Comparison of the flat torso versus the elevated torso shoulder pad removal techniques in a cadaveric cervical spine instability model

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Department of Orthopaedics and Rehabilitation

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Aged; Aged, 80 and over; Athletic Injuries; Cadaver; Cervical Vertebrae; Clinical Protocols; Emergency Medical Services; Female; Football; Humans; Iatrogenic Disease; Immobilization; Male; Manipulation, Spinal; Models, Anatomic; Neck Injuries; Patient Care Team; Spinal Cord Injuries; Spinal Injuries; Sports Equipment




STUDY DESIGN: Controlled laboratory study in a cadaveric model.

OBJECTIVE: To determine if removing shoulder pads using the elevated torso technique generated less spinal segment motion than using the flat torso method.

SUMMARY OF BACKGROUND DATA: Guidelines for care of the injured football player with a suspected spinal injury recommend initial immobilization with shoulder pads and helmet in place. There is a need to develop a safe protocol, for shoulder pad removal that maintains optimum cervical stability.

METHODS: Five lightly embalmed cadavers were studied before and after a globally unstable segment was created at C5-C6. A trained group of medical staff conducted repeated measures trials for 2 pad removal protocols. The elevated torso technique, outlined by the NATA Inter-Association Task Force, is the same as the flat torso except an additional assistant is employed to lift the patient's shoulders 30 degrees to 40 degrees off the ground while the head holder maintains spinal alignment as the pads are removed. An electromagnetic tracking device captured angular and linear motions in 3 planes between the C5-C6 segments.

RESULTS: The elevated torso technique generated significantly less C5-C6 motion in flexion/extension (P = 0.015) and lateral bending (P = 0.001), with a trend toward decreased cervical motion in axial rotation (P = 0.052). When moving the spine-injured cadavers, linear translation was also slightly, but not significantly less when the elevated torso technique was used. In the intact spine, significantly less motion was seen in 5 of 6 measures when the elevated torso technique was used. However, the differences were not large enough to be clinically significant in an intact spine.

CONCLUSION: These findings support use of the elevated torso method to minimize cervical spine motion during shoulder pad removal when neither thoracic nor lumbar spinal injury is a concern.

DOI of Published Version



Spine (Phila Pa 1976). 2009 Apr 1;34(7):687-91. doi: 10.1097/BRS.0b013e31819794e7. Link to article on publisher's site

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At the time of publication Christian P. DiPaola was not yet affiliated with the University of Massachusetts Medical School.

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