 ~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  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):

 National Football Head and Neck Injury Registry  > 1300 documented cervical spine injuries  Anti-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  % 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 Fracture *

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Articular facet fracture Vertebral artery injury

Gravity and collisions!

Jefferson Fracture *

57 yo diving accident18 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):

 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%