Avaliação das alterações degenerativas da coluna cervical em jogadores de rúgbi brasileiros
Data
2022-07-05
Autores
Nagasse, Yoshinobu 
Orientadores
Wajchenberg, Marcelo
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O rúgbi é um esporte de colisão com risco de lesões cervicais traumáticas leves ou catastróficas, além de degeneração cervical precoce. A partir destas lesões podem ocorrer alterações neurológicas como stingers, tetraparesia transitória, radiculopatias e até lesões medulares. Desequilíbrios do alinhamento sagital podem estar associados a lesões catastróficas, sendo possível relacionar desalinhamento sagital com piora na qualidade de vida e com o aumento de incidência de degeneração. Objetivo: Avaliar, por meio de radiografias da coluna cervical de atletas profissionais de rúgbi, a presença de alterações degenerativas e de alterações de alinhamento da coluna cervical e correlacionar essas alterações com queixas clínicas e aumento da incapacidade. Também foi realizada a comparação entre atletas iniciantes e veteranos. Métodos: Foi realizado estudo transversal com 64 atletas profissionais de rúgbi, que foram submetidos a questionário com informações sobre prática esportiva e sintomas clínicos. Também foi realizada radiografia de coluna cervical, a fim de investigar alterações degenerativas como perda de altura intervertebral, osteofitose e esclerose óssea de platô vertebral, além de outras anomalias como malformações e deformidades sugestivas de fraturas prévias. Foram medidos parâmetros de alinhamento do eixo sagital vertical cervical, inclinação da vértebra de T1 e lordose cervical. Resultados: A média dos parâmetros, obtidos nas 64 radiografias, foi 19,8º ± 14,1 para lordose cervical, 28,1 ± 8,1 para inclinação de T1 e 12,7mm ± 10,2 para o eixo vertical sagital cervical. A diferença entre inclinação de T1 e lordose cervical foi de 8,3 ± 10,4. Alguma alteração degenerativa foi observada em 20,3% das radiografias. Não houve diferença na incidência de alterações degenerativas e de alinhamento, entre jogadores veteranos e iniciantes. Atletas que apresentaram lordose cervical maior que 2 desvios-padrões tiveram pontuação na escala visual analógica de dor de 2,43 ± 1,62 contra 1,16 ± 1,35 nos atletas com lordose normal (p=0,024). Os atletas na posição avançada também tiveram maior pontuação com 1,64 ± 1,58 em comparação com jogadores na posição recuada que obtiveram 0,76 ± 0,96 (p=0,007). Conclusão: A variação da lordose cervical, maior que 2 desvios-padrões, está relacionada a um aumento na escala visual analógica de dor. Os jogadores avançados também mostraram um aumento nessa escala. Não foi observada diferença nos sintomas entre jogadores veteranos e iniciantes, assim como alterações de alinhamento e degeneração.
Introduction: Rugby is a collision sport with a risk of mild or catastrophic traumatic neck injuries and early cervical degeneration. These injuries can cause neurological changes such as stingers, transient tetraparesis, radiculopathies and even spinal cord injuries. Sagittal alignment imbalance may be associated with catastrophic injuries. It is also possible to relate sagittal misalignment to a worsening of quality of life and an increased incidence of degeneration. Objective: Evaluate presence of degenerative and alignment changes through cervical spine radiographs of professional rugby athletes correlating these changes with clinical complaints and increase in disability. A comparison was also made between novice and veteran athletes. Method: A cross-sectional study was carried out with 64 professional rugby athletes, which answered a questionnaire with information about sports practice and clinical symptoms. Cervical spine radiographs of these professional rugby athletes were evaluated to investigate degenerative changes such as intervertebral height loss, osteophytosis and vertebral plateau associated with bone sclerosis and besides other anomalies such as malformations and deformities suggestive of previous fractures. We also measured alignment parameters of cervical sagittal vertical axis, T1 slope and cervical lordosis. Results: Parameters average obtained from the 64 radiographs were 19.8º±14.1 for cervical lordosis, 28.1±8.1 for T1 Slope and 12.7mm±10.2 for cervical sagittal vertical axis. Mismatch between T1 slope and cervical lordosis was 8.3±10.4. Some degenerative disorders were found in 20.3% of radiographs. There was no difference in the incidence of degenerative and alignment changes between veteran and novice players. Athletes who had cervical lordosis greater than 2 standard deviations scored on visual analogue scale of pain 2,43 ± 1,62 versus 1,16 ± 1,35 in athletes with normal lordosis (p=0,024). Forward players also had higher scores 1,64 ± 1,58 in comparison with backs players whom scored 0,76 ± 0,96 (p=0.007). Conclusion: variation of cervical lordosis greater than 2 standard deviations is related to an increase in visual analogue scale of pain. The forward players also showed an increase in this scale. There was no difference in symptoms between veteran and novice players, as well as alignment and degeneration changes.
Introduction: Rugby is a collision sport with a risk of mild or catastrophic traumatic neck injuries and early cervical degeneration. These injuries can cause neurological changes such as stingers, transient tetraparesis, radiculopathies and even spinal cord injuries. Sagittal alignment imbalance may be associated with catastrophic injuries. It is also possible to relate sagittal misalignment to a worsening of quality of life and an increased incidence of degeneration. Objective: Evaluate presence of degenerative and alignment changes through cervical spine radiographs of professional rugby athletes correlating these changes with clinical complaints and increase in disability. A comparison was also made between novice and veteran athletes. Method: A cross-sectional study was carried out with 64 professional rugby athletes, which answered a questionnaire with information about sports practice and clinical symptoms. Cervical spine radiographs of these professional rugby athletes were evaluated to investigate degenerative changes such as intervertebral height loss, osteophytosis and vertebral plateau associated with bone sclerosis and besides other anomalies such as malformations and deformities suggestive of previous fractures. We also measured alignment parameters of cervical sagittal vertical axis, T1 slope and cervical lordosis. Results: Parameters average obtained from the 64 radiographs were 19.8º±14.1 for cervical lordosis, 28.1±8.1 for T1 Slope and 12.7mm±10.2 for cervical sagittal vertical axis. Mismatch between T1 slope and cervical lordosis was 8.3±10.4. Some degenerative disorders were found in 20.3% of radiographs. There was no difference in the incidence of degenerative and alignment changes between veteran and novice players. Athletes who had cervical lordosis greater than 2 standard deviations scored on visual analogue scale of pain 2,43 ± 1,62 versus 1,16 ± 1,35 in athletes with normal lordosis (p=0,024). Forward players also had higher scores 1,64 ± 1,58 in comparison with backs players whom scored 0,76 ± 0,96 (p=0.007). Conclusion: variation of cervical lordosis greater than 2 standard deviations is related to an increase in visual analogue scale of pain. The forward players also showed an increase in this scale. There was no difference in symptoms between veteran and novice players, as well as alignment and degeneration changes.