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Cervical Spine Alignment in the Immobilized Football Player

Radiographic Analysis Before and After Helmet Removal

Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

William C. Lauerman, MD

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Robert O. Blanc, MS AT,C

Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

William F. Donaldson, III, MD

Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Freddie H. Fu, MD

Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

We investigated the effect of football helmet removal on the sagittal alignment of the cervical spine. A quan titative radiographic assessment of relative cervical spine position in subjects immobilized to a standard backboard wearing shoulder pads either with or with out a helmet was performed. Comparison was made to a control situation with subjects on a backboard wear ing no equipment. Ten subjects were studied using lateral computed tomographic scout films; each subject served as his own control. Radiographs were meas ured 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 cervi cal sagittal alignment was noted when either no equip ment 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. There fore, 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."

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