Emergency Removal of Football Equipment: A Cadaveric Cervical Spine Injury Model, ,

Study objective: To determine the influence of 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. [Gastel JA, Palumbo MA, Hulstyn MJ, Fadale PD, Lucas P: Emergency removal of football equipment: A cadaveric cervical spine injury model. Ann Emerg Med October 1998;32:411-417.]