Cervical Spine Abnormality In A College Football Player With An Unusual Twist To The Story

HISTORY: A 19-year-old football defensive back sustained a concussion when blocking a receiver. He was hit on the chin by his opponent’s helmet and was knocked backward. He was diagnosed with a concussion and was sent to the ER for further evaluation. While in the ER, he reported feeling a shock like sensation into both arms which occurred with the impact. He had a similar sensation during a tackle 2 weeks earlier but was localized to the upper arms and resolved overnight. He has no history of stingers or neurologic symptoms in the past. FAMILY HISTORY: No cervical abnormalities or neurologic disorders. He has an identical twin brother. PHYSICAL EXAMINATION: Cervical spine range of motion was full and pain free. Spurling's was negative. No muscular tenderness in the cervical spine. Strength, sensation and reflexes in the upper extremities was normal. Neural tension signs were negative. Adson’s and Roos maneuvers negative. DIFFERENTIAL DIAGNOSIS: 1.Brachial Plexopathy2.Cervical Disc herniation3.Cervical stenosis TESTS AND RESULTS: Cervical Spine Xrays: No acute abnormalities. Torg Ratio = 0.7 Cervical Spine MRI: Spinal canal diameter at C4 = 9 mm. There is minimal spinal fluid around the cord anteriorly and posteriorly. There is slight posterior bulging of the C3-4 disc. FINAL DIAGNOSIS: Cervical stenosis TREATMENT AND OUTCOMES: 1.Immediate removal from contact and collision sports2.Twin brother (asymptomatic) was evaluated and C-spine xrays which confirmed cervical stenosis. He was also restricted from contact and collision sports.3.Consultation with a spine surgeon was offered to the family, but they declined and were comfortable with the activity restrictions.