football

Spinal Issues in the NFL Make News

Commentary from Dr. Arien Smith of ANA

footballRecently, the career ending neck injury of New York Giants running back David Wilson made the news. In addition to many articles, the New York Times featured the 23-year-old’s case prominently on the front page of the Sports section (Wednesday, August 6, 2014).

Wilson aggravated a neck injury that was surgically repaired in January. Consequently, he experienced what is called a burner, or stinger (a nerve pinch injury). Although these are not technically in the category of the more serious spinal cord injuries, they are an intensely painful nerve injury that causes a shooting, stinging pain which is followed by numbness in the extremities. These injuries most often happen in contact sports, and are most common in football. In this case, doctors were alarmed when Wilson experienced that numbness down his arm and leg. What’s more alarming, these nerve injuries, which result from trauma to the neck or shoulder, also have a high recurrence rate.

In the world of football, Wilson is not alone. Stingers are common. A survey of college football players found that 65 percent had at least one burner in their college careers, but yet 70 percent of these athletes did not report the injury to anyone. It is estimated that approximately half of NFL players will suffer a stinger at some point in their careers.

Wilson is also not alone when it comes to spinal stenosis. He suffers from cervical spinal stenosis, a narrowing of the spinal canal which encloses the spinal cord. A number of other football players also have this condition, some without consequences and who continue to play. A case in point is the renowned Peyton Manning, who had successful cervical spinal fusion surgery to correct stenosis.

In fact, spinal stenosis is also a feature of the general population. There are several types of spinal stenosis. While lumbar stenosis is more common, cervical spinal stenosis is also prevalent, and is more dangerous because it involves compression of the spinal cord.

Wilson was cleared to play following his January surgery, which was spinal fusion for a herniated disc. But his pre-existing cervical spinal stenosis, coupled with the experience of re-injury, brings about the risk of suffering an episode of cervical cord neurapraxia (CCN), technically a concussion to the spinal cord. This injury causes transient paralysis in one or more of the arms or legs. CCN symptoms that last fewer than 15 minutes are considered grade I injuries. Grade II injuries last between 15 minutes and 24 hours. Grade III injuries persist for longer than 24 hours.

Dr. Arien Smith, neurosurgeon and spine specialist at ANA, further explains these conditions. “A stinger is a degree of neurpraxia. Anyone can get a stinger (think of bumping your funny bone and the temporary pain and numbness in the arm). Although this is a mild, temporary injury, given David Wilson’s history of cervical spinal stenosis and surgery, the concern would be that he is at greater risk of serious injury.” The ultimate fear is of permanent paralysis.

“CCN is a spinal cord concussion. With repeated concussion, one can sustain permanent damage. It’s particularly a risk by the nature of the sport of football, where the head and neck are very vulnerable. In addition, in the cervical spine, the spinal cord is less protected than the thoracic and lumbar spinal regions. The cervical spine’s ligaments are not as strong, its bones not as big, and the surrounding musculature is not as hearty.”

As to the case of David Wilson, Dr. Smith concludes, “Football is a game of risk. This guy could continue to play without further incident and have a successful career. However, I don’t think it’s unreasonable he was told to retire, given the position he plays. As a running back, he takes a number of hits, and a lot of punishment from some big guys. The most conservative thing to do is to tell him not to play.”