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

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° to 40° 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.