Understanding Jarvis Jones' Case of Cervical Spinal Stenosis

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Understanding Jarvis Jones' Case of Cervical Spinal Stenosis
Scott Cunningham/Getty Images

Jarvis Jones is regarded by some to be the best overall player heading into April's 2013 NFL draft, but his diagnosis of cervical spinal stenosis may make teams shy away from calling him to the podium and rightly so.

Or is it?

Jones' saga started in 2009 when he played for USC (h/t Jordan Conn, ESPN The Magazine). Following a tackle during a game against the Oregon Ducks, Jones felt his shoulders go numb. He sat out the rest of the game and later received a diagnosis of a neck sprain.

Shoulder and arm numbness following a hit that forces the neck to bend sharply—called a "stinger"—is extremely common in football. In fact, the American Academy of Orthopedic Surgeons estimates that up to 70 percent of collegiate football players will suffer the injury at least once. However, the two-sided nature of Jones' symptoms concerned doctors, as stingers are generally limited to one side of the body.

Daniel Shirey-USA TODAY Sports
At one point, Jarvis Jones thought he would never play football again.

Those concerns were later confirmed.

As Conn's story discusses, doctors discovered Jones' cervical spinal stenosis during their evaluation of his neck sprain. After initially being told he would likely play again, USC physicians did not feel comfortable clearing him to return. Later on, however, re-evaluation by other medical staffs led to his reinstatement into the sport, demonstrating the uncertainty that currently exists in the medical community regarding how to handle the condition.

To understand spinal stenosis, picture a vertical PVC pipe with a rope dangled down the center. The pipe represents the 33 vertebrae that make up the spine. Under normal conditions, each vertebra encircles the spinal cord—represented by the rope—thereby protecting it.

In spinal stenosis, one or more vertebrae encloses the spinal cord more tightly than usual. To put it another way, part of the PVC pipe is narrower than normal—or "stenotic."

Jones' case involves the fourth and fifth of seven cervical vertebrae—the vertebrae that make up the spine at the level of the neck—called C4 and C5 for short.

This Neck MRI demonstrates cervical spinal stenosis. Though this likely represents a significantly more severe case than that of Jarvis Jones, the spinal cord can be seen being compressed by cervical vertebrae at the C4, C5 and C6 levels. Photo from Wikimedia Commons and labeled by the author.

So, what's the big deal? After all, unlike fellow draft prospect Walter Stewart, Jones' vertebrae are intact and still fully protecting his spinal cord, right? Well, in one way, they are.

Yet in another way, they aren't.

The smaller diameter of the PVC pipe in spinal stenosis means there is less room between the incredibly sensitive nerves of the spinal cord and the rock-hard vertebrae of the spine.

To make sense of why that smaller diameter matters, think back to the last time you hit your "funny bone." That isn't actually a bone. Rather, when you bump the inside of your elbow against, say, a table, you are actually pinching the ulnar nerve between the table and the humerus, or the bone of the upper arm.

Nerve injury causes downstream symptoms. However, when you hit the ulnar nerve—the funny bone—that "downstream" is merely the forearm and hand. In the case of the spinal cord at the level of the neck, "downstream" can represent the entire body. Photo from Wikimedia Commons and edited by the author.

Now, apply that sensation to the entire body, but instead of that "funny" feeling, make it paralysis instead. Scary, right? Unfortunately, that is what Jarvis Jones risks—theoretically, at least.

In 1997, Dr. Joseph Torg and colleagues demonstrated that cervical spinal stenosis likely increases the risk of developing cervical cord neurapraxia (CCN), a condition defined as temporary paralysis of two or more limbs for up to 48 hours (h/t Pub Med). Current theory states that in CCN, direct hits to the head or neck compress the spinal cord between two vertebrae, thereby interrupting its signaling and producing symptoms.

Dr. Torg found that out of 104 patients who suffered an episode of CCN, 86 percent had some degree of cervical spinal stenosis. Additionally, 100 percent of the episodes occurred during participation in a sport, and 87 percent occurred during football. Finally, of the 63 patients that returned to contact sports after their CCN resolved, 56 percent had another episode.

In short, cervical spinal stenosis predisposes to CCN, and those who have had one episode of CCN are likely to have another.

Patrick McDermott/Getty Images
Former Rutgers defensive tackle Eric LeGrand suffered fractures to his C3 and C4 vertebrae in 2010. The injury left him paralyzed from the neck down. Current evidence does not yet suggest that cervical spinal stenosis increases the risk of injuries similar to that of LeGrand's.

Just as important, however, is Dr. Torg's finding that not a single patient in the study suffered permanent neurological damage. In fact, although it makes anatomical sense that it would be the case, there is no evidence to date suggesting that cervical spinal stenosis increases the risk of catastrophic injury similar to the heartbreaking story of former Rutgers defensive tackle Eric LeGrand.

That said, case reports of players with spinal stenosis becoming permanently paralyzed do exist. However, it is impossible to say whether or not the stenosis played a role—they may have become paralyzed with a normal spine, too.

Unfortunately, the lack of certainty over whether or not it is safe for Jarvis Jones to play football led to his transfer from USC. Conversely, that same grey area led to his medical clearance at the University of Georgia.

Nevertheless, episodes of CCN certainly make playing football impossible. Stingers—something for which Jones is, in fact, at increased risk—can too, as arm weakness or numbness would severely limit the effectiveness of a linebacker.

That is where Jones' condition comes into play for NFL teams.

Though he may not be at increased risk for permanent damage—at least as far as we know—the possibility of repeated injury cutting into playing time can scare teams from drafting him at a high position.

The areas of skin to which a given spinal level provides sensation are called "dermatomes." The C4 and C5 dermatomes supply sensation to the shoulder. Photo from Wikimedia Commons.

Frankly, Jones' 2009 episode of shoulder numbness is probably not a coincidence. As mentioned, his spinal stenosis involves the C4 and C5 vertebrae, and the nerves that control sensation in the shoulder exit the spinal cord at the C3, C4 and C5 levels. In other words, the hit that started it all likely compressed those very nerves, and Jones' narrower-than-normal spinal canal may have contributed.

How does this affect Jones' draft stock? Matt Miller—Bleacher Report's NFL draft lead writer—weighed in:

Jarvis Jones' stock will vary across the league. There could be 10 teams that remove him from their board but one who loves him. It only takes one team, though. Jones could be drafted anywhere from No. 2 to No. 50 at this point. A healthy spine is key.

A number of factors will determine when Jones' name is called this April. For instance, each team's individual medical evaluation and needs at the linebacker position will play prominent roles. Yet in the end, just like all sports medicine decisions, Jones' value comes down to simple risk versus reward.

When will Jarvis Jones be drafted?

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Jones is certainly the best linebacker prospect in this year's class. If a team decides that its linebacker needs outweigh the risk of injury determined by its medical staff, the decision to draft Jones at a high position becomes a no-brainer. After all, he has had no repeat symptoms since the 2009 episode.

On the other hand, if a team believes it will be set at the linebacker position for some time, Jones' value falls to a much lower level, as spinal stenosis did indeed end Michael Irvin's career. Additionally, with each successive injury that may occur, it will become more and more difficult for any physician to feel safe allowing Jones to return to play.

Either way, though, the incredibly talented Jones will almost surely be drafted early, and as long as he is fully aware of the nature and risks of his condition, no one can be anything but happy about that fact.

Well, except for the teams that face him, that is.

 

Dave Siebert is a medical Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury and anatomical information is based on his own knowledge except where otherwise cited, and all quotes were obtained firsthand.

 

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