title: Significance of T2 Hyperintensity on Magnetic Resonance Imaging After Cervical Cord Injury and Return to Play in Professional Athletes.
abstract: BACKGROUND
  Cervical cord magnetic resonance imaging (MRI) T2 hyperintensity is used as evidence of cord trauma in the evaluation and management of athletes in contact sports. The long-term pathophysiologic and prognostic value of this finding is poorly understood, especially in return to play (RTP).
  
  
  OBJECTIVE
  To examine the significance of T2 hyperintensity in the cervical spinal cord of professional athletes.
  
  
  METHODS
  Retrospective review of MRI T2 hyperintensity findings between 2007 and 2014 in 5 professional athletes. Pertinent examination and demographics, including mechanism of injury, surgical intervention, radiographs, MRI studies, long-term outcomes, and RTP recommendations were collected.
  
  
  RESULTS
  Four National Football League players and 1 professional wrestler had prior traumatic neurapraxia that at the time of initial consultation had resolved. MRIs showed congenitally small cervical canal (1) and multilevel spondylosis/stenosis/disc herniation (4) along with focal cord T2 hyperintensity (5). The signal abnormalities were at C3/C4 (3), C4 mid-vertebral body (1), and C5/C6 (1). Four athletes had single-level anterior cervical discectomy and fusion, and 1 was nonoperative. Serial MRI imaging at 3 months after surgery showed hyperintensity partially resolved (4) and unchanged (1), and at 9-months 3 of the 5 completely resolved. Based on the author's RTP criteria, 4 of 5 were released to return to their sport. Clearance for RTP preceded complete resolution of MRI T2 hyperintensity in 3 of 4 athletes. The 2 athletes that have returned to profession sport have not had any additional episodes of neurapraxia or any cervical spine-related complications.
  
  
  CONCLUSIONS
  MRI T2 hyperintensity in contact sport athletes who are symptom-free with normal examination and no evidence of spinal instability may not be a contraindication to RTP. Additional observations are needed to confirm this observation.
authors: *Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡Pittsburgh Steelers Football Club, Pittsburgh, Pennsylvania.
authors: Zachary J
authors: ZJ
authors: Tempel
authors: Jeffrey W
authors: JW
authors: Bost
authors: John A
authors: JA
authors: Norwig
authors: Joseph C
authors: JC
authors: Maroon
mesh_terms: D056352:Athletes; D066193:Cervical Cord; D002574:Cervical Vertebrae / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D000068958:Return to Sport; D013119:Spinal Cord Injuries / Q000473:pathology*