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Mount Sinai Health Beat: Levine Treated for Rare Injury

April 16, 2014 09:15 AM
Dr. Andrew Hecht
Robert Levine in action during his second-round match at the 2013 Metropolia Orange Bowl
Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA and the US Open. Each month, the Mount Sinai Health System will provide tips to prevent nagging injuries from cropping up, which prevent players from competing in tennis. One of the world’s leading medical institutions, Mount Sinai’s experts are uniquely positioned to help athletes from professionals to club players succeed in sport.
 
In addition to providing on-site clinical care for the professionals competing in the US Open, Mount Sinai’s team of medical experts aims to lead the development of policies around injury prevention and to conduct educational outreach to promote the health benefits of tennis.  
 
This month, Dr. Andrew Hecht shares how he discovered and treated the cause of pain that Robert Levine had suffered with for almost a year.
 

Robert Levine is an uncommon tennis player and has been an elite Eastern competitor for years. Three years ago, he claimed the USTA Boys' National Hard Court Singles Title and held the No. 1 ranking for Eastern. Last year, Robert won back-to-back titles in the Dominican Republic and Puerto Rico. This spring, the 16 year-old reached the semi-finals in the International Tennis Federation Grade 1 Easter Bowl Championships in Indian Wells, California and is now ranked No. 137 in the ITF World Junior Rankings. This Bedford, New York native trains at the IMG Academy in Florida and Gotham Tennis Academy in New York.

But he is uncommon in another way — one that almost derailed his promising career. At age 13, he suffered an injury so rare that you can count the number of known occurrences in the U.S. on the fingers of one hand. In fact, it’s so exceptional that it became the subject of two medical journal articles penned by Andrew Hecht, MD, co-director Spine Surgery in the Leni and Peter W. May Department of Orthopaedics at the Icahn School of Medicine at Mount Sinai.

Dr. Hecht was the medical sleuth that discovered the cause of pain that Robert had suffered for almost a year and which became so bad he couldn’t even arch his back. A different orthopedic surgeon told Robert he had a common condition called spondylosis, a stress fracture in the lumbar spine usually caused by hyperextension or a lot of twisting. Robert wore a back brace and waited for the injury to heal — but it only got worse. The chronic pain made training almost impossible.

So Robert and his parents sought a second opinion from Dr. Hecht who, with the aid of an MRI and bone scan, found that Robert had an interspinous ligament avulsion.  A ligament tore a piece of bone off one of the spinous processes, the bones one feels when you run a hand down the spine. “In young people, ligaments are often stronger than bone and can rip the end of the bone, but, usually, this injury repairs itself,” he says.

Not so in Robert’s case. Hecht could see that the spine, in trying to heal itself, created what looked like a mass. He had seen this kind of injury only once before — in a young elite dancer who later became an NFL cheerleader.

Hecht removed the non-healing bone and Robert’s recovery was long and painful — four months after the surgery, he was able to play tennis, but only for a few minutes at a time.

Hecht has nothing but praise for the young player. “His commitment to the surgery was equally matched by his commitment to the rehabilitation afterwards. It is a pleasure to care for an athlete like Robert who is so super motivated,” he says. “I think he is even better than he has ever been. I don’t take the credit for that. I think we simply gave him the opportunity to be the best that he could be.”

The lesson from Robert’s story is that if an injured player isn’t getting better based a plan of treatment, it’s time to question the diagnosis. “I like to say that common things happen commonly, but in medicine, the art is in understanding what is not common,” says Hecht. “And, in so many ways, nothing about Robert is common.”

 

For more information on "Orthopaedic Surgery" and "Sports Medicine," click here.

Upcoming health tips include: Shoulder injuries with James Gladstone and Preventing tennis injuries in youth with Alexis Colvin.

 
 

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