Spine
Core concepts
Focus on cervical radiculopathy, stingers/burners, cervical disc herniation, spondylolysis and spondylolisthesis, lumbar disc herniation, spinal stenosis, cauda equina syndrome, and cervical cord neurapraxia. Know dermatomal and myotomal patterns, Spurling and Lhermitte tests, and the distinction between radicular and myelopathic findings. In athletes, congenital cervical stenosis and Torg ratios may modify return-to-play decisions, but clinical syndrome and imaging must be integrated. Lumbar extension injuries in young athletes suggest spondylolysis; obtain oblique or thin-slice imaging when needed.
Traps
Bilateral hand numbness, gait disturbance, and hyperreflexia suggest cervical myelopathy, not a simple burner. A stinger is usually unilateral and resolves quickly; persistent weakness requires imaging. Cauda equina syndrome is an emergency with saddle anesthesia, urinary retention, and bilateral leg symptoms. Do not clear a cervical spine injury based on a single normal radiograph if the patient has midline tenderness or neurologic deficit. Vascular claudication can mimic lumbar stenosis.
Worked example
A 20-year-old defensive back has transient quadriparesis after a tackle, with symptoms resolving and no midline tenderness. Rule of thumb: any athlete with bilateral symptoms, prolonged symptoms, or cord-signal change on MRI needs specialist clearance before return; a single uncomplicated episode with normal imaging and full painless motion may allow return after stepwise evaluation.