Pounded spinal cord can mimic more serious injury
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A football player lies motionless after having made a tackle. He's conscious but has no sensation in his arms or legs. Everyone in the stadium holds his or her breath as the trainers -- and the stretcher-bearers -- rush onto the field.
The player likely is suffering from what trainers and sports medicine physicians call spinal shock, a term they use to describe a concussion-like injury to the spinal cord that leads to a temporary loss of feeling and motor reflexes below the area of injury.
This doesn't happen often -- only about one athlete in 100,000 experiences it, according to Dr. Tanya Hagen, a sports medicine physician for UPMC -- but it's frightening when it does.
"This kind of thing is the scariest thing I've ever had to deal with," said Dr. Hagen, who has provided medical assistance at dozens of local high school football games. "We can deal with blood and bones and other traumatic injuries, but when it comes to the spine ...
"We take it seriously when it happens," said Dr. Jack Wilberger, chair of the department of neurosurgery at Allegheny General Hospital. "But as it turns out, fortunately, it's a scary problem but relatively benign."
What Dr. Hagen calls spinal shock really ought to be called spinal concussion, said Dr. Adam Kanter, a neurosurgeon who is director of UPMC's Minimally Invasive Spine program.
"Spinal shock and spinal concussion are often used interchangeably, but they shouldn't be," Dr. Kanter said. "Spinal shock involves loss of sensation, motor paralysis and reflexes that is often the result of a spinal cord injury. This does not typically recover."
Spinal concussion, on the other hand, "by definition is transient in nature," he said. "It often involves the immediate onset of sensory and motor deficits in the arms or the legs that fully resolve in 15 or 30 minutes or so."
The problem with the neurosurgeon's definition from a sports medicine physician's perspective, Dr. Hagen said, is that the sports medicine physician can't tell at the time of the injury whether it's the really, really bad thing (spinal shock) or the less serious deal (spinal concussion).
"There is no way to tell how severe the injury is, based on a physical exam alone," Dr. Hagen said. That requires hospital tests.
Dr. Wilberger works a lot with athletes. So although he makes the same distinction Dr. Kanter does, he is comfortable with the more broadly used definition.
First Published October 4, 2010 12:00 am
