Spine Injuries

May 20, 2017

 

Spine injuries can be deceptive. Even to the most highly trained medical professional, it may not appear that the athlete is seriously injured. The athlete may even be able to get up and even walk off the field. As with all sports injuries, the decisions made in the minutes immediately after the injury can determine the outcome.

 

In this instance, an athlete was tackled, experienced an inability to move for a few seconds, and then "was able to move his legs and roll over onto his back." This athlete was attended to by a volunteer physician who was covering the game.

 

The physician "attended to the athlete immediately on the field and evaluated him for approximately 15 minutes." "The physician did not believe that the plaintiff had suffered a spinal cord injury, and with the assistance of the athletic trainer, he removed his helmet. The athlete was placed in a seated position and then escorted off the field." On the sideline, the athlete began to complain of nausea and "the physician decided to send him to the emergency room." 

 

Regular X-rays and a CT scan were performed, both of which were read as "unremarkable." 

 

Three days later, the plaintiff went to the physician’s office but was seen by another provider. By then, the plaintiff could not elevate his arm or flex his elbow. He had also lost significant strength in his arm and had diffused tenderness to touch throughout his elbow, forearm, wrist, and hand. The athlete was referred for magnetic resonance imaging, which revealed an epidural hematoma on the right side of the spinal cord at the C1-C4 levels and a nonhemorrhagic cord contusion behind the C5 level. The team physician admitted in retrospect that he “would have put [the plaintiff] in a backboard on the field.”

 

What is the lesson here? The decision making in the first few minutes is critical. Coaches must be educated on what to do.

 

Spine Injury On-the-Field Care

 

  1. Do NOT move injured athlete! 

  2. Stabilize in the position found, unless athlete is unresponsive.

    1. How to Log Roll from Face Down to Face Up 

  3. Maintain stabilized position and wait for EMS.

 

"An emergency plan should be in place to ensure smooth initial management of an athlete with suspected cervical spine injury. This plan must be established, approved, revised and rehearsed on a regular basis. It must be practical and flexible to adapt to any emergency situation. There must be written documents that are distributed to key personnel."

 

"Current practice suggests that the immobilization of a prone athlete and movement from prone to supine should be done with a minimum of four persons. To immobilize a prone athlete, the rescuer at the head should maintain the head/neck complex in the position in which it was found [24]. If a prone athlete is not breathing, a log roll should be performed immediately. Unless the immobilization device is readily available, the athlete must be log rolled into a supine position on the playing surface and then moved a second time onto the long back board (the chances of secondary injury increase with each movement). If the athlete is conscious and stable, the log roll should be delayed until the backboard is available [25]. It is common practice to load the stretcher in the ambulance with the athlete’s head at the rear to avoid axial loading during ambulance braking."

 

Cervical Spine Immobilization in Sports Related Injuries: Review of Current Guidelines and a Case Study of an Injured Athlete

 

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