On-Field Assessment and Management of Spine Injuries

  • Shawn Sahota
  • Bryan Kelly


The incidence of spine injuries in athletics remains low, but when they occur, they are associated with significant morbidity and long-term disability. Prevention is key as sport-specific education, innovation in protective equipment, and rule modifications can protect athletes while preserving the integrity of the sport. Still, medical personnel should have an outlined plan well before the injury occurs to effectively make an appropriate response, including an emergency action plan that will accelerate care during this critical time. Communication is vital to the success of the plan, and a team approach will be needed. Team leaders should take charge and direct other medical personnel to ensure safety in delivery of care to the athlete. Prioritizing spinal stabilization during on-field assessment should be standard, and careful consideration must be given to maintaining spinal stability during maneuvers necessary for resuscitation. A rehearsed and regimented exam allows for an efficient and comprehensive on-field evaluation. If necessary, safe transfer of the athlete requires coordination of care and proper communication among all team members to make sure the athlete is properly boarded and secured prior to transport. While each injury is unique and circumstances surrounding the injury change, a well-organized systematic response will help ensure safe and efficient care for the athlete and will mitigate risk of further injury.


On-field Initial assessment Spine board Team physician Spinal cord injury Resuscitation 


  1. 1.
    National Spinal Cord Injury Statistical Center: spinal cord information network: facts and figures at a glance. University of Alabama at Birmingham. http:/ Accessed 28 Dec 2018.
  2. 2.
    Nobunga AI, Go BK, Karunas RB. Recent demographic and injury trends in people served by the model spine cord injury care systems. Arch Phys Med Rehabil. 1999;80:1372–82.CrossRefGoogle Scholar
  3. 3.
    Sanchez AR, Sugalski MT, LaPrade RF. Field-side and pre-hospital management of the spine-injured athlete. Curr Sports Med Rep. 2005;4(1):50–5.CrossRefGoogle Scholar
  4. 4.
    Levy AS, Smith RH. Neurologic injuries in skiers and snowboarders. Semin Neurol. 2000;20:233–45.CrossRefGoogle Scholar
  5. 5.
    Quarrie KL, Cantu RC, Chalmers DJ. Ruby union injuries to the cervical spine and spinal cord. Sports Med. 2002;32:633–53.CrossRefGoogle Scholar
  6. 6.
    Schmitt H, Gerner HJ. Paralysis from sport and diving accidents. Clin J Sport Med. 2001;11:17–22.CrossRefGoogle Scholar
  7. 7.
    Tarazi F, Dvorak MFS, Wing PC. Spinal injuries in skiers and snowboarders. Am J Sports Med. 1999;27:177–80.CrossRefGoogle Scholar
  8. 8.
    Zahir U, Ludwig S. Sports-related cervical spine injuries: on-field assessment and management. Semin Spine Surg. 2010;22:173–80.CrossRefGoogle Scholar
  9. 9.
    Mueller FO, Cantu RC. Annual survey of catastrophic football injuries. Accessed 2 Nov 2018.
  10. 10.
    Torg JS, Vegso JJ, Sennett B, Das M. The National Football Head and Neck Injury Registry: 14-year report on cervical quadriplegia, 1971 through 1984. JAMA. 1985;254:3439–43.CrossRefGoogle Scholar
  11. 11.
    Torg JS, Vegso JJ, O’Neill MJ, Sennett B. The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma. Am J Sports Med. 1990;18:50–7.CrossRefGoogle Scholar
  12. 12.
    Biasca N, Wirth S, Tegner Y. The avoidability of head and neck injuries in ice hockey: an historical review. Br J Sports Med. 2002;36:410–27.CrossRefGoogle Scholar
  13. 13.
    Swartz EE, Del Rossi G. Cervical spine alignment during on-field management of potential catastrophic spine injuries. Sports Health. 2009;1(3):247–52.CrossRefGoogle Scholar
  14. 14.
    Bailes JE, Petschauer M, Guskiewicz KM, Marano G. Management of cervical spine injuries in athletes. J Athl Train. 2007;42(1):126–34.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Domier RM, Swor RA, Evans RW, Hancock JB, Fales W, Krohmer J, Frederiksen SN, et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma. 2002;53(4):744–50.CrossRefGoogle Scholar
  16. 16.
    Criswell JC, Parr MJ, Nolan PJ. Emergency airway management in patients with cervical spine injuries. Anaesthesia. 1994;49(10):900–3.CrossRefGoogle Scholar
  17. 17.
    Hauswald M, Sklar D, Tandber D, et al. Cervical spine movement during airway management: cinefluroscopic appraisal in human cadavers. Am J Emerg Med. 1991;9:535–8.CrossRefGoogle Scholar
  18. 18.
    Crisswell JC, Parr MJ, Nolan PJ. Emergency airway management in patients with cervical spine injuries. Anaethesia. 1994;49(10):900–3.CrossRefGoogle Scholar
  19. 19.
    Shatney CH, Brunner RD, Nguyen TQ. The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury. Am J Surg. 1995;170:676–80.CrossRefGoogle Scholar
  20. 20.
    Demetraiades D, Charalambiades K, Chahwan S, Hanpeter D, Alo K, Velmahos G, Murray J, Asensio J. Nonskeletal cervical spine injuries: epidemiology and diagnostic pitfalls. J Trauma. 2000;48(4):724–7.CrossRefGoogle Scholar
  21. 21.
    McAlinden RJ. On field evaluation and management of head and neck injured athletes. Clin Sports Med. 2002;21:1–13.CrossRefGoogle Scholar
  22. 22.
    Wojtys EM, Hovda D, Landry G, Boland A, Lovell M, McCrea M, Minkoff J. Concussion in sports. Am J Sports Med. 1999;27:676–86.CrossRefGoogle Scholar
  23. 23.
    Kaufmann HH, Harris JH, Spencer JA, Kopanisky DR. Danger of traction during radiography for cervical trauma. JAMA. 1982;247(17):2369.CrossRefGoogle Scholar
  24. 24.
    Bivins HF, Ford S, Bezmalinovic Z, Price HM, Williams JL. The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine. Ann Emerg Med. 1988;17(1):25–9.CrossRefGoogle Scholar
  25. 25.
    Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94(2 Suppl):265–70.PubMedGoogle Scholar
  26. 26.
    Swartz EE, Boden PP, Courson RW, Decoster LC, Horodyski M, Norkus SA, et al. National Athletic Trainers’ Association position statement: acute management of the cervical spine injured athlete. J Athl Train. 2009;44(3):306–31.CrossRefGoogle Scholar
  27. 27.
    Del Rossi G, Heffernan T, Horodyski M, Rechtine GR. The effectiveness of extrication collars tested during the execution of spine-board transfer techniques. Spine J. 2004;4:619–23.CrossRefGoogle Scholar
  28. 28.
    Del Rossi G, Horodyski M, Conrad BP, Di Paola CP, Di Paola MJ, Rechtine GR. The 6-plus-person lift transfer technique compared with other methods of spine boarding. J Athl Train. 2008;43(1):6–13.CrossRefGoogle Scholar
  29. 29.
    LaPrade RF, Broxterman RJ, Bahr M, Wentorf FA, Feist RJ, Cardinal KJ, Freed J. Care and transport of injured participants with potential spine injuries from ice rinks. Safety in ice hockey: Third Volume, ASTM 1341, AB Ashare, Conshohocken: American Society for Testing and Materials; 2000. 173–184.Google Scholar
  30. 30.
    Hoenshel RW, Pearson DB, Kleiner DM. The technique most commonly employed with a FM extractor. J Athl Train. 2001;36:S70.Google Scholar
  31. 31.
    Kleiner DM, Sonnenberg RJ. The influence of temperature on the ability to cut the football helmet facemask loop-strap attachment. J Athl Train. 1995;34:S62.Google Scholar
  32. 32.
    Kleiner DM. Football helmet facemask removal. Athl Ther Today. 1996;1:11–4.CrossRefGoogle Scholar
  33. 33.
    Swartz EE, Armstrong CW, Rankin JM, Rogers B. A 3-dimensional analysis of face-mask removal tools in inducing helmet movement. J Athl Train. 2002;37(2):178–84.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Jenkins HL, Valovich TC, Arnold BL, Gansneder BM. Removal tools are faster and produce less force and torque on the helmet than cutting tolls during face-mask retraction. J Athl Train. 2002;37(3):246–51.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Waninger KN, Richard JG, Pan WT, Shay AR, Shindle MK. An evaluation of head movement in backboard-immobilized helmeted football, lacrosse, and ice hockey players. Clin J Sport Med. 2001;11:82–6.CrossRefGoogle Scholar
  36. 36.
    Kleiner DM, Almquist JL, Bailes J, et al. Prehospital care of the spine injured athlete. A document from the Inter-Association Task Force for Appropriate Care of the Spine Injured Athlete. Dallas: National Trainers’ Association; 2001.Google Scholar
  37. 37.
    Swenson TM, Lauerman WC, Blanc RO, Donaldson WF 3rd, Fu FH. Cervical spine alignment in the immobilized football player: radiographic analysis before and after helmet removal. Am J Sports Med. 1997;25:226–30.CrossRefGoogle Scholar
  38. 38.
    LaPrade RF, Schnetzker KA, Broxterman RJ, Wentorf F, Gilbert TJ. Cervical spine alignment in the immobilized ice hockey player: a computed tomographic analysis of the effect of helmet removal. Am J Sports Med. 2000;28:800–3.CrossRefGoogle Scholar
  39. 39.
    Waninger KN. Management of the helmeted athlete with suspected cervical spine injury. Am J Sports Med. 2004;32:1331–50.CrossRefGoogle Scholar
  40. 40.
    Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am. 1989;71(1):15–22.CrossRefGoogle Scholar
  41. 41.
    Nypaver M, Treoloar D. Neutral cervical spine positioning in children. Ann Emerg Med. 1994;23(2):208–11.CrossRefGoogle Scholar
  42. 42.
    Banerjee R, Palumbo MA, Fandale PD. Catastrophic cervical spine injuries in the collision sport athlete, part 1: epidemiology, functional anatomy, and diagnosis. Am J Sports Med. 2004;32(4):1077–87.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Shawn Sahota
    • 1
  • Bryan Kelly
    • 2
  1. 1.Department of Orthopedic Sports Medicine and Shoulder SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Sports MedicineHospital for Special SurgeryNew YorkUSA

Personalised recommendations