Neck Slap Shots on Brain and Spine

Impact of Neck Slap Shots on Brain and Spine: Insights from a Neurosurgeon

In a recent NHL incident, St. Louis Blues forward Dylan Holloway suffered a rare injury when a puck struck his neck during the game. Despite this alarming event, Holloway displayed resilience by completing his shift before leaving the ice on a stretcher due to dizziness and disorientation. Fortunately, he has made a full recovery and is now back in action.

The injury highlights the risks associated with hockey, particularly the dangers posed by a puck to the neck. Ice hockey has been found to have a higher incidence of cervical spine injuries compared to football, with rates three to six times greater. The neck is home to vital anatomical structures, including the cervical spine, arteries, veins, nerves, trachea, and esophagus, all of which are essential for critical functions such as breathing and circulation.

The trachea, located at the front of the neck, plays a crucial role in respiration. A powerful hit from a puck can cause significant injury to the trachea, resulting in difficulties in breathing, coughing, and vocal changes. Severe trauma may lead to respiratory distress, necessitating immediate medical intervention. It is important to note that swelling in the neck can sometimes be delayed, surfacing days after the injury due to the body’s natural response to trauma.

Neurosurgeons express particular concern regarding potential brain or spinal cord injuries following a striking event. A puck directed to the neck may fracture cervical vertebrae, particularly when under substantial force. A range of symptoms can accompany such fractures, including severe neck pain, limited range of motion, numbness, and weakness, depending on whether nerves or the spinal cord are affected.

Treatment for cervical spine fractures varies based on the severity of the injury. Minor fractures may only require rest and the use of a soft cervical collar, while more severe cases could necessitate a rigid neck brace for substantial support. In the most serious situations, surgical procedures involving rods, screws, or plates may be required to stabilize the cervical spine and protect nerves and the spinal cord from further harm.

Additionally, injury to the arteries supplying blood to the brain poses another risk. The carotid and vertebral arteries run through the neck, providing essential blood flow. A direct hit could tear these vessels, resulting in potentially life-threatening complications such as hemorrhage, clotting, or ischemic strokes. Early medical evaluation and often anticoagulant therapy are crucial to manage these injuries properly.

Along with vascular concerns, the sudden impact to the neck can lead to concussions as the brain moves within the skull. Symptoms of a concussion may include headaches, nausea, confusion, and balance issues. Both immediate and long-lasting consequences can arise from such injuries, necessitating thorough monitoring during athletic activities. Established protocols in professional sports aim to assess and manage concussion symptoms promptly.

Starting August 1, 2024, USA Hockey has mandated that all players under 18 will need to wear neck laceration guards to mitigate the unique risks in the sport. Though some NHL players have begun incorporating neck protections, the primary aim is to prevent injuries from skate blades, which while rare, can cause disastrous outcomes.

A recent incident highlighted the gravity of neck safety in hockey when Nottingham Panthers forward Adam Johnson tragically died following a skate blade injury to his neck during a game. In the wake of this tragedy, the English Ice Hockey Association has also mandated neck guards in 2024, recognizing the critical need for enhanced protective gear in the sport.

Despite advancements in protective equipment, the effectiveness of current neck guards against impact-related injuries remains uncertain. The necessity for continued research and development is vital, as history shows that protective gear in other sports, such as rugby, often fails to prevent head injuries despite players’ perceptions to the contrary. Misunderstandings about the capabilities of safety gear can lead to reckless behaviors on the field and an increased risk of injury.

While USA Hockey sets a precedent for youth players, the acceptance of mandatory neck guards in professional leagues continues to be debated. A recent survey indicated that approximately 78% of NHL players oppose the idea of mandatory neck protections. Discussions surrounding player safety have evolved over the years, with the NHL implementing visor mandates beginning in 2013. A significant study found a reduction in eye injuries following this policy change, showing that increased safety regulations can lead to positive outcomes.

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