Sports Related
Cervical Spine Alignment in the Immobilized Ice Hockey Player: A Computed Tomographic Analysis of the Effects of Helmet Removal The purpose of our study was to radiographically assess the relative position of the cervical spine in subjects immobilized to a standard spine back board wearing ice hockey shoulder pads both with and without a helmet. Our goal is to determine if removing the helmet from an ice hockey player causes significant increase in extension (kyphosis) of the cervical spine. Ten adult male volunteers (ages 18 to 28) with no previous history of cervical spine injuries were enrolled in the study after signing an informed consent approved by the Institutional Review Board. Each volunteer served as his own control. Each subject was fitted with an appropriate sized ice hockey helmet and shoulder pads as would be provided to participants on the University Ice Hockey Team. All subjects were immobilized in a supine position to a standard spine back board with straps and lateral foam pads attached to the back board to secure the head in a neutral position. Images of the cervical spine were obtained with computerized tomography scout scans with the subjects wearing no protective equipment (the initial control), wearing an appropriate sized ice hockey helmet and shoulder pads, and wearing only shoulder pads after the helmet was removed. The cervical spine lateral tomographic analysis was assessed by an experienced orthopaedic spine surgeon and the amount of cervical kyphosis or lordosis was measured using the Cobb angle. When the helmet was removed and the shoulder pads remained, a significant increase in C2-C6 lordosis was found when compared to helmet and shoulder pads remaining (P<.01) and to controls (P<.0004). Individual segmental measurements revealed a significant increase in cervical lordosis at the C4-C5 level when comparing the shoulder pads only to the helmet and shoulder pads treatment (P<.02). Our results demonstrate that the removal of an ice hockey helmet from a downed player causes a significant increase in lordosis (extension) of the cervical spine. We recommend that ice hockey helmets not be removed from injured players, as they maintain the cervical spine in a neutral position. Over the past 2 decades, the annual incidence of hockey related spinal injuries has increased markedly. The most common area of injury has been found to be the mid- cervical spine. Our study has demonstrated that this is the area that is most at risk with removal of the helmet in a downed ice hockey player. The findings in our study parallel those found in studies of immobilized football players, but in addition, we have found that there is an additional risk of increasing the area of lordosis where the majority of cervical spine injuries occur in ice hockey players. We recommend universal adaptation of immobilization of these hockey players in all circumstances until a cervical spine injury has been ruled out.
{photo4}
{photo5}
{photo6}
{caption2}
{caption3}
{caption4}
{caption5}
