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The Pathomechanics of Chronic, Recurrent Cervical Nerve Root Neurapraxia

The Chronic Burner Syndrome

Department of Orthopaedic Surgery, University of Pennsylvania

Philip J. Reilly, MD

Allegheny University, Philadelphia, Pennsylvania

Joseph S. Torg, MD

Allegheny University, Philadelphia, Pennsylvania

This study defined chronic recurrent cervical nerve root neurapraxia, the chronic burner syndrome, character ized the clinical findings, and described the responsible pathomechanics. We studied a subset of 55 athletes (mean age, 22 years) for evaluation of recurrent burn ers. Eleven subjects were professional athletes. The mechanism of injury was extension combined with ip silateral-lateral deviation in 46 patients (83%). Spurl ing's sign was positive in 39 patients (70%). Twenty- nine patients (53%) had developmentally narrowed cervical canals, and 48 patients (87%) had evidence of disk disease by magnetic resonance imaging. The disk disease was in the form of a disk bulge, disk protrusion, or a frank disk herniation deforming the cord. Fifty-one patients (93%) had disk disease or narrowing of the intervertebral foramina secondary to degenerative disk disease. Although burners may be the result of a bra chial plexus stretch injury in high school and collegiate football players seen with acute symptoms, nerve root compression in the intervertebral foramina secondary to disk disease is a more common cause in collegiate and professional players who have recurrent or chronic burner syndromes. There is a high incidence of cervi cal canal stenosis in football players with recurrent burner syndrome. The combination of disk disease and cervical spinal canal stenosis may lead to an alteration in normal cervical spine mechanics that may make these athletes more prone to chronic burner syndromes.

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