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The Thoracolumbar Spine

Key Points

  • The majority of thoracolumbar spine injuries arising from low-velocity sports usually are less catastrophic than some of the athletic injuries involving the more vulnerable cervical spine. The thoracic spinal cord is protected by the relatively larger and less mobile thoracic vertebra and rib cage.
  • The sports physician may be required to assess for a spinal problem in situations varying from an unconscious athlete on a steep ski slope to a preparticipation examination in a sports medicine clinic.
  • If the patient has any disorientation or depressed level of consciousness, the spine should be protected with a cervical collar and with log-roll precautions for the lumbar spine.
  • The primary concern of a sports physician for a severely traumatized athlete should be to assess the airway once the cervical spine has been immobilized, followed by a rapid survey of respiratory and circulatory function.
  • The initial investigation for the majority of athletes with thoracolumbar pain includes 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 junction.
  • The use of computed tomography (CT) enhances the evaluation of osseous structures. This modality better depicts the contents of the spinal canal and any small, lytic lesions in the bone.
  • Magnetic resonance imaging (MRI) is now the modality of choice to evaluate soft tissues of the thoracolumbar spine. An MRI can depict nerve root compression with various degrees of disc degeneration, ligamentous injury, hematoma formation, and soft-tissue tumors.
  • The use of 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 follow spinal infections.

Management of the athletic spine by the sports physician may vary from the preparticipation examination of an asymptomatic athlete to on-field stabilization of an acute injury in an athlete with neurological deficits. The majority of thoracolumbar spinal injuries may be relatively minor and self-limiting.

The incidence of these injuries may vary greatly, ranging from 7% to 27%. Serious thoracolumbar injuries may be relatively rare; however, the fear of major neurological loss or mechanical instability may make return to play a difficult task for the athlete.

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