Cause of Injury
Trauma is the primary cause of spinal cord injury, accounting for at least 93% of all SCI. Since 2000, motor vehicle crashes (MVCs) account for 42% of SCI, falls 27.1%, violence 15.3%, and sports injuries 7.4%.
The remaining 8.1% are other and unknown causes (1). In those under age 20, violence and sports injuries are more common than falls. The sports most commonly associated with SCI are American football, ice hockey, wrestling, diving, skiing, snowboarding, rugby, and cheerleading (2).Hadley and colleagues (3) reviewed 122 cases of spine injury in children 16 years and younger. Median age was 15 years in males and 14 years in females. SCIs were due to MVC in 39% overall, with MVC the cause in 17% of children under 10 years of age, 26% of those 10-14 years, and 52% in those 15-16 years. Pedestrian versus MVC were 11% overall and 33%, 16 %, and 3%, respectively, for the three age groups. Falls were the second leading cause under 10 years, with sports the second leading cause at ages 15-16 years. Fifty percent of those under the age of 10 had an occiput-C1 injury, with all levels of cervical injuries occurring in 72%, 60%, and 55% in the three age groups. Fifty percent of the subjects were neurologically intact, with bony or ligamentous injury only.
More recently, Bilston and Brown (4) have reported similar data from Australia, looking at children 16 years and younger. MVC accounted for 30% of all spine injuries and 50% of serious injuries. Sports were the next most common cause of all spine injuries, though falls resulted in a higher (20% vs 16%) risk of serious injury. Gender plays a significant role in cause of injury. Violence and sports-related injuries are more common in males, while MVC injuries are less genderspecific. The authors again demonstrate that children are at higher risk for cervical spine injury, especially under the age of 8, with higher injuries occurring in younger children.
The incidence in sports-related injuries is 8.7%. SCIs in American football have decreased markedly since the mid-1970s, when “spearing” was made illegal. This now-banned tackling technique resulted in a high degree of axial cervical loading. Since institution of the ban, SCI in football has decreased by 80% (5). Since the 1980s, the incidence of spine injuries and SCI have been increasing in ice hockey. These injuries are most often the result of a player being checked from behind, with his head down, into the boards, again resulting in high axial compression loads (6). Over the last several years, cheerleading has evolved into a competitive sport. This often involves gymnastic moves, tosses, jumps, and pyramid formations. While the incidence of SCI is low, this is a risk category where females are more likely to be injured (7).