Columna Cervical
Enviado por vivianacancino • 18 de Junio de 2013 • 5.427 Palabras (22 Páginas) • 380 Visitas
Journal of Athletic Training 155
Journal of Athletic Training 2005;40(3):155–161
q by the National Athletic Trainers’ Association, Inc
www.journalofathletictraining.org
Cervical Spine Functional Anatomy and the
Biomechanics of Injury Due to Compressive
Loading
Erik E. Swartz*; R. T. Floyd†; Mike Cendoma‡
*University of New Hampshire, Durham, NH; †University of West Alabama, Livingston, AL; ‡Sports Medicine
Concepts, Inc, Geneseo, NY
Erik E. Swartz, PhD, ATC; R. T. Floyd, EdD, ATC; and Mike Cendoma, MS, ATC, contributed to conception and design and
drafting, critical revision, and final approval of the article.
Address correspondence to Erik E. Swartz, PhD, ATC, Department of Kinesiology, New Hampshire Hall, 124 Main Street,
University of New Hampshire, Durham, NH 03824. Address e-mail to eswartz@cisunix.unh.edu.
Objective: To provide a foundation of knowledge concerning
the functional anatomy, kinematic response, and mechanisms
involved in axial-compression cervical spine injury as they relate
to sport injury.
Data Sources: We conducted literature searches through the
Index Medicus, SPORT Discus, and PubMed databases and
the Library of Congress from 1975–2003 using the key phrases
cervical spine injury, biomechanics of cervical spine, football
spinal injuries, kinematics of the cervical spine, and axial load.
Data Synthesis: Research on normal kinematics and minor
and major injury mechanisms to the cervical spine reveals the
complex nature of movement in this segment. The movement
into a single plane is not the product of equal and summative
movement between and among all cervical vertebrae. Instead,
individual vertebrae may experience a reversal of motion while
traveling through a single plane of movement. Furthermore, vertebral
movement in 1 plane often requires contributed movement
in 1 or 2 other planes. Injury mechanisms are even more
complex. The reaction of the cervical spine to an axial-load impact
has been investigated using cadaver specimens and demonstrates
a buckling effect. Impact location and head orientation
affect the degree and level of resultant injury.
Conclusions/Recommendations: As with any joint of the
body, our understanding of the mechanisms of cervical spine
injury will ultimately serve to reduce their occurrence and increase
the likelihood of recognition and immediate care. However,
the cervical spine is unique in its normal kinematics compared
with joints of the extremities. Injury biomechanics in the
cervical spine are complex, and much can still be learned about
mechanisms of the cervical spine injury specific to sports.
Key Words: catastrophic injury, whiplash, injury mechanisms,
spinal cord, axial load
Because of the potentially catastrophic and life-altering
nature of cervical spine injury (CSI), much concern
exists regarding the prehospital management of the cervical
spine–injured athlete. This is evidenced by a multiprofessional
task force effort initiated by the National Athletic
Trainers’ Association to establish general guidelines for the
acute care of the spine-injured athlete.1 Major CSIs, although
rare compared with sprain and strain injuries to the extremities,
are troubling because of mortality rates and the potential permanent
loss of neural function. A CSI requires an immediate
and deliberate, yet sensitive, response. The highest rate of severe
neck injuries has occurred in American football and rugby.
2–8 Other sports and activities that contribute to a high rate
of CSI are wrestling, diving, recreational diving, ice hockey,
gymnastics, and horseback riding.3,5,9
The more severe CSIs associated with athletics can be attributed
to compressive forces from axial loading.10,11 Clinically,
a major CSI results in compromised integrity of the cervical
segment due to fracture, dislocation, subluxation, or
ligamentous tearing, leaving the cervical spine unstable. White
et al12 defined clinical instability in the spine as more than a
3.5-mm horizontal displacement of one cervical segment on
another. Obviously, the athletic trainer is unable to detect the
presence of such a diminutive irregularity in the structure of
the spine and must, therefore, assume the worst-case scenario.
Motion in one plane at the cervical spine requires the contribution
of complementary motion from
...