On-Field Management of Spine and Spinal Cord Injuries

Acute spinal injuries are rare in athletes. However when these injuries occur, they can be life threatening. All team physicians should be prepared to deal with spine and spinal cord injuries, and it is critical that on-field physicians have an established plan and protocol in place. All patients with a suspected spine injury should undergo an advanced trauma and life-support survey, as well as a thorough neurologic examination. During this initial evaluation, precautionary measures for the spine must be maintained. Athletes wearing helmets should have their helmets left in place; however, face masks should be removed to allow for access to the athletes’ airway. If a spine injury is suspected or confirmed on field, the athlete should be rapidly taken to a trauma center for a complete evaluation and early treatment. However, additional early interventions, such as high-dose methylprednisolone or hypothermia, are not supported by the evidence and should not be a routine component of care.