THE EFFECT OF PROTECTIVE FOOTBALL EQUIPMENT ON ALIGNMENT OF THE INJURED CERVICAL-SPINE - RADIOGRAPHIC ANALYSIS IN A CADAVERIC MODEL

No universally accepted management protocol is available for dealing w ith the protective equipment worn by a neck-injured football player. T he purpose of this cadaveric study was to determine the effects of the helmet and shoulder pads on the alignment of 1) the intact lower cerv ical spine and 2) the partially destabilized C5-6 motion segment. In G roup I cadavers (N = 15), the lower cervical spine was tested in an in tact condition. In Group II (N = 8), the C5-6 motion segment was teste d in both an intact and a partially destabilized condition. Each cadav er was placed supine on a backboard and four lateral cervical radiogra phs were obtained as follows: no protective equipment, helmet only, he lmet and shoulder pads, and shoulder pads only. Results for Group I sh owed that wearing both helmet and shoulder pads did not result in a si gnificant change in cervical lordosis when compared with the neutral p osition (i.e., the no-equipment test). Cervical lordosis was significa ntly decreased in the helmet-only category (mean, 9.6 degrees) and sig nificantly increased in the shoulder pads-only category (mean, 13.6 de grees). In Group II, destabilized specimens under the helmet test situ ation showed a significant mean increase in C5-6 forward angulation (1 6.5 degrees), posterior disk space height (3.8 mm), and dorsal element distraction (8.3 mm). Immobilizing the neck-injured football player w ith only the helmet or only the shoulder pads in place violates the pr inciple of splinting the cervical spine in neutral alignment, accordin g to our findings, We support the concept that removal of the helmet a nd shoulder pads should be an all-or-none proposition.