Cervical osteogenic degeneration in Japanese professional wrestlers and its relationship to cervical spine injury

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This study aimed to investigate the characteristics of cervical degeneration in Japanese professional wrestlers and its relationship with the risk of cervical spine injury (CSI).


Since 2012, 27 Japanese male wrestlers belonging to a professional wrestling association have undergone periodical medical examinations of the cervical spine. If neurological symptoms were observed in the wrestlers, the resident trainers urged them to undergo a brief examination at the authors’ institutions. In addition to this prospective research study, the mechanisms of the CSIs that occurred in 5 wrestlers, including 2 with CSI before 2012 and 3 who were independent from the professional wrestling association, were retrospectively investigated by reviewing the circumstances of the injury and the wrestlers’ imaging studies.


The mean age of the wrestlers was 36.9 years (range 23–56 years) at the initial examination. An anterior giant ossifying lesion (AGOL) was observed in the anterior aspect of the cervical spine of 11 wrestlers (41%). The AGOLs tended to grow and spread to multiple spinal levels as the wrestlers aged. Of the 12 wrestlers with osteogenic lesions, 10 older than 40 years of age (83%) had an AGOL, which is frequently accompanied by osseous spinal canal stenosis. Two wrestlers presented with spinal cord compression with intramedullary intensity change on MRI. However, during the follow-up period, no spinal cord injury (SCI) occurred in the wrestlers, although thoracolumbar injury occurred in 2 wrestlers during a match. In examining the 5 wrestlers with CSI, the injury occurred at the spinal levels without an AGOL. The most frequent pathology of CSI (60%) was SCI at the spinal level adjacent to the multilevel AGOL.


AGOL is a peculiar cervical degeneration of Japanese professional wrestlers, especially in aged wrestlers. The AGOL appears to be a biological reaction to reinforce the anterior aspect of the cervical spine of professional wrestlers, who routinely defend themselves in a flexed neck posture against their opponent. The present results suggest that the risk of CSI is not increased by spinal canal stenosis accompanied by AGOL. Further studies are needed to investigate the relationship between the wrestlers’ cervical degeneration and the risk of CSI in more detail.

ABBREVIATIONS AGOL = anterior giant ossifying lesion; CSI = cervical spine injury; OALL = ossification of the anterior longitudinal ligament; OPLL = ossification of the posterior longitudinal ligament; PME = periodical medical examination; SCI = spinal cord injury; VA = vertebral assimilation.

Article Information

Correspondence Manabu Sasaki: Iseikai Hospital, Osaka, Japan. mana-nsu@umin.net.

INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.5.SPINE18283.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Imaging studies of a 44-year-old wrestler (A–C, case 22) and a 38-year-old wrestler (D–F, case 16). The initial plain radiograph (A) and MR image (B) of the former wrestler show an AGOL at the C3–4 levels, VA at the C5–7 levels, and spinal canal stenosis at the C3–5 levels. The initial plain radiograph (D) and MR image (E) of the latter wrestler show an AGOL at the C4–5 levels, OPLL at the C5–6 levels, and spinal cord compression with intramedullary signal intensity change. The plain radiographs taken 5 years later (C and F) show that the AGOL of both wrestlers increased in size.

  • View in gallery

    Imaging studies of the 3 wrestlers (case 24, A and B; case 29, C and D; and case 30, E and F) who sustained SCI during their professional wrestling matches. CT scans (A, C, and E) show a multilevel AGOL below the C4 level in all 3 wrestlers. MR images (B, D, and F) show intramedullary signal intensity at the C3–4 levels, which suggested that the region of SCI is adjacent to the AGOL. The CT scan also shows OPLL at the C3–4 levels in 1 wrestler (C), and the MR images show injury of the dorsal soft tissues around the spinous process in 2 wrestlers (B and D).



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