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Sports-Related Disorders of the Spine and Sacrum

  • Rob CampbellEmail author
  • Andrew Dunn
Chapter

Abstract

Modern sports activities are associated with a high incidence of spine pain. Low back pain (LBP) occurs in up to 50% of elite athletes (Curr Sports Med Rep 3(1):41–46, 2004). The majority are under 40 years of age. Most acute spinal injuries are soft tissue related, attributed to muscle and ligament strains, which can be successfully managed with non-invasive therapies. LBP may not be spine related but secondary to injury at other sites resulting in a breakdown of the bio-mechanical linkage of the spine, pelvis and lower limb. Changes in training regime, running surfaces and even footwear can all be responsible for LBP. It is therefore vital that athletes have a full clinical assessment prior to imaging of the spine. MRI is the primary imaging modality for diagnosis of most spinal pathology. Fat-suppressed T2W or STIR images are the most sensitive techniques for identifying bone marrow oedema, and should be included in MR protocols for investigation of back pain (Table 10.1). Radiological interpretation should always be informed by clinical findings. Asymptomatic abnormalities such as pars injuries and facet disease in the lower lumbar spine are common in elite athletes (Br J Sports Med 41(11):836–841, 2007). Radiography, CT and SPECT imaging have a limited and specific role in a minority of cases, where MR imaging is normal or required for further evaluation of a bony lesion. Spinal interventional procedures maybe required as part of the diagnostic or therapeutic management following clinical review. These are often safer and more effectively performed under image guidance.

Keywords

Spine Sports injury Stress fracture Spondylolysis Facet joint Ring apophysis Sacro-iliac joint Biomechanics 

References

  1. 1.
    Trainor TJ, Trainor MA (2004) Etiology of low back pain in athletes. Curr Sports Med Rep 3(1):41–46PubMedGoogle Scholar
  2. 2.
    Alyas F, Turner M, Connell D (2007) MRI findings in the lumbar spines f asymptomatic, adolescent, elite tennis players. Br J Sports Med 41(11):836–841, discussion 841PubMedCrossRefGoogle Scholar
  3. 3.
    Bogduk N (1997) The lumbar vertebrae. In: Clinical anatomy of the lumbar spine and sacrum. Churchill Livingstone, New York, pp 1–12Google Scholar
  4. 4.
    Hukins DW, Kirby MC, Sikoryn TA, Aspden RM, Cox AJ (1990) Comparison of structure, mechanical properties, and functions of lumbar spinal ligaments. Spine 15(8):787–795PubMedGoogle Scholar
  5. 5.
    Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA et al (2001) Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil 80(6):425–432PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen SP (2005) Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg 101(5):1440–1453PubMedCrossRefGoogle Scholar
  7. 7.
    Van Mameren H, Drukker J, Sanches H, Beursgens J (1990) Cervical spine motion in the sagittal plane (I) range of motion of actually performed movements, an X-ray cinematographic study. Eur J Morphol 28(1):47–68PubMedGoogle Scholar
  8. 8.
    Penning L, Wilmink JT (1987) Rotation of the cervical spine. A CT study in normal subjects. Spine 12(8):732–738PubMedCrossRefGoogle Scholar
  9. 9.
    Andriacchi T, Schultz A, Belytschko T, Galante J (1974) A model for studies of mechanical interactions between the human spine and rib cage. J Biomech 7(6):497–507PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein JD, Berger PE, Windler GE, Jackson DW (1991) Spine injuries in gymnasts and swimmers. An epidemiologic investigation. Am J Sports Med 19(5):463–468PubMedCrossRefGoogle Scholar
  11. 11.
    Cappozzo A (1983) Force actions in the human trunk during running. J Sports Med Phys Fitness 23(1):14–22PubMedGoogle Scholar
  12. 12.
    Twomey LT, Taylor JR (1983) Sagittal movements of the human lumbar vertebral column: a quantitative study of the role of the posterior vertebral elements. Arch Phys Med Rehabil 64(7):322–325PubMedGoogle Scholar
  13. 13.
    Gluck GS, Bendo JA, Spivak JM (2008) The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine J 8(5):778–788PubMedCrossRefGoogle Scholar
  14. 14.
    van Dieen JH, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 28(8):834–841PubMedGoogle Scholar
  15. 15.
    Tassone JC, Duey-Holtz A (2008) Spine concerns in the Special Olympian with Down syndrome. Sports Med Arthrosc 16(1): 55–60PubMedCrossRefGoogle Scholar
  16. 16.
    Gymnastics B Atlanto-axial information pack. www.british-gymnastics.org
  17. 17.
    Fuller CW, Brooks JH, Kemp SP (2007) Spinal injuries in professional rugby union: a prospective cohort study. Clin J Sport Med 17(1):10–16PubMedCrossRefGoogle Scholar
  18. 18.
    Shelly MJ, Butler JS, Timlin M, Walsh MG, Poynton AR, O’Byrne JM (2006) Spinal injuries in Irish rugby: a ten-year review. J Bone Joint Surg Br 88(6):771–775PubMedCrossRefGoogle Scholar
  19. 19.
    Franz T, Hasler RM, Benneker L, Zimmermann H, Siebenrock KA, Exadaktylos AK (2008) Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts Switzerland. Br J Sports Med 42(1):55–58PubMedCrossRefGoogle Scholar
  20. 20.
    Donald S, Chalmers D, Theis JC (2005) Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand. N Z Med J 118(1217):U1530PubMedGoogle Scholar
  21. 21.
    Shaskan G, Simons SM (2008) Thoracic apophyseal avulsion fracture in an adolescent football player. Curr Sports Med Rep 7(1):33–34PubMedGoogle Scholar
  22. 22.
    Jones A, Andrews J, Shoaib A, Lyons K, Ahuja S, Howes J et al (2005) Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report. Spine 30(11):E323–E325PubMedCrossRefGoogle Scholar
  23. 23.
    Gundry CR, Fritts HM Jr (1999) MR imaging of the spine in sports injuries. Magn Reson Imaging Clin N Am 7(1):85–103PubMedGoogle Scholar
  24. 24.
    Sairyo K, Katoh S, Sasa T, Yasui N, Goel VK, Vadapalli S et al (2005) Athletes with unilateral spondylolysis are at risk of stress fracture at the contralateral pedicle and pars interarticularis: a clinical and biomechanical study. Am J Sports Med 33(4):583–590PubMedCrossRefGoogle Scholar
  25. 25.
    Papanicolaou N, Wilkinson RH, Emans JB, Treves S, Micheli LJ (1985) Bone scintigraphy and radiography in young athletes with low back pain. AJR Am J Roentgenol 145(5):1039–1044PubMedGoogle Scholar
  26. 26.
    Langston JW, Gavant ML (1985) “Incomplete ring” sign: a simple method for CT detection of spondylolysis. J Comput Assist Tomogr 9(4):728–729PubMedCrossRefGoogle Scholar
  27. 27.
    Campbell RS, Grainger AJ, Hide IG, Papastefanou S, Greenough CG (2005) Juvenile spondylolysis: a comparative analysis of CT SPECT and MRI. Skeletal Radiol 34(2):63–73PubMedCrossRefGoogle Scholar
  28. 28.
    Saifuddin A, Burnett SJ (1997) The value of lumbar spine MRI in the assessment of the pars interarticularis. Clin Radiol 52(9): 666–671PubMedCrossRefGoogle Scholar
  29. 29.
    Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG (1987) Scintigraphic uptake of 99mTc at non-painful sites in athletes with stress fractures. The concept of bone strain. Sports Med 4(1):65–75PubMedCrossRefGoogle Scholar
  30. 30.
    Dunn AJ, Campbell RS, Mayor PE, Rees D (2008) Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol 37(5):443–450PubMedCrossRefGoogle Scholar
  31. 31.
    Hollenberg GM, Beattie PF, Meyers SP, Weinberg EP, Adams MJ (2002) Stress reactions of the lumbar pars interarticularis: the development of a new MRI classification system. Spine 27(2):181–186PubMedCrossRefGoogle Scholar
  32. 32.
    Lalam R, Cassar-Pullicino VN, Kumar DS, Fotiado A, Tins B, Tyrrell PNM (2008) Ossicles of the lumbar articular facets: normal variant or spondylolytic variant? In: Proceedings of the scientific session of the international skeletal society, New DelhiGoogle Scholar
  33. 33.
    Parvataneni HK, Nicholas SJ, McCance SE (2004) Bilateral pedicle stress fractures in a female athlete: case report and review of the literature. Spine 29(2):E19–E21PubMedCrossRefGoogle Scholar
  34. 34.
    Barker PJ, Urquhart DM, Story IH, Fahrer M, Briggs CA (2007) The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. Eur Spine J 16(12):2232–2237PubMedCrossRefGoogle Scholar
  35. 35.
    Tewes DP, Fischer DA, Quick DC, Zamberletti F, Powell J (1995) Lumbar transverse process fractures in professional football players. Am J Sports Med 23(4):507–509PubMedCrossRefGoogle Scholar
  36. 36.
    Wick LF, Kaim A, Bongartz G (2000) Retroisthmic cleft: a stress fracture of the lamina. Skeletal Radiol 29(3):162–164PubMedCrossRefGoogle Scholar
  37. 37.
    Aylwin A, Saifuddin A, Tucker S (2003) L5 radiculopathy due to sacral stress fracture. Skeletal Radiol 32(10):590–593PubMedCrossRefGoogle Scholar
  38. 38.
    Ahovuo JA, Kiuru MJ, Visuri T (2004) Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol 14(3):500–505PubMedCrossRefGoogle Scholar
  39. 39.
    Fredericson M, Moore W, Biswal S (2007) Sacral stress fractures: magnetic resonance imaging not always definitive for early stage injuries: a report of 2 cases. Am J Sports Med 35(5):835–839PubMedCrossRefGoogle Scholar
  40. 40.
    Bono CM (2004) Low-back pain in athletes. J Bone Joint Surg Am 86-A(2):382–396PubMedGoogle Scholar
  41. 41.
    Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66(5):699–707PubMedGoogle Scholar
  42. 42.
    Wu SS, Lee CH, Chen PQ (1999) Operative repair of symptomatic spondylolysis following a positive response to diagnostic pars injection. J Spinal Disord 12(1):10–16PubMedCrossRefGoogle Scholar
  43. 43.
    Eisenstein SM, Ashton IK, Roberts S, Darby AJ, Kanse P, Menage J et al (1994) Innervation of the spondylolysis “ligament”. Spine 19(8):912–916PubMedCrossRefGoogle Scholar
  44. 44.
    Muschik M, Hahnel H, Robinson PN, Perka C, Muschik C (1996) Competitive sports and the progression of spondylolisthesis. J Pediatr Orthop 16(3):364–369PubMedCrossRefGoogle Scholar
  45. 45.
    Mac-Thiong JM, Labelle H, Parent S, Hresko MT, Deviren V, Weidenbaum M (2008) Reliability and development of a new classification of lumbosacral spondylolisthesis. Scoliosis 3:19PubMedCrossRefGoogle Scholar
  46. 46.
    Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209(3):661–666PubMedGoogle Scholar
  47. 47.
    Micheli LJ, Wood R (1995) Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 149(1):15–18PubMedCrossRefGoogle Scholar
  48. 48.
    DePalma MJ, Bhargava A, Slipman CW (2005) A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy. Arch Phys Med Rehabil 86(7):1477–1483PubMedCrossRefGoogle Scholar
  49. 49.
    Narozny M, Zanetti M, Boos N (2001) Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Swiss Med Wkly 131(5–6):75–80PubMedGoogle Scholar
  50. 50.
    Ong A, Anderson J, Roche J (2003) A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med 37(3):263–266PubMedCrossRefGoogle Scholar
  51. 51.
    Videman T, Sarna S, Battie MC, Koskinen S, Gill K, Paananen H et al (1995) The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine 20(6):699–709PubMedCrossRefGoogle Scholar
  52. 52.
    Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(3):403–408PubMedGoogle Scholar
  53. 53.
    Blazek O, Streda A, Cermak V, Skallova O (1986) The incidence of morbus Scheuermann in sportsmen. J Sports Med Phys Fitness 26(1):55–59PubMedGoogle Scholar
  54. 54.
    Sward L (1992) The thoracolumbar spine in young elite athletes. Current concepts on the effects of physical training. Sports Med 13(5):357–364PubMedCrossRefGoogle Scholar
  55. 55.
    Blumenthal SL, Roach J, Herring JA (1987) Lumbar Scheuermann’s. A clinical series and classification. Spine 12(9):929–932PubMedCrossRefGoogle Scholar
  56. 56.
    Tallroth K, Schlenzka D (1990) Spinal stenosis subsequent to juvenile lumbar osteochondrosis. Skeletal Radiol 19(3):203–205PubMedCrossRefGoogle Scholar
  57. 57.
    McCall IW, Park WM, O’Brien JP, Seal V (1985) Acute traumatic intraosseous disc herniation. Spine 10(2):134–137PubMedCrossRefGoogle Scholar
  58. 58.
    Yang IK, Bahk YW, Choi KH, Paik MW, Shinn KS (1994) Posterior lumbar apophyseal ring fractures: a report of 20 cases. Neuroradiology 36(6):453–455PubMedCrossRefGoogle Scholar
  59. 59.
    Chang CH, Lee ZL, Chen WJ, Tan CF, Chen LH (2008) Clinical significance of ring apophysis fracture in adolescent lumbar disc herniation. Spine 33(16):1750–1754PubMedCrossRefGoogle Scholar
  60. 60.
    Helbig T, Lee CK (1988) The lumbar facet syndrome. Spine 13(1):61–64PubMedCrossRefGoogle Scholar
  61. 61.
    Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R (2007) A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician 10(1):229–253PubMedGoogle Scholar
  62. 62.
    Barnsley L (2002) Steroid injections: effect on pain of spinal origin. Best Pract Res Clin Anaesthesiol 16(4):579–596PubMedCrossRefGoogle Scholar
  63. 63.
    Manchikanti L, Damron K, Cash K, Manchukonda R, Pampati V (2006) Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary report of a randomized, double-blind, controlled trial: clinical trial NCT0033272. Pain Physician 9(4):333–346PubMedGoogle Scholar
  64. 64.
    Hossain M, Nokes LD (2005) A model of dynamic sacro-iliac joint instability from malrecruitment of gluteus maximus and biceps femoris muscles resulting in low back pain. Med Hypotheses 65(2):278–281PubMedCrossRefGoogle Scholar
  65. 65.
    Hungerford B, Gilleard W, Hodges P (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14):1593–1600PubMedGoogle Scholar
  66. 66.
    Brolinson PG, Kozar AJ, Cibor G (2003) Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep 2(1):47–56PubMedGoogle Scholar
  67. 67.
    Tuite MJ (2008) Sacroiliac joint imaging. Semin Musculoskelet Radiol 12(1):72–82PubMedCrossRefGoogle Scholar
  68. 68.
    Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B, Stengaard-Pedersen K, van Overeem Hansen G et al (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 44(2):218–229PubMedCrossRefGoogle Scholar
  69. 69.
    Tuite MJ (2004) Facet joint and sacroiliac joint injection. Semin Roentgenol 39(1):37–51PubMedCrossRefGoogle Scholar
  70. 70.
    Bollow M, Hermann KG, Biedermann T, Sieper J, Schontube M, Braun J (2005) Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis 64(11):1644–1646PubMedCrossRefGoogle Scholar
  71. 71.
    Fortin JD, Dwyer AP, West S, Pier J (1994) Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine 19(13):1475–1482PubMedCrossRefGoogle Scholar
  72. 72.
    Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ (2001) Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res (382):112–118PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of RadiologyRoyal Liverpool University HospitalLiverpoolUK

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