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Catastrophic Cervical Spine Injuries-Transient Quadriplegia

The clinical syndrome of neuropraxia often can help to explain more complex clinical syndromes of the cervical spinal cord. Transient quadriplegia has been estimated to occur in 7 per 10,000 football players. As mentioned previously, congenital cervical stenosis may predispose athletes to cord compression .

In one study, a Pavlov ratio of less than 0.8 was documented in 93% of football players with cervical cord neuropraxia. The phrase “pincer mechanism” has been used by Penning to describe a momentary cord compression at the extremes of neck extension or flexion.

This forced hyperextension of a lower cervical motion segment causes an impingement on the posterior margin of the end plate of the more cranial vertebral body. Therefore, the spinolaminar line of the subjacent vertebra is disturbed. The soft-tissue structures that lie along this radiographic spinolaminar line (posterior longitudinal ligament and the ligamentum flavum) will then displace and make the spinal canal narrower.

Most experts now agree that the pathophysiology associated with this phenomenon is less an anatomical disruption and more a physiological conduction block. The conduction block, or neuropraxia, in this case relates to possible segmental demyelination and increasing refractory period of the long tract axons. Describing this postconcussive state, Torg et al. It theorized that local anoxia and increased intracellular calcium concentration are responsible for the temporary disturbance of spinal cord function.

Signs and symptoms of transient quadriplegia include pain, tingling, or loss of sensation bilaterally in the upper and/or lower extremities. A mild quadriparesis usually exists, but motor weakness does not need to be present. Of course, complete quadriplegia also is possible.

Limited range of motion and neck pain/tenderness usually are absent. Although transient in nature, this syndrome may last from 15 minutes to 48 hours, but full recovery often is expected. Certain players have risk factors (spinal canal stenosis) for developing transient quadriplegia, and recurrence rates as high as 56% have been reported.

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