Cervical Disk Herniations

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Cervical disk injuries occur with higher frequency in highperformance athletes playing football or wrestling than the general population.3 Cervical disk disease is generally categorized into soft versus hard disk disease. Acute disk herniations in sports are thought to occur from uncontrolled lateral bending3 (Fig. 15-4). Hard disk disease (disco-osteophytic disease) can become symptomatic through various mechanisms (Fig. 15-5). Both entities can cause varying amounts of neck and arm pain. Athletes with radicular symptoms or long tract signs should undergo MRI examination.17 It can be difficult to differentiate

Figure 15-3 Spear tackler's spine. The sagittal magnetic resonance imaging demonstrates loss of the normal cervical lordosis, multilevel spondylosis leading to cervical stenosis. Torg et al46 showed that athletes with radiographic findings of stenosis, spondylosis, and loss of cervical lordosis were at increased risk of permanent neurologic injury when combined with poor tackling techniques such as "spearing."

Figure 15-3 Spear tackler's spine. The sagittal magnetic resonance imaging demonstrates loss of the normal cervical lordosis, multilevel spondylosis leading to cervical stenosis. Torg et al46 showed that athletes with radiographic findings of stenosis, spondylosis, and loss of cervical lordosis were at increased risk of permanent neurologic injury when combined with poor tackling techniques such as "spearing."

Figure 15-4 Axial magnetic resonance image of a large extruded soft disk herniation at C6-C7.

Sports Hernia Mri Sagittal Coverage

Figure 15-4 Axial magnetic resonance image of a large extruded soft disk herniation at C6-C7.

between an acute herniation and symptomatic hard disk disease in patients with significant spondylosis. Regardless, initial treatment is generally nonoperative with few exceptions. Treatment includes rest, short-term immobilization, activity modifications, anti-inflammatory medications, cervical traction, and possibly selective nerve root injections and is successful in the majority of patients.17 Once initial symptoms improve, a three-phase rehabilitation program of stretching, range of motion, and isometric strengthening is performed. The athlete should be allowed to return to play once symptoms have resolved, the neurologic examination is normal, and painless full range of motion has been restored.44

Surgical indications include progressive neurologic deficits, disabling motor deficits at presentation, acute myelopathy, or persistent or recurrent radicular symptoms despite 6 weeks of nonoperative treatment.47 The two most common surgical procedures performed for cervical herniated disk are anterior cervical diskectomy and fusion and posterior lamino-

Figure 15-5 Axial magnetic resonance image of the cervical spine demonstrating hypertrophy of the uncovertebral joints causing narrowing of the neuroforamen and radiculopathy.

Figure 15-6 Postoperative lateral cervical spine radiograph demonstrating anterior cervical diskectomy and fusion. The patient's iliac crest was used as the interbody bone graft and a small anterior cervical plate applied to prevent extrusion and enhance healing.

foraminotomy17 (Fig. 15-6). After a healed single-level anterior diskectomy and fusion or posterior laminoforaminotomy, an athlete should be able to return to play after appropriate rehabilitation.44 Relative contraindications to return to play after cervical surgery include two-level anterior cervical procedures or single-level posterior fusion procedures. Absolute contraindications include single-level fusions with surrounding congenital stenosis, multilevel posterior fusion procedures, and circumferential fusions.44

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Cure Tennis Elbow Without Surgery

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