Photo courtesy NHL.com/Detroit Red Wings
In light of the NHL defenseman's season-ending injury, let's look at the cervical spine, its function, and why it should be handled with care
The Detroit Red Wings announced that defenseman Mike Green will undergo season-ending surgery on his cervical spine. Green, who missed seven games in February following a hit from Tampa Bay Lightning left winger Adam Erne, re-aggravated the injury during practice on Wednesday, March 21 in Detroit at Little Caesars Arena. It’s not the first time he’s been sidelined by this injury. "This dates back to a year ago," coach Jeff Blashill said. "He's played through it. We knew at some point this was inevitable. We were hoping he was going to be able to get through it. There were different times throughout the year where if he took the wrong hit, it created the symptoms.”
Dr. Frank Cammisa, Chief Emeritus of the Spine Service at Hospital for Special Surgery, who has a history of working with professional athletes on spine-related sports injuries, will perform the surgery on April 5 at his New York City hospital.
What is the cervical spine and what does it control?
The cervical spine is a network comprised of the seven smallest, uppermost vertebrae in the spinal column. These vertebrae reside in the neck and support the skull. They’re responsible for motion in the head, protecting sensitive areas of the spinal cord, and routing nerves connecting the brain to the rest of the body. Unlike other back and spine related injuries, an injury to the cervical spine can have serious implications on your health that can be life-threatening (e.g., a spinal fracture, commonly referred to as a broken neck). Since the vertebrae of the cervical spine house the spinal cord, nerve roots, and blood vessels, it’s important to be aware of any sensations—pain, tingling, numbness, or general weakness—when one or more cervical spinal nerves are injured or hyperextended. Below is a list of cervical spine vertebrae and he centers of the body maintained by it:
- C1: Head and neck
- C2: Head and neck
- C3: Diaphragm
- C4: Upper body muscles (eg, deltoids, biceps)
- C5: Wrist extensors
- C6: Wrist extensors
- C7: Triceps
- C8: Hands
Since the cervical nerves manage major bodily functions including many motor-related functions, injuries to the cervical spine should be regarded as emergencies and prompt treatment should be sought. These injuries can lead to paralysis, and may even prevent you from breathing (e.g., a C3 injury).
Common causes of cervical spine injuries
It’s not uncommon for this area of the body to suffer injuries, and they are most frequently in infants and the elderly. Some of the most common ways to injure the cervical spine include:
- Motorcycle and bicycle accidents
- Diving head first into shallow water
- Sports accidents: hockey, wrestling, football, boxing, and horseback riding
- In older people, minor traumas like falls
- In infants and toddlers, car accidents and mild fender benders that result in the jerking of car seats
Athletes and cervical spine injuries
There are an estimated 12,000 new cases of spinal cord injuries (SCI) in the United States annually. Those injuries resulting from contact sports represent 8.9 percent—motor vehicle collisions top the list at 47.5 percent. The question for Mike Green and fellow athletes surrounds severity. When is a cervical injury damaging enough to force retirement? Catastrophic cervical spine injuries are the most devastating sports injuries. If an athlete decides to return, he must count the cost. For doctors and players alike, knowing when or if returning from a cervical spine injury is one of the most difficult in diagnoses and decisions sports medicine.
Lessons from the gridiron
The Detroit Lions drafted offensive lineman Mike Utley in the third round of the 1989 NFL Draft. As a rookie, Utley worked his way into the starting lineup at right guard. In his third season, Utley suffered an injury to C6 and C7 cervical vertebrae in a game against the Los Angeles Rams on November 17, 1991. The game stopped and as Utley was stabilized by field medical personnel and hoisted up on a gurney, he flashed the crowd a "thumbs up" as he was being taken off the field. Utley was forced to retire from football, and deemed functionally paraplegic since he has use of his upper extremities.
Dennis Byrd, a second-round pick of the New York Jets in the 1989 NFL Draft. He was widely considered to be the heir apparent to Jets great Mark Gastineau and lived up to the billing when he set the team rookie sack record. In 1992, while attempting to sack Chiefs quarterback Dave Krieg, Byrd collided with Jets teammate Scott Mersereau. The head-first collision shattered his fifth cervical vertebra into hundreds of pieces, leaving him unable to move. The injury forced Byrd to retire and only after years of extensive physical therapy was he able to walk again.
The injuries of these promising athletes, coupled by the recent spine injury of Pittsburgh Steelers linebacker Ryan Shazier beg us to ask the question, is the risk worth the reward?
Should athletes with cervical spine injuries risk playing again?
Shazier intends to play again. Despite suffering temporary paralysis from a neck injury sustained in a Monday night football game against the Cincinnati Bengals, he's optimistic about seeing the field again. It just won't be until 2019.
Mike Green, now 32-years-old, has to count the cost of continuing to play a fast-paced contact sport in which a defenseless player can be blindsided by a hit coming in at speeds of 15 to 20 miles per hour—the jolt of a minor fender bender. His recovery time is listed as a two-month minimum before he is cleared for rehabilitation. A study by Cantu, Robert C. MD, et al. published in Current Sports Medicine Reports in 2013 stated that “even after the fracture has healed, the altered biomechanics in surrounding spinal segments and loss of normal motion may produce a high risk of future sports-related injury. For many athletes, walking away from the game is difficult. It’s even harder when an injury causes retirement. While Green’s injury may not be severe and he’s likely to return to the ice, guys like Utley and Byrd weren’t as fortunate.