Cervical Spine Injuries in Athletes

On December 31^st, 2015, a professional hockey player, Denna Laing, playing in the NHL Winter Classic tournament, sustained a severe spinal injury.  The accident happened during one of the games when the 24-year-old player tripped on another player’s hockey stick and struck the boards head first.  Ms. Laing was immediately transported to hospital and then to a rehab centre.  The players in the NHL competition had signed a liability waiver before playing; however, the waiver was based on the ice being in good condition. Initially, there was a suggestion that the ice was soft and this may have contributed to the accident, but there is no indication that a civil suit was filed as a result of this unfortunate injury.

Although spinal injuries are less common in sports than some other serious injuries, such as traumatic brain injury, and leg and arm fractures, they do sometimes occur.  Fortunately, the occurrence of catastrophic cervical spine injury in athletes has decreased in the past 30 years.  According to the Journal of Athletic Training (2007), past research on how these injuries occur led to improvements and innovations in equipment, education in techniques, rule changes and in offseason conditioning.  These changes have, in particular, decreased football-related neck and head injuries, and also, the incidence of players who suffer quadriplegia or paraplegia. 

Cervical spine injuries are most common in contact sports such as football, ice hockey, boxing and wrestling. Cervical vertebrae are located in the upper portion of the spinal cord, beginning at the neck, and are grouped into the high cervical nerves (C1-C4) and the low cervical nerves (C5-C8).  Typically, the higher on the spinal cord that an injury occurs, the greater the level of impact and dysfunction resulting from the injury.  Correspondingly, if someone sustains damage to the C1 to C4 vertebrae, they experience the most severe symptoms, which includes paralysis in their arms and legs, inability to breathe on their own, a lack of bladder/bowel control and may affect the ability to speak.  Quadriplegia or tetraplegia means all four limbs are affected.  Damage to the C5 to C8 vertebrae may result in partial paralysis and impacts to other bodily functions, with C5 injuries being the most severe and C8 having a lesser impact. 

Clearly any injury to the cervical nerves can be devastating, with a significant effect on the life of the injured athlete.

The Mechanics of a Spinal Injury

The cause of a spinal injury may be sports-related, but these injuries arise under specific circumtances which may also occur in other traumatic incidents, such as car accidents and falls.  The primary mechanism causing a serious cervical injury involves a significant compressive force or load applied to the top of a person’s head.  The risk of injury is particularly great when the neck is slightly flexed, because this causes the spine to be brought out of its normal alignment and thwarts proper distribution of force to a person’s thorax.  The action of bending puts the cervical spine into a straight line so that the muscles are unable to help in absorbing the force.   Essentially, a cervical spine injury happens when the spine is compressed between a person’s body and their rapidly decelerating head.   If a fracture results from this event, then bone fragments or parts of a herniated disc may infringe on, and damage the spinal cord, causing neurological damage.  These are the primary processes that cause cervical fractures, dislocation and/or quadriplegia.

Treatments and Impact

An athlete who may have experienced a cervical spine injury must seek immediate medical assessment, and should be removed from further participation in sport until a physician has diagnosed the nature of their injury.  Injured persons may be required to undergo cervical traction to maintain alignment or their spine, as well as repeated assessments and examinations. Physicians also typically monitor for respiratory and cardiovascular complications that often occur after a spinal cord injury, and must treat these if and when they arise. Depending on the diagnosis from such assessments, they may require surgical fusion or other treatments to stabilize the spine.

An injured person who has incurred a minor fracture and does not have a spinal cord injury, is generally allowed to return to their normal everyday activities.  However, for athletes who have a suspected spinal injury, it may be difficult to ascertain with any certainty whether they should return to contact sports.  In particular, if an athlete has suffered a neurologic injury to their spinal cord, they should not be permitted to do so.  Also, athletes who suffered a fracture or dislocation of the spine requiring a surgical stabilization or halo brace, are generally considered not to have sufficient strength to withstand further contact sports.  However, some fractures are inherently stable and don’t involve neurologic injury, and therefore don’t preclude re-engaging in physical activity.  A healed minor vertebral body fracture that has stabilized, for example, may allow participation in sports.

Of course, athletes who have sustained catastrophic spinal injuries resulting in structural failure of the vertebral column and causing paraplegia or quadriplegia, are not only precluded from future contact sports, every aspect of their lives is impacted by their disability.  This type of injury is most often caused by a particular blow to the top or crown of the head or helmet.  If may occur, for example, when an athlete is speared in football or driven into the boards in hockey.  

Depending on the severity of injury (generally related to which cervical nerves have suffered damage), the injured person may require a different degree of care and support.  Someone who has suffered quadriplegia will require 24-hour care and assistance with daily living activities such as eating, bathing, dressing and moving around.  On the other end of the spectrum, a person with a C-8 injury may be able to complete hand movements and function mostly on their own, with some assistance with more difficult functions.

Teenager sustains catastrophic spinal cord injury in hockey game

In Zaccardo c. Chartis Insurance Company of Canada, a young man and his family successfully sued another player after the young man was checked from behind and sustained a fractured vertebrae and broken rib.  The tragic accident left the (then) 16-year-old boy as a paraplegic and confined to a wheelchair.  The boy and his family were awarded about $8 million in damages when the opposing player who caused the injury was found negligent by a Quebec court.  The young man’s compensation included calculated amounts for his lifetime medical and rehabilitation expenses, attendant care, loss of income, and pain and suffering.  His family also received a substantial award in damages. In a 2016 trial, the judge ruled that the body check was intentional and the other player had opportunity to reduce the impact or change direction, but he choose not to do so.   The substantial damages in this case reflected the significant care and needs resulting from the boy’s catastrophic injury, but was also meant to send a message to all players, coaches and sports organisations that everyone has an obligation to prevent injury in sports.

Sources:

http://nypost.com/2016/01/13/female-hockey-player-plans-to-sue-nhl-following-spinal-injury/

Journal of Athletic Training abstract in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1896065/