title: Chronic spinal cord injury in the cervical spine of a young soccer player.
abstract: A 17-year-old male soccer player presented with numbness in the upper- and lower-left extremities of 6 months' duration. He had no apparent history of trauma but experienced neck pain during heading of the ball 5 years prior. A high-signal intensity area was seen on T2-weighted magnetic resonance imaging (MRI) of the cervical spine. No muscle weakness was observed. Hypoesthesia was observed in bilateral forearms, hands, and extremities below the inguinal region. Plain radiographs in the neutral position showed local kyphosis at C3/4. A small protrusion of the C3/4 disk was observed on T1-weighted MRI. A high-signal area in the spinal cord at the C3/4 level was observed on T2-weighted MRI, but this was not enhanced by gadolinium. Multiple sclerosis, intramedullary spinal cord tumor, sarcoidosis and malignant lymphoma, and spinal cord injury were all considered in the differential diagnosis. However, in view of the clinical, laboratory, and radiological investigations, we concluded that repeated impacts to the neck caused by heading of the ball during soccer induced a chronic, minor spinal cord injury. This contributed to the high-signal intensity change of the spinal cord in T2-weighted MRI. The present case demonstrates that repeated impact may cause chronic spinal cord injury. Soccer, American football, or rugby players presenting with neck or extremity symptoms should not be overlooked for the possibility of latent spinal cord injury, as this could present later development of more severe or unrecoverable spinal cord injuries.
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. kato-yo@yamaguchi-u.ac.jp
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kato
authors.forename: Michiaki
authors.initials: M
authors.lastname: Koga
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000209:etiology*; D002574:Cervical Vertebrae; D006801:Humans; D008297:Male; D012916:Soccer / Q000293:injuries*; D013119:Spinal Cord Injuries / Q000209:etiology*