Cervical Spine Alignment in the Immobilized Football Player

Abstract

We investigated the effect of football helmet removal on the sagittal alignment of the cervical spine. A quantitative radiographic assessment of relative cervical spine position in subjects immobilized to a standard backboard wearing shoulder pads either with or without a helmet was performed. Comparison was made to a control situation with subjects on a backboard wearing no equipment. Ten subjects were studied using lateral computed tomographic scout films; each subject served as his own control. Radiographs were measured for overall sagittal cervical alignment and the amount of lordosis or kyphosis present within specific segments of the cervical spine. Mean values for each of the three defined situations (no equipment, shoulder pads and helmet, shoulder pads alone after helmet removal) were calculated and subjected to statistical analysis. No statistically significant difference in cervical sagittal alignment was noted when either no equipment or both shoulder pads and helmet were worn. In contrast, a statistically significant increase in cervical lordosis (extension) was found when comparing the control situation to that when only shoulder pads were worn after the helmet had been removed. The majority of this increase occurred in the subaxial spine. Therefore, the authors recommend that football players with a potential cervical spine injury be immobilized for transport with both their helmet and shoulder pads left in place, thereby maintaining the neck in a position most closely approximating "normal."

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

“…Question 2b: Are outcomes after CSI likely to be better when the helmet/shoulder pads are removed prior to transport? The systematic review identified studies 22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (N ¼ 18) of both static cervical alignment and dynamic cervical motion during immobilization in American tackle football, ice hockey, and lacrosse players. No studies directly examined patient outcomes.…”

“…Comparisons of alignment and motion were made between participants wearing full equipment (helmet and shoulder pads), wearing shoulder pads but no helmet, and wearing no equipment. Studies 27,28,[31][32][33][34]36,40 involving American tackle football and ice hockey equipment did not indicate statistically significant differences in either static cervical alignment or dynamic cervical motion when comparing participants wearing full equipment with participants wearing no equipment. Removal of the football or ice hockey helmet alone, without removing shoulder pads, resulted in cervical alignment that was statistically significantly different from alignment when not wearing any equipment, with greater cervical lordosis seen when only the helmet is removed.…”

“…Removal of the football or ice hockey helmet alone, without removing shoulder pads, resulted in cervical alignment that was statistically significantly different from alignment when not wearing any equipment, with greater cervical lordosis seen when only the helmet is removed. [33][34][35] However, authors of studies 26,38,39 of lacrosse players (N ¼ 3) disagreed on the difference in cervical alignment between full equipment and no equipment. According to the results of cadaver studies, 28,37 removing only the helmet may lead to more angular displacement in injured spines than is suggested by healthy model studies.…”

Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

“…14 Studies in other helmeted sports such as football and hockey have helped create guidelines for the emergency transportation of athletes with suspected head/neck injuries regarding the appropriate timing and location of helmet removal. [15][16][17][18] To date there have been no studies that address this issue for alpine winter sports, and ski patrollers currently must rely solely on clinical judgement to decide when to remove a helmet rather than scientific evidence, leading to potential confusion and variation in practice.…”

A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint

“…Acceptable alignment of the cervical spine when both the helmet and shoulder pads were present provided further evidence to maintain on-field equipment. 15 , 16 However, the recently updated NATA consensus statement now advocates for the removal of equipment under the appropriate conditions before transfer to an emergency medical facility. 10 The NATA noted the advancement of equipment technology, expertise in removing equipment by athletic trainers, and expedited access to the athlete (specifically the chest) as rationales for early equipment removal.…”