Last Friday on Smackdown, Big E suffered a broken neck.
Today we’ll take a look at what happened to Big E and what he can expect moving forward.
In the fateful match, his opponent Ridge Holland achieved suboptimal rotation and botched a
belly to belly suplex, dropping Ettore awkwardly on his neck.
The belly to belly suplex is a dangerous manoeuvre that, if performed incorrectly, leaves the
person being thrown in a compromised position.
Ideally, the person being thrown will land on their back with the neck safely out of
harm’s way in a relatively neutral position.
Proper belly to belly suplex form
But if not enough rotation is achieved, the victim’s head and neck may collide with
the floor, with all of their weight and the momentum of the throw behind the impact.
Whether the neck is in extension, lateral flexion or forward flexion (as it was in Big
E’s case) at the point of impact, there is risk of injury.
This mechanism might result in a flexion injury of the cervical spine which could include
cervical disc protrusions, cervical disc herniations, flexion tear drop fractures, fracture dislocations
of the cervical spine, or ligamentous injuries of the posterior ligaments of the cervical
spine.
And To be honest, with the force with which Big E was slammed to the floor, there is a
significant possibility of neurologic injury after this type of impact.
But with Big E noted to be moving after his injury, we can see that there was not a significant
neurologic injury at that time.
However, lack of neurologic injury does not preclude other structural injuries which could
result in persistent pain or instability of the cervical spine.
AEW wrestler Taz was vocal on twitter about Big E’s injury after the incident, stressing
the importance of proper technique when performing the Belly to Belly suplex.
I don’t know that the onus is on just Ridge, who in other matches has performed the move
with excellent technique.
Ridge Holland performing suplex well
Both wrestlers contribute to the momentum and rotation of the move, and perhaps this
“botch” may have been just that: a mistake…
With this in mind, the comparative size of these two men may have played a role in the
suboptimal rotation.
Standing 6’1 and billed at 253lbs, Ridge Holland is definitely packing some muscle.
While Big E is shorter standing 5’11, he is also considerably heavier than his opponent,
weighing in at 285lbs.
No matter how strong you are, that is a lot of weight to lift up and over your head.
And as these wrestlers give their all to the performance, a tiny slip or miscalculation
on either of their parts could have serious consequences.
But it’s all part of the sport.
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the video.
Now, when
Big E
landed on his neck he: suffered an axial load to the top of his head when he was thrown
forward.
With this mechanism the neck would be forced into forward flexion upon impact of the head
with the floor.
As mentioned previously, there are a number of injuries that might occur from this mechanism
of injury.
However, the most concerning injuries would include a burst fracture of the cervical spine,
where one or more vertebrae blow out their back wall into the spinal canal and spinal
cord, or a facet dislocation, where one vertebrae jumps its connection with an adjoining vertebrae
causing compression on, or transection of the spinal cord.
Neither of these injuries is desirable and both result in significant instability of
the cervical spine and serious neurologic compromise.
There is also the potential for a skull fracture at the back of the skull with injury to the
posterosuperior aspect of the brain.
And any time that you injure the skull, you have to worry about the possibility of bleeding
under the skull, either outside, or inside the lining of the brain.
This includes epidural, subdural, and subarachnoid bleeds, any of which can kill you either quickly,
or over time.
Initially, at the time of injury it is not possible to determine exactly what the pattern
of injuries that has occurred is.
This will be determined by subsequent physical examination and diagnostic imaging once he
has arrived in the hospital.
However, initial observations of motor activity in his extremities at the time of injury is
certainly a good sign suggesting that spinal shock is not present, and that there has not
been catastrophic injury to the spine or the spinal cord.
Spinal shock is an altered physiologic state that occurs immediately after a spinal cord
injury whose presence is demonstrated by a loss of spinal cord function caudal to or
below the level of the injury, with flaccid paralysis, anesthesia, absent bowel, and bladder
control, and loss of reflex activity.
Of course, a lack of neurological findings at the time of injury is not an absolute certainty
that subsequent neurologic injury mightn’t occur later as swelling associated with the
injury progresses and compresses neurologic elements later.
After the injury, Big E was put on a stretcher and received immediate medical attention at
UAB in Birmingham.
He posted a video on twitter that night and although he was wearing a neck brace his smile
was reassuring.
Hospital Clip 1
Being able to move your digits after breaking your neck is a very good sign.
This implies that motor pathways from the brain, through the spinal cord, and into the
peripheral nerves of the upper extremity are still intact, which in turn means that they
haven’t been cut or squished by bone or swelling.
For the time being, Big E is safe.
Big E posted another video to twitter sharing further information on his injury.
Hospital Clip 2
With fractured C1 and C6 vertebrae but “no damage to the spinal cord and no ligament
damage,” he will not have to undergo surgery.
He dodged a bullet, as many variables could have resulted in necessary surgical fixation.
Fortunately, his fractures are non displaced, which refers to: the relationship of the fracture
fragments to one another.
A C1, or atlas, vertebral fracture usually occurs after an axial load injury.
The associated fracture pattern is determined by the force that is applied in conjunction
with the axial load.
In the case of axial load and forward flexion, fractures of the anterior arch often occur.
Patients usually do not have a spinal cord injury or neurologic deficits with atlas fractures
because the fracture fragments spread outward or radially.
However, the vertebral arteries are at high risk of injury as a result of dissection,
thrombosis, or spasm due to inflammation which can result in later neurologic deficits.
C1 fractures are primarily treated nonoperatively.
If isolated, atlas fractures can be effectively managed with 8 to 12 weeks of external immobilization
of the head and neck which could include a rigid collar or cervical traction.
Collar immobilization or cervical traction is usually sufficient to allow for proper
healing; however, the type of orthosis required varies based on the relative stability of
the fracture fragments and the number of fracture fragments involved.
Nonoperative immobilization might include a rigid collar, halo vest, or Minerva jacket.
Soft collars are inadequate for immobilization and can result in worsening pain as a result
of uncontrolled neck motion and further fracture displacement.
After immobilization, dynamic imaging studies such as flexion-extension films are required
to confirm adequate immobilization and to rule out late instability.
The primary consideration for surgery is instability, which is demonstrated by the presence of mobility
on flexion-extension films.
The surgical approach and instrumentation for the treatment of unstable C1 fractures
is determined largely by the presence of associated injuries to the cervical spine.
So, the extent of associated trauma will determine the appropriate course of treatment.
As Big E noted on his social media channels, his injuries did not require surgery, so this
suggests that the C6 fracture was somewhat stable.
Given the mechanism of injury, we would anticipate that the fracture pattern most likely present
was a compression fracture, where the vertebrae is load axially.
Since there was forward flexion of the spine at the same time, the compressive force would
be concentrated at the anterior aspect of the vertebrae.
If minor, this would result in only a marginal loss in height of the anterior aspect of the
vertebral body.
If more serious this would result in significant collapse of the anterior aspect of the vertebral
body and a retropulsion of the back wall of the vertebral body into the spinal canal,
possibly with impingement of the spinal cord.
With the former, only one of the spinal columns described by Denis is involved and the spinal
column retains its overall stability.
However, if the posterior aspect of the vertebral body is also involved, two of the three columns
of Denis become involved and the spine loses its stability.
The former can be treated with rigid immobilization, or non-operative treatment, whereas the latter
requires open reduction and internal fixation with surgical implants.
Fortunately, this was not the case for Big E and it appears that rigid collar immobilization
will be sufficient to stabilize his cervical fractures.
Big E’s road to recovery will entail: rigid collar immobilization for 8-10 weeks until
healing of the fractures is confirmed.
He will undergo serial imaging with radiographs and CT scans to assess healing and ensure
malunion, or the development of non-anatomic fracture union, does not occur.
After healing has been confirmed, he will start physical therapy to restore the range
of motion and the strength of his neck, back, and upper extremity muscles.
The goal will be first to restore range of motion and normal function, before later progressing
to the mobility, strength, and endurance that is required for him to return to competitive
action in the WWE.
He is obviously a strong, optimistic individual and I hope he is able to maintain that attitude
through the recovery process.
After suffering a neck injury, edge returned to wrestling approximately one year after
cervical stabilization surgery, however this was not the end of his problems.
In the years that followed edge began to develop a narrowing of the spinal column above and
below his initial fusion.
The resultant development of arthritis at the adjacent levels this arthritis changed
his spine in such a way that subsequent surgery was necessary.
In Big E’s case, only rigid external immobilization is required, so the overall mobility of his
cervical spine will be preserved after rehabilitation, leaving him with normal function.
Once fully rehabbed, Big E can carry as normal, with no particular precautions required.
None other than not being belly to belly suplexed onto the concrete again.
After dodging a bullet with not one, but two cervical fractures that escaped serious neurologic
consequences, why tempt fate again?
If all goes according to plan, Big E should be able to return to the ring so that he can
fight again for the WWE championship.
Thanks to my sponsor Ritual for allowing me to bring this video to you.
Be sure to let me know what topics you want me to discuss in my upcoming videos.
As always, that’s been a word from Dr. Chris, not your everyday ortho.
Will he be able to wrestle again and if so, what precautions should he take in his future
matches?
Let me know in the comments what you’d like to see me react to next.
Outro.