Citation

Gastel JA, Palumbo MA, Hulstyn MJ, Fadale PD, Lucas P. Ann. Emerg. Med. 1998; 32(4): 411-417.

Affiliation

Department of Orthopaedics, Brown University School of Medicine, Providence, RI, USA. porterr@aehn2.einstein.edu

Copyright

(Copyright © 1998, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI

unavailable

PMID

9774923

Abstract

STUDY OBJECTIVE: To determine the influence of American football helmet and shoulder pads, alone or in combination, on alignment of the unstable cervical spine. METHODS: The alignment of the intact cervical spine in 8 cadavers was assessed radiographically under 4 different football equipment conditions: (1) no equipment, (2) helmet only, (3) helmet and shoulder pads, and (4) shoulder pads only. Each specimen was then surgically destabilized at C5-C6 to simulate a flexion-distraction injury. Repeat radiographs were obtained under the same 4 equipment conditions, and alignment of the unstable segment was analyzed. RESULTS: Before the destabilization, neutral alignment was maintained when both helmet and shoulder pads were in place. The "helmet only" condition caused a significant decrease in lordosis (mean, 9.6 +/- 4.7 degrees), whereas the "shoulder pads only" condition caused increased lordosis (13.6 +/- 6.3 degrees). After destabilization, the "helmet-only" condition demonstrated significant mean increases in C5-C6 forward angulation (16.5 +/- 8.6 degrees), posterior disc space height (3.8 +/- 2.3 mm), and dorsal element distraction (8.3 +/- 5.4 mm). CONCLUSION: Our flexion-distraction model demonstrated that immobilization of the neck-injured football player with only the helmet in place violates the principle of splinting the cervical spine in neutral alignment. By extrapolation to an extension-type injury, immobilization with only the shoulder pads left in place similarly violates this principle. In order to maintain a neutral position and minimize secondary injury to the cervical neural elements, the helmet and shoulder pads should be either both left on or both removed in the emergency setting.