Football protective gear and cervical spine imaging

Study objective: We sought to assess the effect of football protective gear on the cervical spine radiographic evaluation of adult male subjects. Methods: The study used a prospective, randomized, matched-pairs, observati onal design. Subjects served as their own control subjects, with cross-tabl e lateral and open-mouth odontoid cervical spine radiographs. Radiographs w ere obtained with protective head and shoulder equipment (pads group) and w ithout protective equipment (no pads group). Two emergency physicians and 2 neuroradiologists reviewed study radiographs. Physicians assessed radiogra phic views for adequate cervical spine visualization to the C7-T1 level and the odontoid and related structures. Comparison of radiographic readings f or the pads and no pads groups used the McNemar exact test. A McNemar test of equality of paired proportions was used to estimate a population of 20 p aired individuals to detect a significant outcome difference. Results: Zero percent of the pads group's cross-table lateral structures we re adequately visualized by all 4 reviewers (reviewer unanimity decision) c ompared with 25% of the no pads group's cross-table lateral films (between- group difference 25%; 95% confidence interval [CI] 6.0 to 44). When 3 of 4 reviewers noted adequate visualization (reviewer majority decision), 0% of the pads group's cross-table lateral structures were adequately visualized versus 40% of the no pads group's cross-table lateral radiographs (between- group difference 40%; 95% CI 19 to 62). With reviewer unanimity, 25% of the pads group's open-mouth odontoid structures were visualized versus 45% of the no pads group's open-mouth odontoid structures (between-group differenc e 20%; 95% CI -8.9 to 49). With reviewer majority analysis, 35% of the pads group's odontoid radiographs were adequately visualized versus 75% of the no pads group's open-mouth odontoid radiographs (between-group difference 4 0%; 95% CI 12 to 68). Conclusion: Football head and shoulder protective equipment appears to be a n impediment to cervical spine radiographic visualization. Guidelines for p layers' cervical spine imaging should incorporate procedures for removal of equipment before initial radiographic evaluation.