World Cup fever is taking grip among the normally calm and balanced medical imaging community, it seems. A number of imaging specialists are disputing whether a CT scan posted on the Internet of injured Brazilian football star Neymar Junior is authentic, casting doubt on the nature of his injuries in Friday's quarterfinal against Colombia.
Neymar was hauled off the pitch in a stretcher after suffering a brutal tackle from behind by Colombian defender Juan Zuniga, and the Brazilian team's physician said the striker had suffered a fractured third lumbar (L3) vertebra. Images of an emotional Neymar saluting his fans from a hospital bed dominated the media as pundits debated Brazil's chances with its star player knocked out for the duration.
But controversy has been building within the medical community after Brazilian TV posted what it said was an "x-ray image" (actually a CT scan) of Neymar's injured vertebra over the weekend. The image purported to show the damage Neymar suffered in the incident, with some sources claiming that the star could have been paralyzed if he had been hit just slightly higher on the back.
However, a number of imaging experts have criticized the image, pointing out that it does not show any acute damage to the L3 vertebra; instead, it seems to indicate damage to the L5 vertebra that's more consistent with a chronic condition -- a pathology that Neymar may have been playing with for some time.
First of all, the clash between Neymar and Zuniga was not particularly different than the thousands of other similar contacts that occur in football throughout the world, with both bodies traveling in the same direction at the same time, which reduces the magnitude of stresses to each other, according to a blog post by Dr. Antonio Valassina, an orthopedic and vascular surgeon at the Universita' Cattolica in Rome.
Valassina also notes the image posted by Brazilian media does not denote an L3 fracture, but instead spondylolysis of the L5 vertebra: "an interruption of the posterior arch of the vertebra L5 likely ... nontraumatic." In fact, the radiological characteristics of the image seem to suggest an "old disease," Valassina notes.
Finally, Valassina points out that if Neymar did indeed have a vertebral fracture, he should have been immobilized and should not have been sitting in a chair at the airport before being transported to a hospital.
A conversation on Reddit also noted that the scan did not appear to show an acute injury to the L3 vertebra, and instead seemed to indicate a chronic condition. "I thought the team doctor said the fracture was on a transverse process of the L3?" one participant noted. "The image does not ... show an acute fracture, and the defect shown is not on a transverse process."
Another Reddit participant notes the discrepancy, stating "The problem is that his defect has sclerotic margins, which means he's had it for a long time." Like Valassina, several forum participants suggested that the scan denotes spondylolysis, a defect in the pars interarticularis of the vertebral arch, which most often occurs in the L5 vertebra. The contact with Zuniga did not cause the injury, but could have aggravated it, several participants noted.
Valassina speculates that Neymar has suffered from low back pain due to spondylolysis of the L5 vertebra for some time. The "modest" trauma that incurred in the collision with Zuniga created stress in the hyperlordosis of the lumbar spine, making an "old problem" more serious.
"The suspicion is that, in the rush, the media has made a colossal mistake," and that the Brazilian national team does not want the public to know that its champion has been playing with a spondylolysis of L5 spinal injury that could jeopardize its participation in the World Cup. "The question of a fake is very strong," he notes.