Crosby may have had fractured vertebrae as well as concussions by David Shoalts Ottawa— Globe and Mail Update Published Saturday, Jan. 28, 2012 7:23PM EST Last updated Sunday, Jan. 29, 2012 9:46AM EST

Sidney Crosby may have suffered two cracked vertebrae in addition to a concussion, although the Pittsburgh Penguins say his neck injury is “fully healed.” Crosby, who has been skating for the last two weeks, still hopes to play this season, according to his agent, Pat Brisson.

The neck injury was reported Saturday by Sportsnet’s Bob McCown as an “abnormality” in his C1 and C2 vertebrae discovered by someone the Pittsburgh Penguins star consulted in Utah. Brisson said in response that the vertebrae may be cracked. He also said the neck injury was discovered by Dr. Robert Bray in Los Angeles, not by anyone in Utah. Brisson said Crosby is consulting an independent specialist in hopes of an exact diagnosis in the next 24 to 48 hours.

“He’s definitely trying to play this year,” Brisson said. “There is no doubt his goal is to play hockey this year. He wants to come back quickly but safely.”

Brisson, who was in Ottawa for the NHL all-star game, said Dr. Bray told Crosby he is not in any danger from the neck injury. “The doctor said, ‘You’re safe. You’re not in danger.’ That’s No. 1,” Brisson said.

The Penguins, who seemed to be caught off-guard by the initial report, released a statement Saturday night that only described the problem as a “neck injury” and it had healed. Brisson said it is not known when the neck injuries occurred.

Crosby was originally diagnosed with a concussion following games on Jan. 1, 2011 when he was hit by Dave Steckel, then of the Washington Capitals, and Jan. 5 last year when he was hit by Victor Hedman of the Tampa Bay Lightning. In late November, Crosby finally returned to the lineup but lasted only eight games before he was hit by Boston Bruins forward David Krejci on Dec. 5.

While there were reports Crosby suffered a second concussion as a result of the Krejci hit, Brisson said only one concussion has been diagnosed. It is not clear if the vertebrae injuries occurred as a result of the Krejci hit or one of the earlier collisions.

“The diagnosis of Dr. Robert S. Bray, a neurological spine specialist based in Los Angeles, is that [Crosby] had suffered a neck injury in addition to a concussion. Dr. Bray reports that the neck injury is fully healed. Those findings will be evaluated by independent specialists over the next few days. The most important goal all along has been Sidney’s return to full health, and we are encouraged that progress continues to be made,” the Penguins said in the statement.

Earlier on Saturday, Penguins general manager Ray Shero said he hopes Crosby will be able to play before the end of this season.

“We’ll see, hopefully, next week where he is [after] we get the reports from California,” Shero said. “The thing with Sidney is we want to continue to look to see how we can get this under control and manageable. Hopefully we’ll have him back here at some point soon.”

Dr. Paul Echlin, of London, Ont., who specializes in treating concussions, said it is not uncommon for people who suffer concussions to also sustain injuries to their vertebrae. He said he cannot offer an opinion on Crosby’s latest injury because he has not examined him, but did say the C1 and C2 vertebrae are the two most important ones in the cervical spine.

“Those are the ones your neck rotates on and the ones you’re most careful about making sure are not involved [in a head injury],” Dr. Echlin said.

Dr. Echlin also said it is difficult to make a prognosis about when Crosby will play again because the neck injuries complicate the situation. It is already difficult to make predictions about concussions, the doctor said, without other factors.

Even if someone said Crosby could return for the NHL playoffs in April, Dr. Echlin said, “those are big projections for anybody to make.”

The vertebrae problem is the second time a serious injury was not immediately diagnosed by the Penguins’ team doctors. Crosby was allowed to play on Jan. 5 last year, four days after the hit by Steckel in the NHL’s Winter Classic. The team said at the time that Crosby did not display any concussion symptoms until after the Jan. 5 game against the Lightning.

In the past few weeks, Crosby has consulted a chiropractor in Atlanta as well as Dr. Bray in Los Angeles, hoping to speed up his recovery from the concussions.

CEREBROVORTEX.COM analysis: The bone concussion syndrome

So now it’s revealed that Sidney Crosby has two healed vertebral fractures in C1 and C2 at the top of his neck. So the question becomes: did the fractures happen during the concussion impact then heal or did micro-fractures happen during previous concussions? How many times was his neck X-rayed after the first concussion? Why is it only now after  Crosby visits a neck specialist that the healed C1 and C2 vertebrae are noticed? Why was Crosby sent back a second time if he had unhealed vertebral neck fractures? It probably means they were present. Which is precisely the questions we are presently posing in experiments started two weeks ago.

We anticipate to demonstrate metabolic bone changes in our concussed mice experiments, so for our little group here in Montreal at McGill we are already off to a good start to the whole affair. We will measure a bunch of very specific metabolites to help resolve the damage cascade that we hope is significant in terms of compared control differences. If you have read previous posts from me, we are not guessing. Orthopedic surgeons have anecdotally reported for five decades that fractures heal faster with combined head trauma. For whatever weird reason not one of them stopped to ask, why?

Going back to Mr Crosby, did they examine other bone zones in his body for evidence of micro-fractures? Probably not I would expect, but now they should. Did the vertebrae fractures happen during the impact of the first concussion? Breaking neck bones takes a huge force. What may be occurring in a concussion is a destabilization of bone formation, bone loss. Bone tissue moves. Despite its hardness, bone is mobile, its profile is like a 3D object with dimensions constantly changing in time. It’s not a static, inanimate object at all, like a finished slab of granite, stopped in time. Its edges, its internal structure change as we age. That’s the long view on a time scale we do not experience yet is inside of each of us. We go about our daily habits unaware that if we could capture snapshots of our structure, our form, our shape change with time. Each day we change shape yet we think we are the same.

We as scientists, have to temper our enthusiasm to proceed at a diligent pace to define the biology of the query: do concussions reveal the potential of bone micro-fractures to happen more readily following minor traumatic brain injury (concussion)? The orthopedic surgeons have  already noticed this, it’s up to our research group to describe the beginning of how.

Suddenly in a flip of roles Sidney Crosby is no longer the concussion patient, he becomes the concussion experiment, his bones are talking to us. Crosby has now a new extraordinary gift to give, not only is he the world’s elite hockey player, he is teaching us the beginnings of our knowledge of concussion. This second gift will benefit all who suffer from brain injury.

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Montreal Grandmother, Agnes Kent was saved by Raul Wallenberg from certain death, when he provided papers for her and her Mom to escape away from the Nazis. Today when asked what that escape meant, she replied,"Remind people, that while statesmen and whole countries remained silent and did nothing, a single individual chose to act, with ramifications that proved enormous. Similar choices confront us today. Write that simple truth she said, it can never be repeated often enough because the world keeps forgetting it."
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