A Narrow Wrestling Decision

HISTORY: A 25 year-old male college wrestler presented to the training room the day after a wrestling match complaining of neck soreness. He had unintentionally fallen backwards on the mat and sustained a hyperextension injury of his neck. Immediately after the trauma, he felt an “electrical sensation” traveling down both of his arms into his hands, which resolved within 24-48 hours. At the time of evaluation, he denied any weakness, bowel or bladder retention or incontinence, or numbness or tingling. His only complaint was residual neck pain which was previously treated with oral prednisone and NSAIDS. PHYSICAL EXAMINATION: A young healthy male in no distress. Normal ambulation. Neck range of motion demonstrated full flexion, but 50% in extension, right and left rotation and lateral tilting. Pain reproduced with neck extension. There was left and right cervical paraspinal tenderness to palpation with no step-off or crepitus noted. Bilateral upper and lower extremity strength, sensation, and reflex testing were normal. No clonus and negative Babinski, Spurling’s, and Hoffman’s signs. DIFFERENTIAL DIAGNOSIS: 1. Cervical paraspinal muscle strain 2. Cervical Cord Neurapraxia 3. Fracture of cervical vertebrae 4. Congenital Cervical Stenosis TEST AND RESULTS: Cervical Spine AP and Lateral Radiographs: Seven cervical vertebrae seen in AP view. Pedicle shadows intact. Lateral view shows loss of cervical lordosis. Intervertebral disc spaces are well maintained. CT Cervical Spine WO Contrast: No evidence of fracture or subluxation. Mild congenital cervical canal stenosis. MRI Cervical Spine WO Contrast: No evidence of acute injury. Multilevel cervical spondylosis with congenital stenosis with the diameter of the spinal canal measuring 6-7 mm. No significant CSF surrounding the spinal cord. Torg ratio measured on all imaging had values of 0.7 or less. FINAL/WORKING DIAGNOSIS: Congenital Cervical Stenosis with associated Cervical Cord Neurapraxia and Cervical strain TREATMENT AND OUTCOMES: Based off of imaging and Torg ratio of 0.7 or less, the athlete was not cleared to return to participation. Although he had wrestled for 20 years without issues, he did sustain a transient spinal cord injury necessitating a visit to the ER. He was referred for a second opinion to a neurosurgeon regarding clearance for return to play.