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Guidelines For On-Field Management of Neck Injury in Children
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Posted on: 08/28/2008
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Guidelines are in place for adult males injured on the football field. Cervical spine (neck) injuries are of special importance because of the danger of permanent spinal cord damage. In football, the helmet and shoulder pads are left on the adult injured player. The player is placed on a spine board and transported to the hospital. The face mask can be removed to allow for breathing.
But what about the growing number of children participating in tackle football? Should the same guidelines be followed? This is an important question because the number of boys in the seven to 17 years old group active in tackle football has almost doubled in the last 10 years. Participation in other collision sports such as ice hockey and lacrosse has also increased. At the same time, the risk of sports-related neck injuries has gone up.
Studies in the past have shown that the head-to-body size in children is different than in adults. Children grow at variable rates. But for the most part, the head during childhood is the size it will be as an adult. The body grows to match it in proportion. Adding sporting equipment might alter the spinal alignment. With an additional neck injury, this head-to-torso ratio could be important.
In this study, 31 male athletes from a local youth football league were examined by X-ray with and without protective equipment. The goal was to see if immobilization of the pediatric trauma patient is needed. Maintaining spinal alignment may be important to prevent further serious injury.
Each child was X-rayed three times. The base of the skull and cervical spine were the main focus areas. The child was placed supine (on his back) and X-rayed without the protective equipment. The second X-ray was taken in the same position with shoulder pads only. The third view was with helmet and shoulder pads.
Two physicians independently measured angles of the cervical spine. They used the standard Cobb measurement for C1 to C7 and the Gore measurement from C2 to C7. The angles were then compared among the three radiographic views. Each child's height, weight, and age were factored into the analysis.
The results showed excellent reliability between the two physicians using both methods to calculate the spine angles. This tells us that the method of measuring spine angles can be depended on to give a true picture of what's going on. The angle of cervical lordosis (backward curve of the spine) was greatest when the children wore just the shoulder pads.
Cervical angle did not change between being fully equipped with helmet and shoulder pads versus no equipment at all. Age, height, and weight did not seem to be a factor in spine angulation for the three equipment conditions.
Based on these findings, the authors recommend transporting pediatric patients with a potential neck injury with helmet and shoulder pads in place. The equipment aligns the cervical spine better than just one or the other. These guidelines only apply to football players. Further study is needed to identify the best way to manage and/or transport ice hockey or lacrosse players with cervical spine injuries.
Removing the equipment may result in increased cervical motion. If there is an injury, this increased motion could result in spinal cord damage. It's best to wait until the protective gear can be removed in a controlled setting. Usually this means after X-rays have been taken at the hospital emergency department.
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References:
Gehron Treme, MD, et al. Cervical Spine Alignment in the Youth Football Athlete. In The American Journal of Sports Medicine. August 2008. Vol. 36. No. 8. Pp. 1582-1586.
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