Sports-Related Cervical Spine Fracture and Spinal Cord Injury: A Review of Nationwide Pediatric Trends

INTRODUCTION: As youth athletic sports continue to be played at a highly competitive level, more attention is called to potentially fatal cervical spine injuries. METHODS: KID was queried for patients with E-Codes (ICD-9-CM codes) pertaining to external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped by cervical spine injury type [C 1-4 and C 5-7 fracture with and without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4-9), preadolescents (pre,10-13), and adolescents (14-17). Sports included by E-Code: American football, other team sports, individual, winter, water, and martial arts. Kruskall-Wallis tests with posthocs identified differences in cervical injury type across age groups and sports. Logistic regression assessed predictors of traumatic brain injury (TBI) and cervical injury type. RESULTS: A total of 38 539 pts with sports injuries were identified (12.76 yr, 24.5% F). Adolescents had the highest rate of sports injuries per year, but rates decreased in pre and adolescents and increased in children. Adolescents had the highest rate of any type of cervical spine injury and TBI. Adolescence increased odds for C 1-4 fx with and without SCI, C 5-7 fx with and without SCI, cervical dislocation, and cervical SCIWORA (all P < .05). Cervical fx of any type tended to occur in disproportionately higher rates via team, winter, or water sports (P < .001). Martial arts had significantly higher rates of cervical dislocations compared to other sports (P = .039). Football injuries rose from 5.83% to 9.14% (2009-2012) (P < .001) and had significantly more SCIWORA than non-football sports (1.6 vs 1.0%, P = .012). Football increased odds of SCI by 1.56x compared to any other sport (OR: 1.56 [1.11-2.20], P = .011). SCIWORA was a significant predictor for concurrent TBI across all sports (OR: 2.35[1.77-3.11], P < .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.