Giants LB Pierce Sidelined with Neck Injury

By Asheesh Bedi, MD

Just at the Giants began to embrace the thought of a complete and healthy roster, it was announced that middle linebacker Antonio Pierce would be out indefinitely with a bulging disk in neck (“cervical disk herniation”).

Disk bulges are not uncommon in contact athletes, and require special consideration and examination. The spinal cord and nerves that send signals to the muscles of the arms and legs reside immediately behind the spinal column, and a significant bulge or herniation of a disk in the neck can injure these vital structures. In contact sports like football or rugby, certain positions of the neck – usually slight flexion (“speer tackle”) – can be especially dangerous and increase the risk of spinal cord injury.

Cervical disks reside between the bones (“vertebral bodies”) of the spinal column, a relatively rigid structure designed to surround and protect the spinal cord and nerve roots. The disk is like a shock absorber with a tough ring of tissue on the outside (“annulus”) and gel-like center (“nucleus”). When the outer annulus becomes weak or ruptures, a disk bulge or “herniation” can develop in which a portion of the disk protrudes into the space for the spinal cord and nerve roots (“spinal canal”). When nerve roots are compressed, the disk can be responsible for neck pain, arm pain, numbness, and weakness of the arms and/or legs. Pain and numbness results from pinching of a nerve, and will be felt anywhere along the pathway of that nerve down the arm or leg. When the spinal cord is compressed, it is very serious and can affect ability to walk or perform fine movements of the hands and arms. The most common levels for disks in the neck to bulge is between the fifth and sixth (C5-C6) followed by sixth and seventh (C6-C7) vertebral bodies. The location of disk herniation is often detectable on physical exam, as the pattern of pain and neurological deficits will affect the specific nerve root(s) behind it. An MRI study will typically confirm the diagnosis and help to assess for nerve root or spinal cord injury.

The treatment of a cervical disk herniation can often be complex, and the input of a neck specialist or spine surgeon is usually advocated. It is important to note that not all disk bulges are necessarily responsible for symptoms, and that many times these bulges can be incidentally seen on imaging studies that were obtained for other reasons. For this reason, a careful correlation of symptoms and physical examination by a spine specialist is crucial. Furthermore, the majority of these disk herniations do not require surgery. Many disk bulges will shrink and become asymptomatic over time with rest and anti-inflammatory medications. Physical therapy to decrease pain and increase flexibility is often very helpful as well. If symptoms fail to improve with conservative management, however, surgery may indicated to remove the disk and/or decompress the spinal canal by removing surrounding bone. Surgery is always indicated, sometimes emergently, if there is significant compression of the spinal cord and/or nerve roots. It is best to seek counsel of your local spine specialist if you develop any of the symptoms of a cervical disk injury.

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