Cervical Spine Injuries
Cervical spine injuries ranging from serious to catastrophic can be a cause of sudden death in athletes competing in both contact and non-contact sports. Although the incidence rate is low (0.07/100,000 for high school; 2.12/100,000 for college) this type of injury has a very high fatality rate. There are an estimated 12,000 new cases of cervical spine injury in the US each year, 42% of which are a result of vehicle crashes. Sports constitute about 8% of these cervical spine injuries (~1,000 cases). American football is associated with the highest spine injury among sports; however, rule changes have dramatically improved the incidence of spine injuries since the 1970s.
Mechanism of a Cervical Spine Injury
Cervical spine injuries are the result of deformation to the cervical spinal column that can cause damage to the spinal cord. Injury to the C5 vertebrae and higher can be fatal because it may inhibit ventilation controlled by the central nervous system. In the 24-72 hours after a spinal cord injury has been sustained, many complications can arise. Immediate recognition and treatment is critical to overall survival of the athlete.
HOW DO YOU PREVENT CERVICAL SPINE INJURIES?
- Instruct proper tackling technique: no axial loading (spearing, which occurs when the head and neck is flexed between 20-30°and serves as the point of contact). This is the most common cause of cervical spine injuries in sport.
- Have medical staff to cover exercise sessions and games
- Enforce rules for safety
- Properly fit and maintain protective equipment
- Use protective equipment that meets safety standards (e.g. NOCSAE for football helmets)
- Have an EAP (Emergency Action Plan) specifically for cervical spine injuries
- Continually stay up to date and rehearse skills to manage cervical spine injury
- Properly identify predisposing conditions (eg. cervical stenosis etc.)
- Have multiple tools/mechanisms to remove protective equipment safely
LOOK FOR THESE SYMPTOMS IN ATHLETES WHEN CERVICAL SPINE INJURIES ARE SUSPECTED:
- Witnessing mechanism of injury
- Witnessing athlete who remains down or motionless after play
- Abnormal neurological findings
- Loss of motion in extremities
- Cervical spine pain with or without palpation
- Cervical spine deformity
HOW DO YOU KNOW IF THIS IS A CERVICAL SPINE INJURY?
- Assess breathing/circulatory status (Normal 10-30 breaths per minute)
- Assess pulse (quality, rate, and rhythm)
- Assess neurologic status/level of consciousness
- If conscious, ask patient what symptoms they are experiencing
- Palpate cervical spine and surrounding musculature
- Perform upper/lower extremity sensory and motor assessment
- If assessment reports abnormal finding, prepare for emergency transport
Presence of 4 clinical indicators warrants advanced medical care:
- Unconsciousness (or altered consciousness)
- Bilateral neurologic complaints/findings
- Significant cervical spine pain (with or without palpation)
- Obvious spinal column deformity
WHAT ELSE COULD THIS BE?
- Head injury or concussion
- Neck sprain/strain
- Neck spasm
- Brachial plexus injury
- Cervical disk injury
HOW DO YOU TREAT AN INDIVIDUAL WITH A CERVICAL SPINE INJURY?
- Activate EMS
- Apply manual cervical spine stabilization throughout the entire process of care.
- Realign cervical spine to neutral if possible, and apply cervical collar (if available)
- This is not recommended if:
- Causes increased pain
- Neurologic symptoms
- Muscle spasm
- Airway compromise (jaw thrust maneuver if necessary)
- This is not recommended if:
- Remove protective equipment that impedes access to the airway
- All protective equipment (helmets and shoulder pads) should be removed by trained, healthcare professionals (such as athletic trainers) with experience in removing protective equipment prior to transport to the emergency department (ED).
- Many ED’s do not have the proper training or enough personnel to remove helmets/shoulder pads while minimizing movement and maintaining stabilization of the c-spine.
- If one item is removed (e.g. helmet), all equipment must be removed in order to maintain c-spine stabilization (helmet and shoulder pads)
- Lacrosse and ice hockey helmets should be removed in a suspected c-spine injury due to unique structure of the helmet.
- Sports with helmet only equipment should have helmet removed to establish neutral alignment.
- Move athlete onto long spine board (through log roll if patient is prone or lift and slide maneuver) and secure\
- Secure athlete’s head with blocks to long spine board
- Monitor vitals/level of consciousness throughout entire process
- Have member of athletic training staff accompany athlete to hospital (if possible)
WHEN CAN THE INDIVIDUAL RETURN TO ACTIVITY?
- Long term prognosis is directly related to severity of initial tissue damage (recovery may be complete or incomplete)
- Must be asymptomatic
- Must have full, pain free cervical spine range of motion
- Must have normal neurological exam
- Sport and risk of re-injury must be taken into consideration
- Return to play should be done on an individual basis
Recommended equipment for a Cervical Spine Emergency:
- Spine board/straps
- Cervical collar
- Head blocks
- Electric/cordless screwdriver
- Trauma Sheers/Backup cutting tools
- Quick release tool
- Portable phone
- Pocket mask
- Bailes JE, Petschauer M, Guskiewicz KM, Marano G. Management of cervical spine injuries in athletes. J Athl Train. 2007;42(1):126-134.
- Mueller FO, Cantu RC. Annual Survey of Catastrophic Football Injuries 1977–2012. Chapel Hill, NC: University of North Carolina; 2012.
- National Spinal Cord Injury Statistical Center. The 2007 Annual Statistical Report for the Spinal Cord Injury Model Systems.Birmingham, AL: National Spinal Cord Injury Statistical Center, University of Alabama–Birmingham; 2008.
- Swartz EE, Waninger KN. Cervical Spine Injury. In: Casa DJ, ed. Preventing Sudden Death in Sport and Physical Activity. Sudbury, MA: Jones and Bartlett Learning; 2012:129-126.
- Swartz EE, Boden BP, Courson RW, Decoster LC, Horodyski M, Norkus SA, Rehberg RS, Waninger KN. National Athletic Trainers’ Association position statement: acute management of the cervical spine-injured athlete. J Athl Train. 2009;44(3):306-301.
- Torg JS. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. Med Sci Sports Exerc.1985;17:295–303.
- Waninger KN, Swartz EE. Cervical spine injury management in the helmeted athlete. Curr Sports Med Rep. 2011;10(1):45-49.