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Back Pain

Back Pain

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Spine – Cervical Problems Anterior Cervical Discectomy and Fusion Cervical Burners and Stingers (Brachial Plexus Injuries) Cervical Corpectomy and Strut Graft Cervical Discectomy Cervical Foraminotomy Cervical Laminectomy Cervical Radiculopathy Cervical Spinal Stenosis Cervical Spine Anatomy Dropped Head […]


When obtaining consent for spinal surgery, the possibilities of complications must be discussed with the athlete. Again, the details of the complications of spinal surgery could fill a book, and they are beyond the scope of this chapter.

In general, however, the possible complications include wound infections, postoperative bleeding that requires transfusion, nonunion of the […]


Major changes in techniques are constantly and rapidly evolving, and dissection has become extremely “respectful” of the soft tissues that are encountered. The small-incision trend of arthroscopy is now entering the spinal surgery environment. Adequate decompression, prevention of further malalignment, and obtaining a solid fusion are still the basic goals of spinal surgery intervention.

The […]

Treatment-Indications and Timing

A positive correlation between the history, physical examination, and diagnostic imaging is needed to confirm the presence of a surgically amenable lesion. The patient must have failed conservative therapy or have a lesion that would have a poor outcome if left to nonoperative care, such as a cauda equina syndrome in a weight-lifting bodybuilder.

Neurological […]

Treatment-Operative Treatment

Spinal surgery can be directed toward three main goals:

Decompression of compressed neural elements. Realignment of a spinal deformity. Stabilization of an unstable mobile segment.

Patient selection for surgery is extremely important to achieving favorable outcomes. The patient’s expectations must be realistic and consider what type of rehabilitation he or she must endure postoperatively. Return […]


The goal of treatment is return to play by the athlete. Athletes can perform a certain level of activity if they have conditioned themselves both physically and mentally. Patient education is the key to obtaining compliance in the rehabilitation of the athlete. Although the pathology of a spinal problem appears to be complex, the athlete […]

Decision Making and Classification

The primary decision that a sports physician must make when confronted with a thoracolumbar condition is whether the athlete has a significant mechanical and/or neurological instability requiring urgent or emergent stabilization.

The spinal problem can be categorized initially as a high-energy injury, a low-energy injury, or even a no-injury situation. In turn, high-energy injuries to […]

Other Diagnostic Tools

Blood work, such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein, and blood cultures, may be useful to confirm and to follow spinal infections. A rheumatological workup may be ordered if seronegative spondyloarthropathy, such as ankylosing spondylitis, is suspected.

The use of electrophysiological testing can confirm a clinical diagnosis, such as […]

Diagnostic Imaging

For the majority of athletes presenting with thoracolumbar pain, the initial investigation is still the plain-film anteroposterior (AP) and lateral radiographs. The AP view will depict the sagittal alignment as well as congenital anomalies at the thoracolumbar and lumbosacral junctions.

The architecture of the bodies, spinous processes, transverse processes, lamina, and pedicles also are depicted […]

Clinical Evaluation-Physical Examination

The examination of the injured athlete’s spine initially may be limited to a cursory four-limb sensory and voluntary motor assessment along with palpation of the entire spine for point tenderness during the log-roll onto a spine board for transport off the playing field.

The primary concern of the sports physician with a severely traumatized athlete […]