~1.2 million HS / 200,000 college & pro athletes

Largest number of sports-related injuries among organized team sports in the United States

Spinal injuries in American football: Helmet to helmet Helmet contact with another body part Helmet to ground contact

Most studied sport

196 HS and college spinal injuries 1989-2002

Incidence: 1.10 / 100,000 high school 4.72 / 100,000 college

Quadriplegia in 76 (38.8%) patients 5.85 /100,000 per year

“Spear” tackling predominant activity resulting in quadriplegia

Axial loading > hyperflexion and hyperextension

Boden BP, et al. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med 2006; 34(8): 1223-1232

National Football Head and Neck Injury Registry > 1300 documented cervical spine

injuriesAnti-spearing rules established in 1976

88% reduction of spinal injuries by 1994 Anti-spearing rule coupled with better

coaching of blocking and tackling techniques has reduced football-related spinal injuries

Mueller FO. Fatalities from brain and cervical spine injuries in tackle football: 54 years' experience. Neurologic Athletic Head and Spine Injuries. Philadelphia, PA: WB Saunders; 2000:242–251.

Vertebral artery injury

~ 6500 pts / year in US Emergency Depts High risk of long-term morbidity and

mortality Male teenagers and young adults >50% of injuries occur in <4 ft of water 1.2-21% of all spinal cord injuries thought

to be due to diving related injuries Cervical spine is almost always involved

Almost always axial loading Neck is flexed slightly +/- hyperflexion

Body weight generates axial load 70% are C5–C7 Flexion teardrop/burst fractures

~60%

Jefferson FractureJefferson Fracture*

*

*

Articular facet fracture

Vertebral artery injury

Gravity Gravity and and

collisions!collisions!

Jefferson FractureJefferson Fracture

*

57 yo diving accident 18 yo skiing accident

Initial CT

Type III Odontoid and C7 Spinous Process Fractures

C1-C2 rotatory subluxation

Sports-related spinal injuries are a significant source of long-term morbidity and mortality

Mechanism of injury Injury pattern CT = primary imaging modality for the

evaluation of the potentially injured spine

Diagnostic work-up same as for other more common blunt mechanisms

What is the estimated pooled sensitivity of radiography for the detection of cervical spine fractures?

A. 32% B. 52% C. 72% D. 92%

Holmes et al 2005 Meta-analysis Calculated pooled sensitivity

Radiography = 52% CT = 98% Holmes et al. Computed

tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma 2005;58(5):902-905

What is the most common mechanism of injury for patients with cervical spine fractures following a shallow water diving injury?

A. Axial loading B. Axial loading with hyperflexion C. Hyperflexion D. Rotation E. Hyperextension

What is the most common fracture pattern involving C2?

A. Hyperflexion burst B. Hangman fracture C. Odontoid fracture D. Articular pillar fracture E. Hyperextension teardrop

What is the incidence of spinal cord injuries in the setting of hyperflexion burst fractures?

A. 65% B. 75% C. 85% D. 95%