Neck Injury - Football - "I Can't Feel My Legs"

HISTORY: 21 year old Division I Quarterback, diving forward at the end of a running play. Two defenders converge on him, striking him in the helmet with his shoulder pad and compressing/ laterally flexing his neck. Following the collision, the athlete remained supine on the field, the athlete complained of neck pain and loss of feeling in his legs. His C spine was immediately immobilized. The athlete noted initially that he couldn’t feel his legs, below his waist, but had 5/5 strength in upper and lower extremities. He was carefully spine boarded and transported to a level 1 trauma center. Sensation returned to his legs. (Insert video of injury). PHYSICAL EXAMINATION: AOx4, NAD, PERRL, EOMI Tender to palpation, Cervical Spine BUE 5/5 BLE 5/5 SILTx4 No hoffman's, babinski or clonus Reflexes 2+ throughout C-Spine tenderness to palpation GCS 15 DIFFERENTIAL DIAGNOSIS:Cervical Sprain/ StrainBrachial Plexus InjuryConcussionSubdural/ Epidural HematomaCervical spine fractureVertebral artery Injury TEST AND RESULTS: C spine X rays, reversal of the normal lordosis, no visible acute findings. CT C spine without contrast - Fracture of right C4 posterior elements involving the lamina, facet, pedicle, and transverse foramen with mild displacement. Left C5 anterior superior endplate fracture with minimal displacement. (Insert 3D reconstruction of fracture morphology) FINAL WORKING DIAGNOSIS: Right C4 posterior element fracture involving lamina, facet, pedicle, and transverse foramen with mild displacement. Left C5 anterior superior endplate fracture with minimal displacement. Anterior longitudinal ligament disruption. Right vertebral artery short segment decrease in caliber, concerning for mild vascular injury. TREATMENT AND OUTCOMES: Hospital course: Athlete had consultations with Neurosurgery and Orthopedic Spine, all eventually agreed the best option was a C4C5 ACDF, performed 2 days later. Procedure was successful without complications, and athlete was discharged to home the following day. He had minimal pain, was clear on his need to wear aspen collar 24/7 for the next 8 weeks. Bone growth stimulator was ordered to patient’s home to attempt to optimize the fracture healing.