Sports-Related Cervical Spine Fracture and Spinal Cord Injury

A Review of Nationwide Pediatric Trends

Haddy Alas, BS; Katherine E. Pierce, BS; Avery Brown, BS; Cole Bortz, BA; Sara Naessig, BS; Waleed Ahmad, MS; Michael J. Moses, MD; Brooke O'Connell, MS; Constance Maglaras, PhD; Bassel G. Diebo, MD; Carl B. Paulino, MD; Aaron J. Buckland, MBBS, FRACS; Peter G. Passias, MD


Spine. 2021;46(1):22-28. 

In This Article


Data Source

The Kid Inpatient Database (KID) is the largest publicly-available all-payer pediatric (age <21 at admission) inpatient health care database in the United States. The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) created this KID database. KID sampling includes complicated and uncomplicated births, as well as other pediatric inpatient procedures from community, nonrehabilitation hospitals. The KID database contains 107 data elements, using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) format to code all of the diagnoses and procedures. With over three million hospital stays per 3-year database, it is designed to allow accurate calculation of medical condition incidences using HCUP-provided trend weights.[15,16] A detailed overview of the KID design is available at (

Patient Sample

The 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; these can be viewed in Appendix A, Specific sport categories were queried according to previously published methodology, including Team Sports (American tackle football, American flag or touch football, rugby, baseball, lacrosse, soccer, basketball, volleyball, and other team sports), Winter or Snow Sports (ice skating, ice hockey, skiing, snowboarding, sledding, cross country skiing, ice and snow other activity), Water Sports (swimming, diving, water polo, water aerobics, snorkeling, rowing/kayaking/rafting, water skiing/wakeboarding, surfing, water crafts), Individual Sports (roller skating/skateboarding, horseback riding, golf, bowling, bicycle riding, jumping rope, non-running track and field), Martial Arts (boxing, wrestling, mixed martial arts), Climbing Sports (mountain/rock climbing, rappelling, base jumping, bungee jumping, hang gliding, other). Patients were further stratified using ICD-9-CM codes for CSI type, including C1–4 & C5–7 fracture with/without SCI, cervical dislocation, and cervical SCI without radiographic abnormality (SCIWORA). (SDC) The dichotomization of the CSI type by upper and lower cervical vertebrae were utilized due to restrictions of the ICD-9 CM codes.

Statistical Analysis

Patients were grouped by age at presentation into Children (age 4–9), pre-adolescents (age 10–13), and adolescents (age 14–17) as previously published.[17] Descriptives and univariate analyses, including Kruskall-Wallis testing with post-hoc Mann-Whitney U's identified differences in CSI type and TBI across age groups and sport type. Multivariate analyses including logistic regression sampling found predictors of concurrent TBI and specific cervical injury types including upper (C1-C4) and lower (C5-C7) cervical fracture and SCIWORA. Subanalysis further compared cervical injuries arising specifically via American football (tackle and flag/touch) to any other sport type. All statistics were done using SPSS Statistics version 23.0 (IBM Corp., Armonk, NY). A statistical cutoff value of P < 0.05 was considered significant.