed to return to active play. Two of the players developed recurrent career-ending disc herniations, one above and the other below the fusion level. One player required repeated spinal cord decompression.


CONCLUSIONS
Neurologically intact athletes with focal cord compression due to a single-level herniated disc may safely return to football after undergoing decompressive surgery and confirmation of fusion. It appears, however, that there may be an increased chance of repeated herniation above or below a fused level.
Maroon
Joseph C
JC
Department of Neurosurgery, University of Pittsburgh School of Medicine-Presbyterian Hospital, Pennsylvania 15213, USA. maroonjc@upmc.edu
El-Kadi
Hikmat
H
Abla
Adnan A
AA
Wecht
Daniel A
DA
Bost
Jeffrey
J
Norwig
John
J
Bream
Tim
T
D000328:Adult; D001265:Athletic Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005538:Football / Q000293:injuries*; D017408:Guidelines as Topic; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010292:Paresthesia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D011782:Quadriplegia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D020127:Recovery of Function; D055502:Secondary Prevention; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion