Maintaining Neutral Sagittal Cervical Alignment after Football Helmet Removal during Emergency Spine Injury Management.

By London Spine

Maintaining Neutral Sagittal Cervical Alignment after Football Helmet Removal during Emergency Spine Injury Management.

Spine (Phila Pa 1976). 2011 Aug 18;

Authors: Decoster LC, Burns MF, Swartz EE, Murthi DS, Hernandez AE, Vailas JC, Isham LL

Study Design. Descriptive laboratory study.Objective. To determine whether the placement of padding beneath the occiput after helmet removal is an effective intervention to maintain neutral sagittal cervical spine alignment in a position comparable to the helmeted condition.Summary of Background Data. Current on-field recommendations for managing football athletes with suspected cervical spine injuries call for facemask removal, rather than helmet removal, because the combination of helmet and shoulder pads has been shown to maintain neutral cervical alignment. Therefore, in cases when helmet removal is required, recommendations also call for shoulder pad removal. Because removal of equipment causes motion, any technique that postpones the need to remove the shoulder pads would reduce prehospital motion.Methods. Four lateral radiographs were taken of 20 male participants (age = 23.6±2.7 years). Participants were first imaged wearing shoulder pads and helmet. The helmet was removed and participants were imaged with occipital padding immediately and 20 minutes later, and finally without occipital padding. Cobb angle measurements for C2-C6 vertebral segments were determined by an orthopedic spine surgeon blinded to the study’s purpose. Intraobserver reliability was determined using intraclass coefficient analysis. Measurements were analyzed using a 1×4 repeated measures ANOVA and post-hoc pairwise-comparisons with Bonferroni correction.Results. Intraobserver analysis showed excellent reliability (ICC = 1.0, 95% CI: .999-1.0). Repeated measures ANOVA detected significant differences (F = 13.34 3,17, P<0.001). Pairwise comparisons revealed no differences in cervical alignment (all measurements reported reflect lordosis) when comparing the baseline helmeted condition (10.1°±8.7; 95% CI: 6.0-14.1) to the padded conditions. Measurements taken after removal of occipital padding (14.4°±8.1; 95% CI: 10.6-18.2) demonstrated a significant increase in cervical lordosis compared to the immediate padded measurement (9.5°±6.9; 95% CI: 6.3-12.7; P = 0.011) and the 20-minute padded measurement (6.5°±6.8; 95% CI: 3.4-9.7; P<0.001).Conclusions. Although facemask removal remains the standard, if it becomes necessary to remove the football helmet in the field, occipital padding (along with full body/head immobilization techniques) may be used to limit cervical lordosis, allowing safe delay of shoulder pad removal.

PMID: 21857408 [PubMed – as supplied by publisher]