Even If Cleared To Play, There Are Serious Risks To Going Back Out There

By Abby Sims
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David Wilson was scheduled to see Los Angeles spine specialist Dr. Robert Watkins on Monday for a second opinion on his neck. Wilson, who reportedly commented that he is currently symptom free, left the Giants’ game on Sept. 30 after a cervical injury resulted in transient numbness.

The diagnosis that resulted from precautionary x-rays was spinal stenosis, which is a narrowing of the canal that houses the spinal cord. Though studies have questioned the reliability of using x-rays to determine the diameter of the cervical canal, they remain one method of attempting to do so.

Narrowing of the spinal canal can be congenital (a condition present from birth) or can be due to spondylosis, which is a combination of degenerative disc disease and the formation of osteophytes, which are bony protrusions that can develop – in this case, on the vertebrae. Spondylosis generally occurs in the over-40 population and is most common at the lower levels of the cervical spine. Wilson, who is just 22, commented that he was told one of his vertebrae rests too close to his spinal cord.

Whether or not he is ultimately cleared to return to the field, Wilson’s stenosis poses risks. The most significant of these is spinal cord injury with trauma to the cervical vertebrae. Another unfortunate though less devastating outcome would be radiculopathy (radiating neurologic symptoms). Radicular symptoms can include neck, shoulder, and arm pain, loss of sensation, and numbness.

Myelopathy, a pinching of the cervical spinal cord characterized by weakness and loss of motor skills, is a third problem that can arise in the presence of stenosis. Incidence of both radiculopathy and myelopathy increase with aging, just as the likelihood of developing spondylosis.

Trauma to the cervical spine in football is not unusual — particularly hyperextension or hyperflexion injuries, whereby the neck is forced to an extreme end-range of motion. In the presence of stenosis, the added insult can cause a condition known as “central cord syndrome,” which results in a loss of motor function. This condition generally impacts the upper extremities more so than the lower. It is an incomplete lesion of the spinal cord and so spares some sensory and motor function but is an extremely debilitating disorder.

Unlike treatment of central cord syndrome, if the symptoms of stenosis worsen — such that pain becomes persistent, neurologic deficits are progressive or weakness develops — the condition can be addressed surgically. These issues can occur even in the absence of trauma — an element football adds to complicate the equation.

Fortunately, Wilson is feeling pretty good right now. The doctors will try to determine his degree of risk going forward and whether football is in his future. Even if they agree he can return to the game, it is certainly a crapshoot.

Follow Abby on Twitter at @abcsims

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