Cervical Spinal Stenosis with Cord Neuropraxia

Cervical cord neuropraxia (CCN), or transient quadriparesis, is a temporary loss of spinal cord function affecting 2 or more limbs after a hyperextension, hyperflexion or axial-loading injury to the neck.

It usually occurs in an athlete with a narrow cervical canal, congenital or acquired. Recovery is complete, usually within minutes.

Acutely, it is managed as a cervical spine injury until proven otherwise. Afterwards, return to contact sport is a specialist, shared decision, resting on international expert opinion rather than a UK guideline.

Cervical canal stenosis is either congenital (short pedicles, often over several levels) or acquired: disc-osteophyte complex, ligamentum flavum buckling, facet hypertrophy, ossification of the posterior longitudinal ligament (OPLL) or spondylolisthesis.

In a narrow canal with little cerebrospinal fluid (CSF) around the cord, forced extension, flexion or axial load briefly compresses the cord and disturbs its function without structural damage. Uncomplicated CCN leaves no persistent cord signal change on MRI. Persistent T2 signal change, cord oedema or myelomalacia means structural cord injury, a different and more serious problem.

Related patterns:

• •Spinal cord injury without radiographic abnormality (SCIWORA): cord injury with no bony injury on imaging, classically in children
• •Spear tackler's spine: loss of the normal cervical lordosis, a narrow canal and a habit of head-down tackling