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 with the protective equipment worn by a neck-injured football player. The purpose of this cadaveric study was to determine the effects of the helmet 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 condition. 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 backboard and four lateral cervical radiographs were obtained 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 degrees) and significantly increased in the shoulder pads-only category (mean, 13.6 degrees). In Group II, destabilized specimens under the helmet test situation showed a significant mean increase in C5-6 forward angulation (16.5 degrees), 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.