Cervical spine alignment in the youth football athlete: recommendations for emergency transportation

Abstract

Background: Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine.

Purpose: To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players.

Study design: Descriptive laboratory study.

Methods: Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests.

Results: Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P <or= .001). There was no statistically significant difference in either Cobb or C2-C7 angles between fully equipped (helmet + shoulder pads) and no-equipment conditions (P >.05).

Conclusions: Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the "all or none" policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete.

Clinical relevance: Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.