Pathology

In common with the overall pattern of spinal cord injuries from all causes, in rugby the cervical spine is the most commonly injured area. In non-catastrophic spinal injuries, the cervical and lumbar spine are the most frequently injured, with lumbar injuries resulting in the greatest time loss burden (57%), with cervical nerve root injuries accounting for 15% (Fuller CW 2007).

The mechanisms that may lead to a spinal cord injury have been divided into the following categories in the literature:

• Axial loading/ compression
• Hyperflexion or hyperextension
• Excessive lateral flexion
• Hyper-rotation
• Distraction (unlikely in rugby)

It has been suggested that the actual mechanisms are more complex because an axial force applied to the vertex of the head may result in compression, with flexion and extension occurring at different points along the cervical spine (Winkelstein BA 1997).

A spectrum of pathology is encountered in rugby that may result a spinal cord injury, including the following in isolation or in combination:

• Vertebral fractures -these may be stable or unstable.
• Vertebral dislocation or subluxation - these may be bifacet or unifacet.
• Acute disc prolapse

The commonest sites of injury in rugby are C4/5 and C5/6. Higher injuries may occur including C1/2 injuries e.g. odontoid peg fractures (Silver JR, 1992).

Secondary pathology resulting from hypoxia can be caused by the following:

• Obstructed airway
• Reduced pulmonary ventilation
• Hypovolaemia
• Impaired vascular supply to the cord:
• Direct pressure from fractured/dislocated bone,
• Oedema