Alexander Vaccaro, MD, PhD, a spine surgeon with Rothman Institute in Philadelphia and vice chairman of the department of orthopedics at Thomas Jefferson Hospital, discusses spinal injuries in athletes. Dr. Vaccaro recently worked with Pittsburgh Penguins' Sidney Crosby after spinal injury was suspected.
Question: What is the process of treating an athlete who sustains a spinal injury?
Dr. Alexander Vaccaro: When you are treating high-level athletes, your primary responsibility is to protect the patient from any sort of further injury and allow them to heal. Your final goal is to return them to the same level of play, if possible. In some cases, you may have an injury that would prevent the athlete from returning to play. The literature is somewhat confused regarding patients who have a spinal cord injury and make a full recovery in the absence of deformity or any instability. The literature says if there is no evidence of radiographic parameters that would lead to another injury, athletes who have a full functional return may return to play. This however is individual specific
Q: Do athletes who sustain a spinal cord injury and fully recover typically choose to return to play?
AV: It depends on the level of sports; professional athletes following a cervical spinal cord neuropraxia may return to play in the absence of instability or symptoms but high school and college athletes often do not because of the fear of future injury. When a professional player has a recurrent episode of spinal cord injury or spinal cord concussion, that’s the point at which we often advise the player not to return to play. The literature, however, takes the position that if the patient has a full return of function in the absence of instability, they may return to play depending on the situation. This, however, again is player specific.
Q: Have you ever had any difficulty advising athletes against returning too soon?
AV: A professional team physician's number one priority is the patient; physicians must place all other conflicts — such as the desires of agents or coaches — on the back burner. My experience is that the coaching staff and agents are often in complete agreement with the physician in terms of protecting the player. I have never been influenced to return players back to play before the injury has healed. Everyone is sensitive to the fact that there are guidelines to be followed to return athletes back to play. However, much more research is necessary to determine the potential for reinjury when it comes to the spine.
Q: How do you deal with athletes who have chronic back pain not related to a single traumatic injury?
AV: When athletes come in with non-specific pain in their neck and back, they see other providers before coming to the spine surgeon. They see the trainer and medical staff and often receive diagnostic imaging tests. If there is evidence of spondylolysis or a disc herniation causing neural impingement, the athlete is frequently referred to the spine surgeon. A vast majority of those cases are treated with anti-inflammatory medication, core strengthening, range of motion and other exercises allowing the athlete to eventually return to play.
An athlete with a stress fracture that is symptomatic, i.e. a lumbar spondylolysis can cause great discomfort. When symptoms continue to occur after treatment, it is up to the athlete and family depending on the player's age how they would like to proceed. It's often not an injury that could lead to a serious neurological problem, but patients may continue to have discomfort that affects their play. Most professional athletes do not want to go back to play if they have significant discomfort. When they are not 100 percent, it affects their play and predisposes them to injury.
Q: Is it possible for athletes to prevent these types of injuries?
AV: Injury prevention is based on conditioning of the athlete and their play technique. Coaches teach techniques to avoid injury in contact sports, i.e. not using their heads as a weapon in football and so on. Understanding the rules of the game is critical to preventing injury. The next category is protective equipment, such as what linemen and linebackers wear in football. Once that occurs, having a protocol mandated for when players suffer an injury is important. We must pay strict attention to these protocols to prevent the athlete from reinjury.
Related Articles on Spine Surgery:
5 Spine Specialists on Differentiating Spine Practices
The State of Minimally Invasive Spine Surgery: Q&A With SMISS President Dr. William Taylor
6 Points Comparing Spine Surgeon Compensation
Question: What is the process of treating an athlete who sustains a spinal injury?
Dr. Alexander Vaccaro: When you are treating high-level athletes, your primary responsibility is to protect the patient from any sort of further injury and allow them to heal. Your final goal is to return them to the same level of play, if possible. In some cases, you may have an injury that would prevent the athlete from returning to play. The literature is somewhat confused regarding patients who have a spinal cord injury and make a full recovery in the absence of deformity or any instability. The literature says if there is no evidence of radiographic parameters that would lead to another injury, athletes who have a full functional return may return to play. This however is individual specific
Q: Do athletes who sustain a spinal cord injury and fully recover typically choose to return to play?
AV: It depends on the level of sports; professional athletes following a cervical spinal cord neuropraxia may return to play in the absence of instability or symptoms but high school and college athletes often do not because of the fear of future injury. When a professional player has a recurrent episode of spinal cord injury or spinal cord concussion, that’s the point at which we often advise the player not to return to play. The literature, however, takes the position that if the patient has a full return of function in the absence of instability, they may return to play depending on the situation. This, however, again is player specific.
Q: Have you ever had any difficulty advising athletes against returning too soon?
AV: A professional team physician's number one priority is the patient; physicians must place all other conflicts — such as the desires of agents or coaches — on the back burner. My experience is that the coaching staff and agents are often in complete agreement with the physician in terms of protecting the player. I have never been influenced to return players back to play before the injury has healed. Everyone is sensitive to the fact that there are guidelines to be followed to return athletes back to play. However, much more research is necessary to determine the potential for reinjury when it comes to the spine.
Q: How do you deal with athletes who have chronic back pain not related to a single traumatic injury?
AV: When athletes come in with non-specific pain in their neck and back, they see other providers before coming to the spine surgeon. They see the trainer and medical staff and often receive diagnostic imaging tests. If there is evidence of spondylolysis or a disc herniation causing neural impingement, the athlete is frequently referred to the spine surgeon. A vast majority of those cases are treated with anti-inflammatory medication, core strengthening, range of motion and other exercises allowing the athlete to eventually return to play.
An athlete with a stress fracture that is symptomatic, i.e. a lumbar spondylolysis can cause great discomfort. When symptoms continue to occur after treatment, it is up to the athlete and family depending on the player's age how they would like to proceed. It's often not an injury that could lead to a serious neurological problem, but patients may continue to have discomfort that affects their play. Most professional athletes do not want to go back to play if they have significant discomfort. When they are not 100 percent, it affects their play and predisposes them to injury.
Q: Is it possible for athletes to prevent these types of injuries?
AV: Injury prevention is based on conditioning of the athlete and their play technique. Coaches teach techniques to avoid injury in contact sports, i.e. not using their heads as a weapon in football and so on. Understanding the rules of the game is critical to preventing injury. The next category is protective equipment, such as what linemen and linebackers wear in football. Once that occurs, having a protocol mandated for when players suffer an injury is important. We must pay strict attention to these protocols to prevent the athlete from reinjury.
Related Articles on Spine Surgery:
5 Spine Specialists on Differentiating Spine Practices
The State of Minimally Invasive Spine Surgery: Q&A With SMISS President Dr. William Taylor
6 Points Comparing Spine Surgeon Compensation