Management of the Football Player with Suspected Spine Injury
Management of the Football Player with Suspected Spine Injury
ABSTRACT & COMMENTARY
Synopsis: Football players with potential cervical spine injury should be immobilized for transport, with both their helmets and shoulder pads left in place.
Source: Swenson TM, et al. Cervical spine alignment in the immobilized football player: Radiographic analysis before and after helmet removal. Am J Sports Med 1997;25:226-230.
In cases of suspected cervical trauma, immobi- lization of a football player to a rigid spine board for transport is of critical importance, but the handling of protective equipment, such as shoulder pads and helmet, is not well established. Swenson and colleagues performed quantitative radiographic assessment (lateral CTs) to compare relative cervical spine position in l0 subjects immobilized on a standard backboard wearing shoulder pads either with or without a helmet. The same subjects were studied wearing no equipment. No statistically significant difference in cervical spine alignment was noted when either no equipment or both shoulder pads and helmet were worn. In contrast, a significant increase in cervical lordosis (hyperextension) was found when shoulder pads were worn after the helmet had been removed. Football players with a potential cervical spine injury should be immobilized for transport with both their helmet and shoulder pads left in place, thereby maintaining the neck in a position most closely approximating the "normal."
COMMENT BY BARRY GOLDBERG, MD, FAAP
This is an excellent study by Swenson et al, attempting to standardize the management of cervical injury, based on objective data. In contact sports such as football, the cervical spine is repeatedly subjected to potentially injurious forces. Fracture or fracture-dislocation is relatively uncommon but may be associated with spinal cord injury. Whether to remove the football players’ helmets before immobilization is still controversial, but in my own experience and the experience of many colleagues, removal of the helmet is often associated with uncontrolled motion of the neck. Additionally, by cutting the tabs that hold the helmet, access to the airway can be achieved, and by employing the ear holes of the helmet, better control of the patient can be obtained. The increase in cervical lordosis (C2-C7) noted when the helmet was removed and the shoulder pads worn, afford another reason to maintain the helmet until a well controlled setting is reached. It is certainly true that an unstable neck, the lack of paraspinal spasm, and poorly fitting equipment could modify these results. Catastrophic neck injuries are one of the most devastating accidents in sports, and physicians, including part-time team physicians, should be aware of the optimal protocol to follow. (Dr. Goldberg is Clinical Professor of Pediatrics and Director of Sports Medicine at the Yale University Health Center.)
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