Fatal Cervical Spine Injury From Diving Accident

Abstract

Spinal cord injuries result after diving into shallow water, often after incautious jumps head first into water of unknown depth during recreational or sport activities. Mortality is generally due to upper cervical trauma. The authors present a case of a diving-related death in a young woman who underwent medicolegal investigations. The measured water depth at the supposed dive site was 1.40 m. Postmortem radiology and autopsy revealed fractures of the body and the posterior arch of the fifth cervical vertebra, a fracture of the right transverse process of the sixth cervical vertebra and hemorrhages involving the cervical paraspinal muscles. Neuropathology showed a posterior epidural hematoma involving the whole cervical region and a symmetric laceration of the spinal cord located at the fourth and fifth cervical vertebra level, surrounded by multiple petechial hemorrhages. Toxicology revealed the presence of ethanol in both blood and urine samples. The death was attributed to cervical spine fracture (C5-C6), spinal cord contusion, and subsequent drowning. This case highlights the usefulness of postmortem radiology, examination of the deep structures of the neck, toxicology, neuropathology, and a detailed research of signs of drowning to formulate appropriate hypotheses pertaining to the cause and mechanism of death.

Investigation of Drowning Deaths: A Practical Review

“…This includes subcutaneous dissection of the outer chest wall for the identification of pneumothorax and/or in situ puncture through the right ventricle in the evaluation for intraventricular air, though again these procedures can be difficult to perform and interpret (79). In deaths following diving into shallow water with potential head impact on fixed underwater structures, dissection of the anterior and posterior neck, possibly including in situ examination and removal of the spinal cord, is necessary to look for cervical spine injury including vertebral fracture(s) (especially C5-7), dural-based hemorrhage, and spinal cord contusion (80). Anterior neck dissection should be prompted by the finding of facial petechiae and cutaneous neck injuries in order to document any injuries of the cervical strap muscles, laryngotracheal skeleton, or hyoid bone that indicate anterolateral neck compression caused by ligature of manual strangulation.…”

Inversion Table Fall Injury, the Phantom Menace: Three Case Reports on Cervical Spinal Cord Injury

“…The mechanism of inversion table fall injury resembles that of diving injury—once the ankle power is lost or it slips, the user will land on top of their head. Like head first entry into shallow water, even a fall from a couple of feet high can cause devastating cervical spine injury [ 12 , 13 ]. The potential energy of one’s weight is transformed into kinetic energy and then transmitted to the cervical spine in the form of vertical compression.…”

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

“…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]. us, the severity of the injury is closely related to the weight of the patient and the height of the jumping place, as well as the depth of the water [8].…”

“…This type of injury is more likely to occur for becoming cooler or recreational swimming activity by an unexperienced diver into water or swimming pools with unpredictable depth. Usually, compression-flexion or compression-hyperflexion types of fractures occur [ 4 , 7 ]. The most important form of spinal damage is compression of the cord attributed to the disruption of the integrity of the cervical column [ 3 , 4 ].…”

“…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 ]. It has been speculated that the actual incidence of dive- or fall-related spinal injuries may be underestimated since some victims may be reported as death due to drowning in the absence of postmortem investigations [ 7 ].…”