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Risk Factors for Water Sports–Related Cervical Spine Injuries

Chang, Spencer K. Y. MD; Tominaga, Gail T. MD; Wong, Jan H. MD; Weldon, Edward J. MD; Kaan, Kenneth T. MD

Journal of Trauma and Acute Care Surgery: May 2006 - Volume 60 - Issue 5 - p 1041-1046
doi: 10.1097/01.ta.0000218256.39295.8f
Original Articles

Background: To examine risk factors associated with water sports–related cervical spine injuries (WSCSI).

Methods: A retrospective analysis of all patients admitted for WSCSI from 1993 to 1997 was performed. The severity of cervical spine injury was assessed by review of medical records and imaging studies. Mechanisms of injury and activities at the time of injury were noted to determine risk factors for cervical spine injuries caused by wave forced impacts (WFI) from activities such as bodysurfing and body boarding. These risks were compared with injuries incurred by shallow water dives (SWD).

Results: One hundred patients were analyzed (mean age, 36 years old); 89% were male, 62% were nonresidents of Hawaii, and 75% had a large build. Patients without radiographic evidence of fractures, subluxations, and/or dislocations (n = 26) were significantly older (48 versus 32 years old, p < 0.0001) with a higher rate of pre-existing cervical spine abnormalities (65% versus 15%, p < 0.0001) compared with the remainder of patients (n = 74). Seventy-seven percent of WFI involved nonresidents. The mean age of WFI patients was significantly older than patients involved in SWD (42 versus 25 years). Ninety-six percent of wave-related accidents occurred at moderately to severely rated shorebreak beaches.

Conclusions: Wave forced impacts of the head with the ocean bottom typically occurred at moderate to severe shorebreaks, and involved inexperienced, large-build males in their 40s. Spinal stenosis and degenerative spondylosis may increase the risk of cervical spine injury associated with WFI due to the increased risk of neck hyperextension and hyperflexion impacts inherent to this activity.

From the Division of Orthopaedic Surgery (S.K.Y.C., E.J.W., K.T.K.) and the Department of Surgery (G.T.T., J.H.W.), John A. Burns School of Medicine, University of Hawaii; and Trauma Services (G.T.T.), The Queen's Medical Center, Honolulu, Hawaii.

Submitted for publication October 15, 2004.

Accepted for publication May 20, 2005.

Presented at the Committee on Trauma Resident Paper Competition, April 1999, Washington, DC.

Address for reprints: Gail T. Tominaga, MD, Scripps Memorial Hospital La Jolla, Trauma Services, 9888 Genesee Ave LJ601, La Jolla, California 92037; email:

© 2006 Lippincott Williams & Wilkins, Inc.