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Background: To date, there is no demographic study of spinal surgery in France. We analyzed the French trend of spinal surgery as well as the variations in incidence according to the type of pathology, the type of institutions, and its distribution on the territory.Methods: Retrospective cohort study using French National Health Data, from 2016 to 2019. We analyzed the market sare, the leakage rate, the utilization rate and the attractiveness rate for each region. Results: There were 103,350 surgical acts on spinal degenerative pathologies in 2019, an increase of 5% since 2016. This increase is found in all procedures, particularly in traumatology with an increase of 34%, from 10,340 procedures in 2016 to 13,858 in 2019. There was a 75% increase in treatments for infectious diseases.There was a clear decrease in the total number of procedures between 2019 and 2020 corresponding to the global pandemic at COVID 19 with a total decrease of 13%.The majority of spinal surgery procedures are performed in private structures and represent almost two-thirds of total activity, i.e. 80,147 procedures in 2019 out of 126,183. The distribution of spinal surgery is based on the major population centers, the coastal areas, and the cities with university hospitals.Conclusion: There is a growing increase in the number of spinal surgery procedures performed in France before the international pandemic with a clear slowdown afterwards. This trend affects all surgical procedures performed regardless of the indication or type of institution in which the procedures were performed, with a very clear increase in private institutions. There are major disparities in the organization of the positioning of the health care supply.

Purpose: Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. Methods: We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006–2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. Results: A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat’s bow, without anticipating the trauma, when the ship’s bow suddenly elevated while crossing another wave, resulting in a “deck-slap” mechanism hitting and propelling the patient in the air. Conclusions: Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat’s bow are the typical victims. Some specific biomechanical patterns are involved with the boat’s deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures.

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