Sports-related Cervical Spine Fracture and Spinal Cord Injury

Abstract

Study Design. Retrospective cohort study. Objective. Assess trends in sports-related cervical spine trauma using a pediatric inpatient database. Summary of Background Data. Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking. Methods. The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1–4 and C5–7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4–9), pre-adolescents (Pre, 10–13), and adolescents (14–17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries. Results. A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1–4 and C5–7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77–3.11], P < 0.001). Conclusion. Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries. Level of Evidence: 3

Spine Fractures in Children and Adolescents—Frequency, Causes, Diagnostics, Therapy and Outcome—A STROBE-Compliant Retrospective Study at a Level 1 Trauma Centre in Central Europe

“…The results in the current study present sport incidents as the most frequent injury mechanism leading to cervical spine fractures (40% of all cervical patients; mean age 14.6 ± 3.8 years). High-schoolers (6) and adolescents (5), out of a total of 12 patients (91.7%), accounted for the majority of these patients, which is comparable to reports in the literature; the incidence of cervical spine injuries in sports increases with age [ 24 ]. Furthermore, the current data reveal that road incidents have decreased over the years: from 2002 to 2007, 16/44 (36.4%) patients suffered spinal fractures in a road incident, whereas from 2014 to 2019, the number decreased to 7/56 (12.5%) patients, which is in contrast to the extant literature [ 12 , 20 , 25 , 26 ].…”

Efficacy of NHP66 Bioactive Cage on Patients with Cervical Spine Injury in Short-Track Speed Skating

“…Short-track speed skating (STSS) is an extreme sport in pursuit of extreme speed and explosive force. In such a sport, once falling or wrestling due to improper operation, athletes are prone to serious injuries under the inertia of high-velocity movement, among which cervical spine injury (CSI) is a common one [ 2 , 3 ]. According to relevant data, the risk of serious CSI in STSS is as high as 10%-20% [ 4 ].…”

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019

“… 11 Another study called for more attentions on pediatric cervical SCI, because up to 80% of spine injuries occur in the cervical region in children compared with 30% in adult. 12 The cervical SCI in children and adolescents can be directly caused by contact sports. Among 468 sports-related cervical fractures, 103 patients had cervical cord injuries.…”

“…Among 468 sports-related cervical fractures, 103 patients had cervical cord injuries. 12 High cervical injury incidences in children may be probably caused by the greater head to body ratio and relatively underdeveloped paraspinal musculature. 12 , 13 Surprisingly, it has been also reported that 1 in 60,000 newborns are complicated by SCI as a consequence of prolonged delivery and abnormal position of the neonate during delivery.…”

“… 12 High cervical injury incidences in children may be probably caused by the greater head to body ratio and relatively underdeveloped paraspinal musculature. 12 , 13 Surprisingly, it has been also reported that 1 in 60,000 newborns are complicated by SCI as a consequence of prolonged delivery and abnormal position of the neonate during delivery. Damage to the cervical spinal cord can lead to paralysis and respiratory compromise, which could be fatal.…”