Pittsburgh Steelers Ryan Shazier was involved in a scary traumatic injury in Monday night football‘s game versus the Cincinnati Bengals. He went for a tackle and apparently suffered an axial load injury, as it appeared he lead with his head. This resulted in instant pain in the mid-part of his back, where he fell to the ground and immediately grabbed the middle part of the thoracic spine with his left hand while rolling over, in almost a limp fashion. The video is very scary as you can imagine. Unfortunately, at the time it appears that Shazier was unable to move his lower extremities, which, after evaluation by the Steelers medical staff, resulted in him being taken emergently off the field by stretcher. He was immediately sent by ambulance to likely the nearest trauma center for full evaluation.
As more information has continued to come out, Steelers GM Kevin Colbert said the running diagnosis for Shazier was spinal cord contusion, and that he will not require surgery. It is possible that Colbert misstated, and meant to say that he had spinal cord concussion, at this point we don’t really know. My suspicion is that he underwent a series of tests, including x-rays, CT and likely an MRI of his head, cervical spine, thoracic spine and lumbar spine. At this time it is being reported that he has been able to move his lower extremities (how much is unclear), which is fantastic news.
I will preface this article with saying the fact that I am not a neurosurgeon, but instead a sports medicine fellowship-trained family medicine physician, so I will try to explain this injury in the easiest way that I can. Spinal cord injuries are a major cause of disability that can have devastating neurological outcomes. Let’s talk about both spinal cord contusion and spinal cord concussion, as it is important to distinguish between the two.
So what is a spinal cord contusion? This injury occurs secondary to crushing of the spinal cord with part of the surrounding tissue often being spared. This often results in a significant amount of bleeding and swelling from local blood vessels, which in turn leads to bruising of the specific injured area(s) of the spinal cord. This bruising and swelling can lead to disruption of the nerve signals that are being transmitted through the spinal cord. The severity of the spinal cord contusion is determined by a variety of factors, including imaging (usually MRI), the status of the remaining nerve fibers, and whether or not the “signals” that are being transmitted through these nerves are still able to do their job.
This type of injury can occur as a result of a traumatic event (motor vehicle accident), but also result from a sports related injury, like the one that Shazier experienced. The most common location for this contusion is in the cervical region, as thoracic and lumbar injuries occur less often. The thoracolumbar junction is a transition zone between the relatively rigid thoracic spine, and the relatively flexible lumbar region, making this area a high risk for injury. While we know Shazier grabbed the middle of his back, likely in the T12 region, we do not know the exact location of his injury, whether it is one or multiple locations.
Some of the symptoms that may be accompanied by this spinal cord contusion include the following: paralysis, loss of bowel and bladder function, muscle spasticity, difficulty breathing, difficulty with heart rate and blood pressure, and difficulties with memory. Obviously each and every one of the symptoms is very scary!
There are other reports claiming that this is being diagnosed as a spinal cord concussion, also known as cervical cord neurapraxia (CCN). Most cases of CCN occur on the football field, secondary to high-speed collisions and open-field tackling. CCN involves a transient injury to the spinal cord causing a brief disturbance of sensation/ability to move. The most common symptoms include numbness and tingling of the hands or feet, as well as weakness and even sometimes complete paralysis, often briefly. This paralysis can range from a single limb, to all four limbs, depending on the severity and location of the injury. The episode typically last less than 24 hours, and some resolve even in a few seconds. CCN occurs in 7 out of every 10,000 football players, and while this does not sound very common, considering the amount of football players there are in United States this injury likely occurs more often than we imagine.
This injury can get quite complicated, including the parameters of return to play – that is if the patient is lucky enough to return to full function. Evaluation of spinal canal width, which can be measured by MRI can play an important role in determining whether or not the athlete will be able to return to play. All of these decisions are typically done by the medical team, often guided by a neurosurgeon. Please click here to learn more about spinal cord concussions.
Let’s briefly compare the two. To keep it simple, a spinal cord contusion means that there was actual bleeding in the spinal cord, which can be seen on MRI. Spinal cord concussion on the other hand typically does not leave any MRI-detectable bleeding or damage. Therefore, a spinal cord concussion would be a better diagnosis for Shazier than a spinal cord contusion.
So what’s next? Shazier will likely continue to go undergo a myriad of tests to evaluate how much swelling and damage he has to his spine, and how this correlates to his symptoms. Shazier has a long ways to go before he can consider stepping onto a football field again. At this point, as fans, we should be happy that he is alive, and not fully paralyzed. My hope is that he will be able to walk again, and I wish him the best of luck in his recovery.