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The Effect of Protective Football Equipment on Alignment of the Injured Cervical Spine

Radiographic Analysis in a Cadaveric Model

Department of Orthopaedic Surgery and Division of Sports Medicine, Brown University School of Medicine, Providence, Rhode Island

Michael J. Hulstyn, MD

Department of Orthopaedic Surgery and Division of Sports Medicine, Brown University School of Medicine, Providence, Rhode Island

Paul D. Fadale, MD

Department of Orthopaedic Surgery and Division of Sports Medicine, Brown University School of Medicine, Providence, Rhode Island

Timothy O'Brien

Department of Orthopaedic Surgery and Division of Sports Medicine, Brown University School of Medicine, Providence, Rhode Island

Larry Shall, MD

Department of Orthopaedic Surgery and Division of Sports Medicine, Brown University School of Medicine, Providence, Rhode Island

No universally accepted management protocol is avail able for dealing with the protective equipment worn by a neck-injured football player. The purpose of this ca daveric study was to determine the effects of the hel met and shoulder pads on the alignment of 1) the intact lower cervical spine and 2) the partially destabilized C5-6 motion segment. In Group I cadavers (N = 15), the lower cervical spine was tested in an intact condi tion. In Group II (N = 8), the C5-6 motion segment was tested in both an intact and a partially destabilized condition. Each cadaver was placed supine on a back- board and four lateral cervical radiographs were ob tained as follows: no protective equipment, helmet only, helmet and shoulder pads, and shoulder pads only. Results for Group I showed that wearing both helmet and shoulder pads did not result in a significant change in cervical lordosis when compared with the neutral position (i.e., the no-equipment test). Cervical lordosis was significantly decreased in the helmet-only category (mean, 9.6°) and significantly increased in the shoulder pads-only category (mean, 13.6°). In Group II, destabilized specimens under the helmet test situa tion showed a significant mean increase in C5-6 for ward angulation (16.5°), posterior disk space height (3.8 mm), and dorsal element distraction (8.3 mm). Immobilizing the neck-injured football player with only the helmet or only the shoulder pads in place violates the principle of splinting the cervical spine in neutral alignment, according to our findings. We support the concept that removal of the helmet and shoulder pads should be an all-or-none proposition.

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