Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients

Abstract

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

Fatal Cervical Spine Injury From Diving Accident

“…Associated injuries involving other organs or systems are usually uncommon in diving accidents and the incidence of reported near drownings is relatively low. 1,[4][5][6][7][8] Cervical spinal cord injury often leads to an interruption of the descending bulbospinal respiratory pathways, resulting in respiratory muscle paresis and/or paralysis; the more rostral the level of the injury, the greater the likelihood that a major respiratory impairment will occur. Injuries higher than C3 cause death instantly unless ventilation is immediately secured.…”

“…Diving injuries have also been reported after striking another swimmer or unseen, submerged object. 3,4,6,7 A head velocity greater than 10 ft/s (3 m/s) is usually sufficient to cause injury, with most fractures occurring at C5 to C7 vertebral levels. These segments are more prone to injury because they form the functional axis of rotation between the head and trunk and are capable of a wide range of motion.…”

An Overview of Spinal Injuries due to Dive or Fall into Shallow Water: Our Long-Term, Double-Center Experience from the Aegean Coast

“…e spinal column and, particularly, the spinal cord are injured after diving into shallow water. Even though the entire spine is vulnerable, the most commonly affected segment is the cervical spinal area [3][4][5][6]. Following dives into shallow pools or sea, the head strikes and stops suddenly which leads to load all of the bodyweight and adversely affects the spine [4,7].…”

“…e most important form of spinal damage is compression of the cord attributed to the disruption of the integrity of the cervical column [3,4]. e incidence of spinal cord injuries (SCI) following dive or fall into shallow ranges between 1.2 and 21% [5,9,10]. ese injuries exist mainly in the young, healthy, and male population [5,[10][11][12].…”

“…e incidence of spinal cord injuries (SCI) following dive or fall into shallow ranges between 1.2 and 21% [5,9,10]. ese injuries exist mainly in the young, healthy, and male population [5,[10][11][12]. Even though the majority of such spinal injuries are cervical vertebral fractures and dislocations, thoracolumbar injuries, including upper lumbar vertebral fracture, may also be detected [6].…”