Catastrophic Spine Injuries Research Articles

The Readiness is All: Here Am I. Send Me.

<p align="center">The article uses contextual biography to examine the psychological and existential dimensions of “an internal environment that interacts with the other contexts in which the [author] evolves (Vidal, F., 2003, p. 73). Through a network of enterprises (Gruber, 1980) as a key aspect of that internal environment, this contextual autobiography conceptualizes a slice of the author’s life through the integration of particular literary and life contexts and her position within these background experiences. By using a unique and creative narrative of personal experiences, the author posits the universal or ontological problem of understanding the “all” of readiness for one of Shakespeare’s central characters with the juxtaposition of her own life as undertaken through the literary contexts examined. A catastrophic spinal injury coupled with the loss of her beloved father serve as prime catalysts for extreme life changes for the author creating questions of self-doubt and self-awareness, and whether the readiness for her was indeed, all. The article purposively adds to our understanding of how the internal environment and network of enterprises within an individual’s life experiences juxtaposed with literary contexts may profoundly inspire others to live unique lives of action and readiness. Findings of the study present the participant’s joyful journey of discovery and personal renewal with the most important lesson learned being that education is the ticket to a life of freedom and personal success. </p>

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy

Objective: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. Methods: Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. Results: The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. Conclusions: Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

Self-extrication in road traffic collisions: do we really need to cut the roof off?

Road traffic collisions are commonly encountered in the pre-hospital environment, and extrication of vehicle occupants can be challenging. Allowing a person to self-extricate from the vehicle, rather than using the process of prolonged mechanical extrication (the process of removing a vehicle from around a person), can be beneficial to the patient in a number of ways. The chance of catastrophic spinal injury (in this case taken to mean ‘any spinal injury that results in permanent disability, long-term medical problems or shortened life expectancy’) is low, and self-immobilisation during the extrication process will mean the patient is capable of protecting any injury they may have, without making it worse in any way. This is supported when the physiology of the spine, and the kinetics involved in road traffic collisions are considered. In addition, the self-extrication method is likely to reduce the time to definitive care, potentially improving the outcomes for many patients. It will also reduce anxiety, mental trauma and an unnecessary use of resources. Inviting a patient to remove themselves from a car is not a declaration of an uninjured cervical spine, and so immobilisation must still be used, in line with local policy, once the patient is out of the vehicle. The author presents an algorithm to assist the pre-hospital clinician in deciding if self-extrication is appropriate. It is based on the alert, systemically well patient agreeing to the plan and being aware that they may change their mind at any time. The need for focused research on the mechanics of extrication, rather than methods of immobilisation, is encouraged with a view to a validated algorithm in the future.

THE EFFECT OF A PRE-BIND ENGAGEMENT TECHNIQUE ON THE BIOMECHANICAL CHARACTERISTICS OF RUGBY SCRUMMAGING ACROSS MULTIPLE PLAYING LEVELS

BackgroundThe Rugby Union scrum has evolved into a highly dynamic activity, particularly during engagement. Although catastrophic spinal injuries in rugby are extremely rare, approximately 40% of these are associated with...

Epidemiology of Spinal Injuries in Sports

Supraphysiological stresses placed on the spine during sporting activity can lead to various spinal injuries, ranging from a simple sprain or strain of the musculoligamentous structures surrounding the spine to a cervical fracture dislocation with complete spinal cord injury. Collision sports, such as football, are responsible for the vast majority of catastrophic spinal injuries. Gymnastics and other sports that require repetitive hyperextension at the waist have been associated with isthmic spondylolysis. This article reviews the epidemiology of spinal injuries associated with various sports, with a specific focus on spinal cord injury.

Catastrophic Spinal Injury After Minor Fall in a Patient with Ankylosing Spondylitis

A 76-year-old man with a history of ankylosing spondylitis presented to the emergency department complaining of neck pain. He stated the pain began when he slipped to the ground from a seated position in his bedroom. On examination his head had adopted a posture so that his chin was resting on his right clavicle, he was noted to have reduced power and altered sensation in his lower limbs. A lateral radiograph of his cervical spine (Figure) shows an acute kyphosis with an associated fracture of the lower cervical vertebra. The vertebras above and below the fracture are rigidly ankylosed. Figure. Acute cervical kyphosis with a fracture in a rigidly ankylosed cervical spine. He was treated with open reduction and internal fixation after a period in halo traction. Unfortunately there was no recovery in neurological function. This image demonstrates that catastrophic spinal injuries can occur with low energy trauma in patients ankylosing spondylitis because the fused segments act as force amplifying levers. These patients should be accorded extra consideration prior to ruling out a fracture.

Epidemiology of Catastrophic Spine Injuries in High School, College, and Professional Sports

Sporting events are the fourth most common cause of spinal cord injuries in the United States. They are the third leading cause in patients younger than 30 years of age. Catastrophic cervical spinal trauma leads to most of these injuries with the key mechanism involving an axial force to a slightly flexed spine. Several sports have a greater risk of catastrophic spinal injuries: football, ice hockey, cheerleading, wrestling, swimming and diving, snow skiing and snowboarding, rugby, and baseball. This article reviews the available epidemiologic data concerning these sports and the catastrophic spinal cord injuries associated with them.

Cervical Spine Alignment During On-Field Management of Potential Catastrophic Spine Injuries

Context:When cervical spine injuries are suspected, the cervical spine should be immobilized in a neutral position and neck motion controlled in preparation for transport to an emergency facility. Protocols for emergency transport utilizing common devices (cervical collars) and methods (transfer techniques) during these procedures are not entirely evidence based.Evidence Acquisition:The medical literature search covered the time period of January 1966 to June 2008 using the following keywords, either alone or in combination: extrication collars, cervical collars, spine orthoses, spinal immobilization, spine board, spinal board, transfer techniques, and back board. Biomedical databases searched included Medline, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL [1982 to 2008]). The reference lists of all trials identified were also searched for additional trials.Methods:Only trials that directly compared the efficacy or safety of transfer methods and/or immobilization devices were included. Studies that measured voluntary head movement after the fitting of the cervical orthoses and those that did not evaluate motion across individual spinal segments were not included.Results:A lift-and-slide transfer method with a full body immobilization device creates less motion than a log-roll maneuver. Extrication-type cervical immobilization collars are limited in their ability to control neck motion in the injured cadaveric model.Conclusion:Allied health professionals responsible for the management of the cervical spine–injured patient should become familiar with and employ a lift-and-slide transfer technique in appropriate situations and should not rely exclusively on extrication-type collars to immobilize the neck.

The Epidemiology of Catastrophic Spine Injuries in High School and College Football

Contemporary Spine Surgery: July 2008 - Volume 9 - Issue 7 - p 6 doi: 10.1097/01.CSS.0000324872.25732.11

The Epidemiology of Catastrophic Spine Injuries in High School and College Football

Dr. Gill is Orthopaedic Surgeon and Adjunct Assistant Professor, Department of Bioengineering, Clemson University, Clemson, SC; and Dr. Boden is Associate Professor, Uniformed Services University of Health Sciences, The Orthopaedic Center, 9711 Medical Center Drive, No. 201, Rockville, MD 20850; E-mail: [email protected]. The authors have disclosed that they have no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity. All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty and staff conflicts of interest regarding this educational activity. This article was published originally in Sports Med Arthrosc Rev 2008; 16:2–6.

The Epidemiology of Catastrophic Spine Injuries in High School and College Football

Athletic events have long been identified as a source of catastrophic spinal injuries. One of the most notorious sports has been American football. At both the amateur and professional level, this collision sport is associated with the highest number of direct catastrophic injuries including cervical spine trauma and quadriplegia. Although modifications in the rules of play and education of players and coaches have significantly diminished the rate of quadriplegia, there remains a need to decrease the number of catastrophic spine injuries in football. Further research related to the prevention and management of athletic cervical spine trauma is necessary.

Catastrophic Injury in Rugby Union

Rugby union is a full contact sport with a relatively high overall risk of injury and a small specific risk of fatal and catastrophic spinal injury. Although catastrophic injuries in rugby union cause public concern and generate strong emotive reactions, the magnitude of society's concern about this type of injury is often dominated by people's perceptions rather than by actual levels of risk. This article assesses published values for the risk of catastrophic injuries in rugby union, evaluates these against the risk standards of the UK Health and Safety Executive (HSE) and compares the values with the risks associated with other common sport and non-sport activities. The assessment showed that the risks of sustaining a catastrophic injury in rugby union in England (0.8/100,000 per year), Ireland (0.9/100,000 per year) and Argentina (1.9/100,000 per year) were within the HSE's 'acceptable' region of risk (0.1-2/100,000 per year), whilst the risks in New Zealand (4.2/100,000 per year), Australia (4.4/100,000 per year) and Fiji (13/100,000 per year) were within the 'tolerable' region of risk (2-100/100,000 per year). The risk of sustaining a catastrophic injury in rugby union was generally lower than or comparable with the levels reported for a wide range of other collision sports, such as ice hockey (4/100,000 per year), rugby league (2/100,000 per year) and American Football (2/100,000 per year). In addition, the risk of catastrophic injury in rugby union was comparable with that experienced by most people in work-based situations and lower than that experienced by motorcyclists, pedestrians and car occupants. Whilst ranking risks provides an effective way of assessing their acceptability, it is recognized that representing risks by a single risk value can be misleading, as account must also be taken of the public's perception of the risks and the inherent differences in the types of risk being considered. However, an acceptable level of risk is often regarded as one that is no greater than the levels of risk that an individual encounters in everyday life. In this respect, the assessment indicated that the risk of sustaining a catastrophic injury in rugby union could be regarded as acceptable and that the laws of the game therefore adequately manage the risk.

Spinal Injuries in Professional Rugby Union: A Prospective Cohort Study

To determine the incidence, severity, nature, and causes of cervical, thoracic, and lumbar spine injuries sustained during competition and training in professional rugby union. A 2 season prospective cohort design. Twelve English Premiership rugby union clubs. Five hundred and forty-six male rugby union players of whom 296 were involved in both seasons. Location, diagnosis, severity (number of days unavailable for training and matches), and cause of injury: incidence of match and training injuries (injuries/1000 player-hours). Player age, body mass, stature, playing position, use of headgear, and activity and period of season. The incidences of spinal injuries were 10.90 (9.43 to 12.60) per 1000 player match-hours and 0.37 (0.29 to 0.47) per 1000 player training-hours. No player sustained a catastrophic spinal injury, but 3 players sustained career-ending injuries. Overall, players were more likely to sustain a cervical injury during matches and a lumbar injury during training. Forwards were significantly more likely to sustain a spinal injury than backs during both matches (P < 0.01) and training (P = 0.02). During matches, injuries to the cervical (average: 13 days; P < 0.01) and lumbar (13 days; P < 0.01) spine were more severe than injuries to the thoracic (5 days) spine; during training, injuries to the lumbar spine (26 days) were more severe than injuries to the cervical (13 days; P = 0.10) or thoracic (12 days; P = 0.06) spine. A total of 4037 days were lost to competition and training through spinal injuries with lumbar disc injuries sustained during training accounting for 926 days (23%) and cervical nerve root injuries sustained during matches for 621 days (15%). During matches, more injuries were caused by tackles (37%), and during training more injuries were caused by weight-training (33%). The results showed that rugby union players were exposed to a high risk of noncatastrophic spinal injury during tackling, scrummaging, and weight-training activities; injury prevention strategies, therefore, should be focused on these activities.

Catastrophic Spine Injuries in Sports

Catastrophic spine injuries in sports are rare but tragic events. The sports with the highest risk of catastrophic spinal injuries are football, ice hockey, wrestling, diving, skiing and snowboarding, rugby, cheerleading, and baseball. A common mechanism of injury for all at-risk sports is an axial compression force to the top of the head with the neck slightly flexed. We review common mechanisms of injury and prevention strategies for spine injuries in the at-risk sports.

Recognition and Autobiography

Recognition and Autobiography Richard Freadman It was less like seeing than being for the first time seen, knocked breathless by a powerful glance. Annie Dillard, Pilgrim at Tinker Creek In February 1974, Robert Rose, a twenty-two year old Australian Rules league footballer and Victorian state cricketer, was involved in a car accident that left him quadriplegic for the remaining twenty-five years of his life. The tragedy received extensive press coverage and struck a chord with many in and beyond the Melbourne sporting community. Robert was a brilliant all-round athlete with an impeccable sporting pedigree. He was the latest of the celebrated Rose family of the Collingwood Football Club —the most famous sporting club in Australia; a bastion of working class pride located close to the center of Melbourne. Robert's father, Bob, had been one of the greatest ever players for the club and had gone on to coach it. Four of Bob's brothers had also played for the Collingwood 'Magpies'. Later in his career, Bob coached Footscray, another Melbourne working class club. At the time of the accident, Robert too had joined Footscray, was playing state cricket, and might have gone on to bat for Australia. His best-remembered cricketing feat was to put Dennis Lillee, perhaps the finest of all Australian fast bowlers, to the sword at Melbourne's coliseum of sport, the Melbourne Cricket Ground. Robert's younger brother, Peter, witnessed the assault on the great fast bowler. Sitting in the top tier of the Northern Stand reading Norman Mailer's autobiography, Peter's attention is drawn to the "microscopic drama" (21) unfolding below. Proud as always of his brother's sporting prowess, he forgets about Mailer and becomes part of the rapturous crowd. [End Page 133] Rose Boys (2001) is Peter's account of his brother's life and death. The book is about their relationship as brothers, about what life is like for the families and friends of catastrophic spinal injury victims. It is also about Peter himself: about the adolescent who had to look up from Mailer to see his brother hooking Lillee; the "Rose boy" who, far from playing for Collingwood, was to become an accomplished poet, a gay man, and now a fine practitioner of a form of life-writing that combines biography, autobiography, autopathography (Couser 1997), disability narrative, eulogy, ethical reflection, and social history —an inquiry into Australian myths, ideologies, styles of masculinity, and cultural locales. In writing the book Peter sets out to "reanimate" Robert; "to examine his achievement, what he symbolized, what he gave and what he withheld, what he divulged and what he never said, as a son, as a brother, as a husband, as a mate, above all as a tragic victim of that 'second or two in time'" (27). Perhaps no book by or about Australian athletes has been written at such a remove as Rose Boys from the tired and uninquiring protocols of Australian sporting hagiography. Though clearly loyal and deeply attached to his family, Peter, "a devotee of Henry James's 'temple of analysis'" (12), concedes that he must "violate old privacies" (12), disclose frailties and failings, in order to capture what is most important about this sporting life —not the deeds enshrined in family scrap books ("those bibles of scrap, collages of self-delight," 3), but the moral, psychological, even spiritual, quality of the life after the accident. And of the other lives that were touched by it. Here, as elsewhere, the book is eloquent, profoundly moving, deep-seeing into the mysteries of human suffering, adaptation, and connectedness. Rose Boys is also a self-proclaimed narrative of recognition.1 The book begins with a description of a disturbing, Dantesque dream Peter has four years after Robert's accident. In the dream, the alarmed Peter sees a burning library. A blond boy who "is clearly the oracle because of his uncanny vision" (ii), appears with two companions at a nearby apartment window, but the boy is neither named nor quite recognized: [End Page 134] He is slender and vivid and blond as an angel. His two companions stare at him open-mouthed. I almost recognise this boy, but he is...

Spinal Injuries in Canadian Ice Hockey: Documentation of Injuries Sustained from 1943-1999

Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts. The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture. Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind. Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

Catastrophic Spinal Injuries in Football-Good News and Bad

Catastrophic Spinal Injuries in Football-Good News and Bad

Catastrophic spine injuries in American football, 1977-2001.

Cervical spinal cord injuries have been the most common catastrophic football injury and the second leading direct cause of death attributable to football skills. This study looks at the 25-year (1977-2001) experience with catastrophic neck injuries and examines not only the incidence but also the cause of injury and variables that have either increased or decreased these injuries. Data were collected on a national level from all organized football programs, including public school, college, professional, and youth programs, through personal contact and questionnaires on each catastrophic football injury. Funded by the National Collegiate Athletic Association, the National Federation of State High School Associations, and the American Football Coaches Association, data were collected by the National Center for Catastrophic Sports Injury Research, University of North Carolina at Chapel Hill (Frederick O. Mueller, Director, and Robert C. Cantu, Medical Director). Teaching the fundamental techniques of the game, equipment standards, and improved medical care both on and off the playing field have led to a 270% reduction in permanent spinal cord injury from a peak of 20 per year during the period 1971 to 1975 to 7.2 per year during the past 10 years. The type of injury, activity at the time of injury, level of play, and whether the injury was incurred in a game or practice are presented. On the basis of the data, recommendations are given for reducing catastrophic cervical spine injury in football.

Hockey Helmets, Face Masks, and Injurious Behavior

To educate physicians about factors that contribute to injurious behaviors in ice hockey and to propose that the medical community play a role in advocating change within the sport. A review of relevant literature on the topic was conducted, with information drawn from scientific journal publications, conference proceeding, theses, and newspaper publications. The introduction of mandatory head and facial protection has been effective in virtually eliminating ocular, facial, and dental injuries in youth hockey, but it has also been problematically linked with an increase in catastrophic spinal injuries. Players adopt a false sense of security when donning the equipment, leading them to take excessive and unwarranted risks because of the protection they are supposedly afforded. The addition of these protective devices has also altered how officials perceive game situations, leading them to be more lenient in administering penalties. The net result has been an increase in illegal and injurious behaviors, such as checking from behind. Physician advocacy may play an important role in effecting change within the sport.

Catastrophic Spine Injuries in Football (1977???1989)

Funded by the National Collegiate Athletes Association, the purpose of the National Center for Catastrophic Sports Injury Research is to reduce catastrophic injuries of the head and neck by analyzing the epidemiologic and medical data, and then recommending appropriate rules, conditioning, and medical changes. Catastrophic cervical spine injuries are defined as those that result in spinal cord injury. All cases result in disability. Deaths are excluded from this report. A total of 128 players incurred permanent cervical cord injuries from 1977 through 1989. Defensive players are at greater risk for quadriplegia than offensive players are, and most are injured while tackling. To further reduce catastrophic spine injuries, players must stop using the head as a battering ram, and use the shoulder for blocking and tackling instead. Other recommendations for reducing catastrophic spine injuries are presented.