See All Evidence Sections
Epidemiology of Traumatic SCI

Sports and Recreation

There were 100 different studies reporting data on sporting activities as a cause of SCI including both organized sports and recreational activities (Table 9). 34 studies provided frequencies of SCI due to a specific sporting activity. The majority of studies were conducted in North America (Canada N=10; United States N=28) and Europe (N=24), and fewer reports were from Asia (N=16), Oceania (N=14), Africa (N=6) and South America (N=2). 16 studies reported on the frequency of SCI resulting from more than one specific sporting activity.

Studies reporting on sporting accidents as one cause of SCI among others include proportions ranging from a low of 0.2% in Tianjian, China (Ning et al. 2011) to a high of 23.8% in Russia (Silberstein and Rabinovich 1995). In the majority of these papers the proportion ranged between 7% and 16% (N=32 studies). Major sources of variation are likely due to differences in reporting techniques, inclusion criteria, and each study’s definition of sports. Some studies fail to define the sporting activities considered for their estimates of SCI due to sports. For example, in the United States, several studies (Acton et al. 1993Calancie et al. 2005Cosar et al. 2010McCammon and Ethans 2011) reported the frequency of SCI due to diving separately while other studies include diving in their overall estimates of SCI due to sporting accidents.

The frequency of SCI due to sports is relatively low in China. Recent reports indicate SCIs due to sporting accidents range from 0.2% (Ning et al. 2011) to 1.1% (Li et al. 2011Hua et al. 2013). A reason for the relatively low frequency is that individuals in China are less active in sports that could lead to a SCI (e.g. skiing, diving, rugby) than individuals in countries where sports participation is higher (Ning et al. 2011Li et al. 2011). Ning et al. (2011) speculate however that as China’s society develops, changes in lifestyle will lead to more participation in high-risk sports that could lead to an increase in the number of sport-related SCIs.

Spinal cord injuries due to diving are commonly reported around the world, and their proportion is highest in Australia (9.4%) (Ring et al. 1986), Brazil (9.3%) (da Paz et al. 1992), and Finland (9.2%) (Dahlberg et al. 2005). Studies from the USA, Canada, and Japan also reported frequencies of SCI due to diving as high as 8.5% (Acton et al. 1993), 2.4% (McCammon and Ethans 2011) and 1.3% (Shingu et al. 1995), respectively. In a recent study focused on SCIs due to shallow-water diving in South Africa, Vlok et al. (2010), reported increasing numbers of SCIs from 2003 to 2009. The occurrences of injuries were most common during summer holidays, and among young males who consumed alcohol.

In South America, Africa, and Oceania, rugby was reported as a leading sports-related cause of SCI. In 16 studies examining SCI due to rugby, the incidence was as high as 4.6 per 10,000 player hours in South Africa (Jakoet and Noakes 1998), and the prevalence ranged from 1.7 (Rugby League) to 6.8 (Rugby Union) per 100,000 players in Australia between 1995 and 2003 (Berry et al. 2006). Hermanus et al. (2010) reported an increasing frequency of SCIs due to playing rugby in the South African Rugby Union between 1980 and 2007. The highest frequency of SCI was reported to be in 2006. Forwards sustained 76% of all SCIs, club players 60%, and those age 17 years had the highest number of SCIs (Hermanus et al. 2010). Other major causes of sports related SCI include skiing/snowboarding (N=7), ice hockey (N=4) and horseback riding (N=2). A report from the United States identifies skimboarding as a new cause of SCI, especially among young males (Collier et al. 2010). The authors’ note that as the sport increases in popularity and more extreme maneuvers are performed, that associated risk of SCI with the sport will likely increase (Collier et al. 2010)

Canada

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
Study

population

Injury features

Cause: %(n of

cases)

Lenehan et al.
2012
N=930
British
Columbia,
Canada
1995-2004
Hospital admissions
to level 1 trauma
center were
prospectively
collected using a
locally designed spine
database
Males = 80%
Median: 35 years
Cervical: 45.1%
Thoracic: 24.5%
L/S: 20.9%
Unspecified: 9.5%
Sports: 17.9%
McCammon
and Ethans
2011
N=553
Manitoba,
Canada
1981-1985, 1998-
2002, 2003-2007
Inclusion criteria:
survival to hospital
admission with TSCI,
or outpatient referral
to an SCI
rehabilitation
specialist.
Exclusion criteria:
congenital causes of
paralysis such as
spina bifida or
cerebral palsy as well
as acquired paralysis
from multiple sclerosis
or Guillan-Barre
syndrome.
75.8% male
Mean Age:
1981-1985: 29.0
years
1998-2002: 35.3
years
2003-2007: 39.8
years
1981-1985:
Cervical: 46.2%
Thoracic:33.0%
Lumbar: 20.9%
Sacral:0.0%
1998-2002:
Cervical:45.0%
Thoracic:33.3%
Lumbar: 21.6%
Sacral:0.0%
2003-2007:
Cervical:51.3%
Thoracic:34.9%
Lumbar:12.5%
Sacral:1.3%
Sports:
81-85: 13.6%
98-02: 2.0%
03-07: 5.2%
Pickett et al.
2006
N=151
London,
Ontario,
Canada
1997-2006
Admissions to
hospital in London,
Ontario with SCI.
Male=74.2%
Mean age = 42.2
± 20.9 (9-96)
years
Mortality=12 (8%)
Cervical=75%
Thoracic= 10%
Lumbar=9%
Junctional=6%
Complete=35%
Incomplete=65%
Sports:
9.3%
(n=14)
Tator et al.
2004
N=271
Canada 1943-1999
Survey results from
physicians and other
sources reporting
spinal or spinal cord
injury in hockey
players.
Exclusion Criteria:
Minor spinal injuries
such as strains,
sprains or whiplash.
Males=97%
Mean age =20.6
(11-50) years
Known features
(n=236):
Cervical =83.5%
Thoracic=5.1%
ThoracoLumbar=5.9%
Lumbo-sacral=5.5%
Complete=58 (21%)
Incomplete=58 (21%)
Transient neurological
symptoms=43 (16%)
Root injury only=26
(10%)
No neurological
deficit=60 (22%)
Unknown=26 (10%)
Ice hockey:
100% (n=271)
Tator et al.
1991
N=117
Canada and
USA
Canada=110
USA=6
Unknown=1
1966-1987
Survey results from
physicians and other
sources reporting
spinal or spinal cord
injury in hockey
player.
Exclusion Criteria:
Minor spinal injuries
such as strains,
sprains, flexionextension injuries and
whiplash.
Males=96%
Mean age=21
(11-47) years
Mortality=5 (4%)
Cervical=93 (80%)
Thoracic=3 (3%)
Thoracolumbar=7
(6%)
Lumbosacral=6 (5%)
Unknown=8 (7%)
Complete=29 (25%)
Incomplete=32 (27%)
Root injury only=12
(10%)
No neurological
deficit=28 (24%)
Unknown=16 (14%)
Ice Hockey:
100% (n=117)

USA

Author
Year
N
Geographic
region
Inclusion/exclusion
criteria
Study
population
Injury features Cause (%) / sample
Devivo et al.
2011
N=45,442
USA 1935-2008
Persons who were
treated at either a SCI
Model System or a
Shriners Hospital SCI
unit
Males= 79.2%
Mean age at
injury= 32.5 years
19.8% C1-4
32.6% C 5-8
45.4% Paraplegic
2.2% Normal
Sports:
10.3%
(n=4,681)
Collier et al.
2010
N=3
Shepherd
Center,
Atlanta,
USA.
Admission to the
spinal cord injury
rehabilitation center
and experienced
traumatic SCI during
skimboarding.
100% (n=3)
males
mean age: 19.7
years
Case 1: motor
incomplete (AIS C)
cervical (C4-C5) SCI
Case 2: sensory
incomplete (AIS B) C4
SCI
Case 3: C3-C4 AIS A
SCI
Sports:
(skiboarding)
(100%)
NSCISC 2010
N=26852
USA 1973-2009
26 federally funded
Model SCI Care
Systems and National
SCI Database
Male= 80.8%
(1973-2009)
Mean age at
injury = 40.2
years (2005-
2009)
2005-2009
Tetraplegia = 55.2%
Paraplegia = 44.4 %
Complete Tetraplegia
= 16.9%
Incomplete tetraplegia
= 38.3%
Complete Paraplegia
= 22.9%
Incomplete
Paraplegia = 21.5%
Sports:
7.9%
(n=2,121)
Macciocchi et
al. 2008
N= 298
Southeastern
USA
2004-2005
All patients admitted
for traumatic SCI
between the ages 16-
59. Excluded if unable
to speak English.
Males=79%
Mean age
=28.7±10.1
years.
74% of all eligible
patients.
C1-4 ASIA A-C, n=9
C1-4 ASIA D, n=5
C5-8 ASIA A-C, n=30
C5-8 ASIA D, n=6
T1-8 ASIA A-C, n=26
T1-8 ASIA D, n=2
T9-12 ASIA A-C,
n=15
T9-12ASIA D, n=3
L1-S3 ASIA A-C, n=5
Sports:
13%
(n=39)
Fassett et al.
2007
N=412
Philadelphia,
Pennsylvania,
USA
1978-2005
Treated in Delaware
Valley Regional
Spinal Cord Injury
Center at Thomas
Jefferson University
Hospital
≥70 years old. No
further
demographics
given.
High quadriplegic (C4
and above)=42%
Paraplegic=22%
ASIA A ~ 45%
ASIA B ~ 13%
ASIA C ~ 15%
ASIA D ~ 24%
Diving:
1%
(n=4)
Boden et al.
2006
N=196
USA 1989-2002
Catastrophic cervical
injuries in high school
and collegiate football
programs reported to
National Center for
Catastrophic Sports
Injury Research
Male=100%
150 (76.5%) high
school and 46
(23.5%)
collegiate.
Average age at
injury=17 (range
14-28) years
93 (48.2%)
permanent neurologic
deficit, 100 (51.8%)
no residual neurologic
deficits
16 (8.2%) C1/C2 level
17 (8.6%) incomplete
American Football:
Prevalence:
Per 100,000 players:
1.10 in high school
4.72 in college
Injury
Prevention
Service,
Oklahoma
Department of
Health
2006
SCI=2312
Oklahoma,
USA
1988-2003
Admissions to
Oklahoma hospitals
with SCI due to
sports; Patients who
died at scene.
Football:
Males=100%
Ages 15-24
years=68%
No mortality
Incomplete
tetraplegia=44
Incomplete
paraplegia=9
Football:
2.3% (n=53)
Injury
Prevention
Service,
Oklahoma
Department of
Health 2006
SCI=2312
Oklahoma,
USA
1988-2003
Admissions to
Oklahoma hospitals
with SCI due to
sports; Patients who
died at scene.
Diving:
Males=86.4%
Ages 15-24
years=53%
Females=12
Mortality=3
Complete
tetraplegia=35
Incomplete
tetraplegia=47
Incomplete
paraplegia=3
Diving:
3.8% (n=88)
Injury
Prevention
Service,
Oklahoma
Department of
Health 2006
SCI=2312
Oklahoma,
USA
1988-2003
Admissions to
Oklahoma hospitals
with SCI due to
sports; Patients who
died at scene.
Horseback
Riding:
Males=66.7%
Mortality=2
Complete
paraplegia=1
Incomplete
tetraplegia=15
Incomplete
paraplegia=15
Horse riding:
1.4%
(n=33)
Calancie et al.
2005
N=229
Dade
County,
Florida,
USA
Acute traumatic spine
and/or spinal cord
injury admitted to
Jackson Memorial
Hospita
Male = 74.6%
Average age at
injury
=40.0±17.5 years
15 were children
ASIA A = 32.8% (75)
ASIA B = 4.8% (11)
ASIA C = 24.0% (55)
ASIA D = 31.5% (72)
ASIA E = 7.0% (7.4)
Fractures:
Cervical = 62%
T1-T10 = 15% (35)
T11-L4 = 19% (44)
Non-fractures:
Cervical = 3% (7)
Complete = 32.8%
Diving:
5.2%
(n=12)
Calancie et al.
2005
N=229
Dade
County,
Florida,
USA
Acute traumatic spine
and/or spinal cord
injury admitted to
Jackson Memorial
Hospital
Male = 74.6%
(175)
Female = 24%
(54);
Average age at
injury=40.0±17.5
years
15 were children
ASIA A = 32.8% (75)
ASIA B = 4.8% (11)
ASIA C = 24.0% (55)
ASIA D = 31.5% (72)
ASIA E = 7.0% (7.4)
Fractures:
Cervical = 62%
T1-T10 = 15% (35)
T11-L4 = 19% (44)
Non-fractures:
Cervical = 3% (7)
Complete = 32.8%
Sports:
3.5%
(n=8)
Bicycle
2.6% (n=6)
Water-related
2.6% (n=6)
National
Spinal Cord
Injury
Statistical
Center 2005
N=23,683
USA 2000-2005
National Spinal Cord
Injury Database from
25 Model SCI Care
Systems
Males=79.6%
Average age of
injury=37.6 years
62.9% Caucasian
22% African
American
12.6% Hispanic
51.8% single
Incomplete tetraplegia
(34.5%)
Complete tetraplegia
(18.4%)
Incomplete paraplegia
(17.5%)
Complete paraplegia
(23.1%)
Sports:
8.9% (n=2108)
Cantu and
Mueller
2003
N=223
USA 1977-2001
All permanent cervical
spinal cord injury
collected at national
level from all
organized football
Programs
National Center for
Catastrophic Sports
Injury Research
Males=100%
183 high school,
29 college,
7 professional,
4 sandlot
71% playing
defense
69% tackles
Fracture/dislocation
= 176 (79%)
Cord contusion
= 31 (14%)
Acute disc rupture
= 11 (5%)
American Football:
Prevalence:
Per 100,000 players:
1991-2001
0.52 in high school
1.55 in college
14 in professional
National
Spinal Cord
Injury
Statistical
Center
2000
N=19648
USA 1973 -1990’s
24 federally funded
Model SCI Care
Systems and National
SCI Database
Males=81.7%
55% within 16-30
years old, mean
age at injury is
31.8 years
Tetraplegia = 51.7%
Paraplegia = 46.7 %
Complete Tetraplegia
= 18.5%
Incomplete tetraplegia
= 29.5%
Complete Paraplegia
= 27.9%
Incomplete
Paraplegia = 21.3%
Sports:
7.1% (n=1395)
Nobunaga et
al.
1999
N=25,054
USA 1973-1998
Admissions to a
Model Spinal Cord
Injury Care System
within 365 days of
injury
Males=81.5%
Mean age
=32.3±15.8
years.
Complete
tetraplegia=44.0%
Incomplete
tetraplegia=45.1%
Complete
paraplegia=5.4%
Incomplete
tetraplegia=4.9%
Sports:
11.1% (n=2781)
Price et al.
1994
N=376
Oklahoma,
USA
1988-1990
SCI cases in
Oklahoma statewide
multilevel surveillance
system
Exclusion Criteria:
Non Oklahoma
residents; patients
who died at scene;
injuries to nerve roots
or spinal plexus.
Males=80%
15-19 years=66
(18%)
20-29 years=110
(29%)
30-59 years=145
(39%)
≥60 years =43
(11%)
Mortality=30 (8%)
Complete
tetraplegia=55 (15%),
Incomplete
tetraplegia=157 (42%)
Complete
paraplegia=59 (16%),
Incomplete
paraplegia=105 (28%)
Sports:
11.1%
(n=42)
Diving (43%)
Horse riding (19%)
Football (17%)
Other (21%)
Thurman et al.
1994
N=223
Utah,
USA
1989-1991
Utah residents with
SCI in Statewide
reporting system of
the Utah Department
of Health, Bureau of
Epidemiology.
Males=76%
Median age=29
years
128 (57%) tetraplegia
95 (43%) paraplegia
41 (18%) fatal
21 (9%) died before
hospital admission
110 (49%) Frankel
A/B/C
46 (21%) Frankel D
25 (11%) returned to
full neurological
function
Diving:
4.9%
(n=11)
Thurman et al.
1994
N=223
Utah,
USA
1989-1991
Utah residents with
SCI in Statewide
reporting system of
the Utah Department
of Health, Bureau of
Epidemiology
Males=76%
Median age=29
years
128 (57%) tetraplegia
95 (43%) paraplegia
41 (18%) fatal
21 (9%) died before
hospital admission
110 (49%) Frankel
A/B/C
46 (21%) Frankel D
25 (11%) returned to
full neurological
function
Sports: (excluding
diving)
10.8% (n=24)
Woodruff and
Baron 1994
N=150
West
Virginia,
USA
1985-1988
Data collected during
the West Virginia
Spinal Cord Injury
Registry, includes
only injured patients
surviving until
hospitalization
Male= 82%
Majority of
individuals were
between 15-24.
56% tetraplegia
44% paraplegia
Sports:
8% (n=12)
Acton et al.
1993
N=644
Arkansas,
USA
1980-1989
Arkansas residents in
Arkansas State Spinal
Cord Commission
registry.
Exclusion Criteria:
Lesions caused by
degenerative disease;
people who died at
scene.
Males=80%
Mean age
males=32.4 years
Mean age
females=35.4
years
Tetraplegia=61
Paraplegia=9
Diving:
8.5%
(n=55)
Acton et al.
1993
N=644
Arkansas,
USA
1980-1989
Arkansas residents in
Arkansas State Spinal
Cord Commission
registry.
Exclusion Criteria:
Lesions caused by
degenerative disease;
people who died at
scene.
Males=80%
Mean age
males=32.4 years
Mean age
females=35.4
years
Tetraplegia=61
Paraplegia=9
Sports:
11.3%
(n=73)
Prevalence:
6.15/million/yr
(males)
0.53/million/yr
(females)
DeVivo et al.
1992
N=6563
USA Admissions to Spinal
Cord Injury Care
Systems within 1 year
of injury from:
1978-1980
N=17841981-1983
N=13911984-1986
N=1433
Mean age=28.4
years
Males=82.4%
Females=17.6%Males=82.7%
Mean age=30.5
yearsMales=84.5%
Mean age=31.2
years
Frankel grade at
discharge:
Complete=51.8%
Sensory=13.7%
Motor
nonfunctional=7.2%
Motor
functional=25.9%
Recovered=1.4%Frankel grade at
discharge:
Complete=57.2%
Sensory=11.7%
Motor
nonfunctional=7.8%
Motor
functional=22.5%
Recovered=0.8%Frankel grade at
discharge:
Complete=48.6%
Sensory=16.2%
Motor
nonfunctional=11.0%
Motor
functional=23.5%
Recovered=0.6%
Sports:
15.0% (n=268)Sports:
13.7% (n=191)Sports:
14.4% (n=206)
Goebert et al.
1991
N=59
Hawaii,
USA
1987-1989
Traumatic injury
Patient at the
Rehabilitation
Hospital of the Pacific
Male=84.7%
Mean age
=20.2 years
0-15years=5.2%
16-30
years=44.8%
31-45
years=25.9%
46-60 years=
12.1%
61-90
years=12.1%
High Tetraplegia (C1-
4)=16.2%
Low Tetraplegia (C5-
8)=45.9%
High Thoracic (T1-
6)=18.9%
Low Thoracic (T7-
12)=10.8%
Lumbar (L1-5)=8.1%
Frankel Grades:
Complete (A)=50.8%
Motor functional
(D)=35.6%
Sports:
19.0%
(n=11)
Diving: (64%)
Surfing: (9%)
Tator et al.
1991
N=117
Canada and
USA
Canada=110
USA=6
Unknown=1
1966-1987
Survey results from
physicians and other
sources reporting
spinal or spinal cord
injury in hockey
player.
Exclusion Criteria:
Minor spinal injuries
such as strains,
sprains, flexionextension injuries and
whiplash.
Males=96%
Mean age=21
(11-47) years
Mortality=5 (4%)
Cervical=93 (80%)
Thoracic=3 (3%)
Thoracolumbar=7
(6%)
Lumbosacral=6 (5%)
Unknown=8 (7%)
Complete=29 (25%)
Incomplete=32(27%)
Root injury only=12
(10%)
No neurological
deficit=28 (24%)
Unknown=16 (14%)
Ice Hockey:
100% (n=117)
Torg et al.
1990
N=979
USA 1976-1987
National Football
Head and Neck Injury
Registry
Note: Rules
prohibiting head first
tackling and blocking
introduced in 1976
(n=720):
Male= 100%
No details given.
Cervical spine
fractures/subluxations
/dislocations=720
158 (21.9%) of these
injuries resulted in
tetraplegia.
American Football:
73.5% (n=720)
Prevalence:
Per 100,000
players/1987
SCI: 2.3
Tetraplegia:
0.73
Ditunno et al.
1985
N=56
Philadelphia,
USA
Traumatic onset of
SCI, aged 16-50
without brain trauma.
Males=94.3%
53% of the
subjects were
between 20-29
years of age.
Not given. Sports:
14%
(n=8)
Griffin and
Opitz
1985
N=154
Olmsted
County,
Minnesota,
USA
1935-1981
Medical recordslinkage system of
the Rochester Project
at the Mayo Clinic,
periodic multi-centre
surveys
Males=72%
153 White, 1
Black
56.5% (n=87) cervical
31.8% (n=49) thoracic
9.1% (n=14) lumbar
2.6% (n=4) sacral
Sports:
7.8% (n=12)

Europe

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: %(n of
cases)
Alshahri et al.
2012
N=307
Riyadh,
Saudi Arabia
2003 to 2008
Traumatic SCI,
admitted to Riyadh
Military Hospital in
Saudi Arabia
Males = 88%
Mean age=29.5
years
Complete tetra = 21%
Incomplete tetra =
31%
Complete para = 29%
Incomplete para =
18%
Diving: 1%
(n=3)
Knutsdottir
2012
N=207
Iceland 1975-2009
Patients admitted to
Landspitali University
Hospital
Males: 72%
Mean Age: 38
years
Cervical: 57%
Thoracic/Lumbar:
43%
Sports: 18.8%
Cosar et al.
2010
N TSCI=127
Turkey Patients with
traumatic SCI who
participated in an inpatient rehabilitation
program at a tertiary
research hospital from
1996-2008.
67.7% (n=86)
male
mean age
37.81±13.65
years
36 (28.3%)-tetraplegic
(C4-T1)
76 (59.8%)-paraplegic
(T2–T12)
15 (11.8%) had
conus–cauda equina
(L1–S4) injury
Sports: (non-diving)
(0.6%)
n=1
Hagen et al.
2010
N=336
Norway (2
counties:
Hordaland
and Sogn og
Fjordane)
Patients who suffered
a TSCI from 1952-
2001 and lived in
Hordaland or Sogn og
Fjordane
Male to female
ratio was 4:7:1
% of women
varied from 6.9-
24.4%
Complete (41.4%)
Incomplete (58.6%)
Cervical (52.4%)
Thoracic (29.5%)
Lumbar/sacral
(18.2%)
Sports:
(8.6%)
n=29
swimming 2.7%
skiing
3.9%
Other
2.1%
Bohu et al.
2009
N=37
France 1996-2006 French
Rugby Union seasons
All permanently
disabling cervical
spine injuries
Males=100% 21
adults over 21
years, 12 juniors
17-21 years.
Average age at
injury = 25.1
years
ASIA A (n=27, 73%)
ASIA B (n=4, 11%)
ASIA C (n=5, 14%)
ASIA D (n=1, 3%)
Rugby:
100% (n=37)
Prevalence:
Per 100,000 players:
2.1 from 1996-1997
1.4 from 2005-2006
Ahoniemi et
al. 2008
N=1647
Finland 1976-2005
Register survey;
Medical records from
registers of Käpylä
Rehabilitation Centre
Males= 83%
Mean age of
injury (M/F):
1976-1985:
34.7/35.8
1986-1995:
36.7/38.3
1996-2005:
42.4/40.4
50.6% tetraplegia
49.4% paraplegia
Diving:
6.6%
(n=109)
Franz et al.
2008
N=73
Bern,
Switzerland
2000-2006
Admissions >16 years
to hospital with severe
spinal injuries
Exclusion Criteria:
Transient neurological
symptoms excluded
(<2 mins)
Skiing (n=63):
Males=73%
Median age=40
years
Mortality=2 (3%)
Snowboarding
(n=10)
Males=100%
Median age=22.5
years
Tetraplegia=5
Paraplegia=3
No persistent
neurological deficits=7
No persistent
neurological deficits
Skiing:
86.3% (n=63)
Snowboarding:
13.7% (n=10)
Dahlberg et
al. 2005
N=152
Helsinki,
Finland
January 1, 1999
cross-section date
Adult citizens (18
years or more) who
had permanent
sensory or motor
deficits (ASIA A–D).
ASIA-E cases were
excluded
Male=76%
Average age of
injury=47.9 years
Data only for 121
subjects:
46% (n=56)
tetraplegia
54% (n=65)
paraplegia
57% (n=69)
incomplete
43% (n=52) complete
Diving:
9.2%
(n=14)
Pagliacci et al.
2003
N=684
Italy 1997-1999
Rehabilitation
admissions to 32
institutions in Italy
with traumatic SCI.
Males = 80%
Mean age=38.5
(11-94) years.
ASIA Scores:
A=346 (50%)
B=72 (10%)
C=149 (22%)
D=94 (14%)
E=12 (2%)
Sports:
7.9%
(n=54)
Schmitt and
Gerner
2001
N=1,016
Heidelberg,
Germany
1985-1997
All traumatic SCI at
Orthopedic
Department at the
University of
Heidelberg
Male = 83%
Average age for
sports accident
=26.8, range (9-
52) years.
Sport accidents
Complete para n=18
Incomplete para n=16
Complete tetra n=21
Incomplete tetra n=14
Sports: (excluding
diving)
6.8%
(n=69)
Karacan et al.
2000
N=581
Turkey 1992
Nation-wide survey of
SCI admissions to
medical institutions.
Exclusion Criteria:
Patients who died
before hospitalization.
Males=71%
Mean
age=35.5±15.1
years.
Cervical=31.7%
Thoracic=26.6%
Lumbar=25.1%
Tetraplegia=87 (32%)
Paraplegia=394
(68%)
Diving:
1.2%
(n=7)
Ravaud et al.
2000
N=1668
France 1995-1996
Self-administered
questionnaire survey
at 35 specialized
Rehabilitation Centres
Males=93%
Mean age at
injury=22.2 years
4.9% C1-C2
22.1% C3
40.4% C4
17.3% C5
12.5% C6
2.8% C7-C8
63.1% complete
Diving:
6.5%
(n=108)
Ravaud et al.
2000
N=1668
France 1995-1996
Self-administered
questionnaire survey
at 35 specialized
Rehabilitation Centres
Males = 94%
Mean age of
injury=26.2 years
6% C1-C2
20.9% C3
32.8% C4
25.7% C5
14.2% C6
0.4% C7-C8
52.5% complete
Sports:
15.8%
(n=264)
van Asbeck et
al.
2000
N=126
(specific data
for 113)
Netherlands 1994
Patients with SCI in
National Registration
system and with
obtainable medical
records.
Exclusion Criteria:
Spinal contusions with
no or temporary
neurological
symptoms.
Males = 77% <20 years=15 (13%) 21-30 years=28 (25%) 31-60 years=36 (32%) >61=34 (30%) Mortality=18 (16%) Complete tetraplegia
=26 (23%)
Incomplete tetraplegia
=39 (34%)
Complete paraplegia
=29 (26%)
Incomplete paraplegia
=19 (17%)
Sports:
8.8%
(n=10)
Molsa et al.
1999
N=16
Finland and
Sweden
1980-1996
Ice hockey related
SCI. Excluded
transient neurological
deficits
Males=100%
Mean age =21.2
years
Tetraplegia n=10
Paraplegia n=6
Ice Hockey:
100% (n=16)
Prevalence
0.011 per 1000
hockey players
Caldana and
Lucca
1998
N=127
Veneto, Italy 1994-1995
New cases of
traumatic spinal cord
injury and nontraumatic spinal cord
disease treated in
regional hospitals
(small hospitals
excluded)
Male = 83.5%
Average age
(male)
= 39.8 years old
Average age
(female)
= 36 years old
Cervical=62
(21 were complete)
Thoracic=29
(25were complete)
Thoracolumbar
(T12-L1)=18(11)
Caudal=14(3)
Unidentified=1
Sports:
1%
(n=8)
Aung and
Masry
1997
N=219
Great Britain 1985-1988
New traumatic
admissions to the
Midlands Centre for
SCI
Male = 79%
Average age
(male)
= 35.5 years.
Average age
(female)
= 44.2 years.
Cervical n=116
Thoracic n=73
Lumbar n=30
Sports:
7.3%
(n=16)
Exner and
Meinecke
1997
N= 22,212
Germany 1976-1996
All traumatic and nontraumatic SCI
72% male 62% paraplegic
38% tetraplegic
Diving:
4%
(n=856)
Exner and
Meinecke
1997
N= 22,212
Germany 1976-1996
All traumatic and nontraumatic SCI
72% male 62% paraplegic
38% tetraplegic
Sports:
4%
(n=853)
Soopramanien 1994
N=412
(SCI=270)
Bucharest,
Romania
1992-1993
SCI patients admitted
to Dr Gh. Marinescu
Hospital
Male=77%
0-40 years
=41.3%
41-90 years
=58.7%
37.6%labourer
8.7% farmer
18.2% retired
158 cervical
81 thoracic
36 lumbar
47% incomplete
Frankel grade A
n=134
Frankel grade B n=24
Frankel grade C n=25
Frankel grade D n=73
Frankel grade E
n=150
Diving:
7%
(n=29)
GarciaReneses et al,
1991
N=1010
Spain 1984-1985
Every traumatic and
non traumatic SCI
patient in specialized
Spanish hospitals
Male = 72.4%
Mean age = 41.8
± 1.2 years.
Sensory-motor
Incomplete SCI =
49%
Complete SCI= 38%
Sports:
4%
(n=40)
BieringSorensen et
al.
1990
N=268
Kingdom of
Denmark
(Denmark,
Greenland,
Faroe
Islands)
January 1975-
December 1984
Admission to national
specialized
rehabilitation hospitals
Male=76.9%
40% within 15-24
years old
Cervical = 136
Thoracic = 76
Lumbar = 56
Complete tetraplegia
= 22%
Incomplete tetraplegia
= 29%
Complete paraplegia
= 26%
Incomplete paraplegia
= 23%
Diving:
6%
(n=15)
Pedersen et
al.
1989
N=27
Greenland 1965-1986
Admissions to
rehabilitation hospital
in Hornback with
traumatic SCI;
Patients injured in
Greenland.
Males=74%
Mean age=33.5
(14-50) years.
Sports:
Incomplete tetraplegia
n=1
Sports:
3.7%
(n=1)

Asia

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: %(n of
cases)
Hua et al.
2013
N=561
China Retrospective review
of individuals who
were treated at The
General Hospital of
Chinese People’s
Armed Police Forces
Males = 79.9%
Mean Age =
31.85 years
Not Specified 1.1%
Ibrahim et al.
2013
N=292
(traumatic and
non)`
Kuala
Lumpur,
Malaysia
2006-2009
Admitted to the
Department of
Rehabilitation
Medicine, Hospital
Kuala Lumpur
Males = 77%
Mean age = 39
years
Tetraplegia: 37%
(108)
Paraplegia: 63%
(180)
Traumatic:
Sports: 2%
Wang et al.
2013
N=761
Anhui
Province,
China
All patients admitted
to two hospitals within
Anhui Province, China
between January
2007 and December
2010.
Males = 77.3%
Mean age = 45
years
Cervical (46.3%)
Thoracic (20.4%)
Lumbrosacral (33.3%)
Other (sports and
assault): 8.1%
Wu et al.
2012
N=143
Tianjin,
China
Patients admitted to
Tianjin Medical
University General
hospital with
diagnosis of tSCI
Mean age 54.6
years
Male:Female =
5:1
ASIA A = 5.6%
ASIA B = 16.8%
ASIA C = 18.9%
ASIA D = 58.7%
Sports: 4.2%
Li et al.
2011
# of patients:
N=1079
data collected:
N=264
Beijing,
China
Patients with acute
TSCI admitted to
civilian or military
hospitals during Jan
1- Dec 31 2002
200 male (76%)
Mean age: 41.7
years
Range: 6-80
years
Cervical (4.9%)
Thoracic (28%)
Thoracolumbar,
lumbar and
lumbosacral (66%)
Sports:
(1.1%)
n=3
Ning et al.
2011
N=869
Tianjin,
China
All patients with TSCI
aged 15 or older
admitted to tertiary
hospitals in Tianjin
from Jan 1, 2004- Dec
31, 2008
738 male (84.9%)
Mean age (sd)
46.0 (14.2)
Cervical (71.5%)
Thoracic (13.3%)
Lumbar (15.1%)
Sacral (0.1%)
Sports:
(0.2%)
n=2
Ye et al.
2009
N=57
Beijing,
China
1993-2006
Admission to 6
institutions in Beijing
with SCI due to sports
and recreation.
Males=77%
Mean age =24.5
±11.9 years
Mortality=2
(3.5%)
ASIA A=32 (56%)
ASIA B=19 (33%)
ASIA C= 5 (9%)
ASIA D= 1 (2%)
Ratio of complete to
incomplete:
1:2.1
Sports:
100%
(n=57)
Water sports (65%)
Gymnastics (9%)
Ball game (7%)
Casual play (5%)
Dancing (5%)
Other (9%)
Shrestha et al.
2007
N=149
Eastern
region,
Nepal
2001-2004
Admission to hospital
in Dharan with
cervical spinal injury.
Males= 80%
Mean age=40 (6-
88) years
Mortality=6 (4%)
Frankel levels:
A=54 (36%)
B=20 (13%)
C=22 (15%)
D=19 (13%)
E=34 (23%)
Sports:
2.0%
(n=3)
Yamakawa et
al.
2001
N=324
SCI=26
Okumino
skiing area,
Gifu
prefecture,
Japan
1988-2000
Admissions with ski or
snowboard related
spinal injuries to
hospital in Okumino
ski area.
Males=67%
Mean age= 26.7
(4-62) years
Beginner=27
(31%)
Intermediate/
Expert=59 (69%)Males=68%
Mean age=22.3
(11-46) years
Beginner=105
(44%)
Intermediate/
Expert=133
(56%)
Cervical=7
Lumbar=2Cervical=14
Thoracic=2
Lumbar=1
Skiing:
(n=86)
(SCI=9)
Prevalence:
SCI
0.42/100,000
Spinal Injury
5.73/100,000 visitsSnowboarding:
(n=238)
(SCI=17)
Prevalence:
SCI
0.69/100,000
Spinal Injury
0.073/100,000
Chen et al.
1997
SCI=1,586
Taiwan 1992-1996
113 hospitals (11
medical centers, 50
regional general
hospitals, 52 local
general hospitals)
Male = 75%
Average age of
injury=46.1 years
49.9% cervical
13.3% thoracic
34.6% lumbar
6.6% (n=105) died
after treatment
Sports:
1.2%
(n=19)
Otom et al.
1997
N=151
Jordan 1988-1993
Royal Jordanian
Rehabilitation Centre
(RJRC) King Hussein
Medical Centre
(KHMC)
Males = 85.4%
Average age of
injury=33 years
Cervical=31.8%
(n=48)
Thoraco-lumbar=
68.2% (n=103)
Frankel A= 53.6%
(n=81)
Frankel B = 10%
(n=15)
Frankel C =22.5%
(n=34)
Frankel D= 13.9%
(n=21)
Sports:
2.6%
(n=4)
Shingu et al.
1995
N=9752
Japan 1990-1992
Survey of nationwide
institutions assumed
to accept SCI
patients.
Exclusion criteria:
Patients only
receiving outpatient
services in this period
Males=80.4%
Mean
age=48.6±19.1
(0.92-96) years
Frankel levels:
A=2518 (25.8%)
B=1208 (12.4%)
C=1984 (20.3%)
D=1761 (18.1%)
E=2242 (23.0%)
Unknown=39 (0.4%)
Cervical=7317
(75.0%)
Below cervical=2408
(24.7%)
Unknown=27 (0.3%)
Complete=61.1%
Skiing:
0.7% (n=71)
Rugby:
0.7%
(n=67)
Diving:
1.2%
(n=114)
Sports:
5.4%
(n=528)
Silberstein
and
Rabinovich
1995
N=196
Novosibirsk,
Russia
1989-1993
All in patients with
SCI admitted to the
Department of SCI.
Nerve root or plexus
injury was excluded.
Males = 93.4%
Mean age =34.7
years.
Cervical spine
C1-2 n=15
C3-7 n=81
Thoracic T1-12 n=54
Lumbar L1-5 n=46
Sports:
23.8%
(n=47)
Shingu et al.
1994
N=3465
Japan 1990
Survey of nationwide
institutions assumed
to accept SCI
patients;
Exclusion criteria:
Traumatic cervical
syndrome cases and
extradural nerve root;
Patients only
receiving outpatient
services in this year
or who obtained injury
abroad
Male (overall)
=81.2%
Mean age
(sports)
=26.1 years
Cervical=158 (87%)
Below cervical=24
(13%)
Skiing:
0.6%
(n=20)
Rugby:
0.7%
(n=24)
Diving:
1.3%
(n=44)
Sports:
5.3%
(n=182)
Lan et al.
1993
N=99
Hualien
county,
Taiwan
1986-1990
Treatment of
traumatic SCI in 4
hospitals in Hualien
county.
Exclusion Criteria:
People who died
before hospitalization;
nontraumatic SCI;
patients with transient
paralysis; non
residents of Hualien.
Males= 80%
Mean age
(males)=44 years
Mean age
(females)=46
years
Mortality=10
(10%)
Complete
tetraplegia=2
Incomplete
tetraplegia=2
Incomplete
paraplegia=2
Sports:
6.1%
(n=6)
Chen et al.
1985
N=560
Taipei,
Taiwan
1978-1981
All record from
general hospitals in
Taipei. Included all
spinal cord lesion with
or without vertebral
injury
Males = 86%
Mean age = 35.9
(range 20-49)
years.
Incomplete
Paraplegia n=118
Complete paraplegia
n=180
Incomplete
Tetraplegia n=117
Complete Tetraplegia
n=145
Death n=31
Sports:
3.7%
(n=21)

Oceania

Author Year
N of study population

Geographic region

Inclusion/exclusion criteria Study population Injury features Cause: % (n of cases)

Middleton et al. 2012
N=324

New South Wales, Australia

January 2004 to June 2008, Data from Ambulance Service of New South Wales

Males = 85% Mean age = 42 years

Not Specified

Sports: 8.3% Water-related: 13.3%

Quarrie et al. 2007
N=77

New Zealand

1976-2005
Spinal injury claims due to rugby in Accident Compensation Corporation database Note: Mandatory education program for rugby players started in 2001.

No details No details

Rugby: 100% (n=77)

Prevalence:
Per 100,000 players

Scrum related: 1.4 (1996-2000) 0.2 (2001-2005)

Other related 1.3 (1996-2000) 1.1 (2001-2005)

Berry et al. 2006
N=54

New South Wales, Australia

1986-2003 rugby seasons
Acute cervical spinal cord injury resulting in tetraplegia and admission to NSW spinal units Australian Spinal Cord Injury Register (ASCIR)

Males=100% 89% adults Median age 24 (range 15-38) years

Complete tetra (n=24, 44%) Incomplete tetra (n=30, 56%)

Rugby Union: 57.4% (n=31):

Prevalence:
Per 100,000 players: 9.2 from 1986-1991 6.8 from 1995-2003

Carmody et al. 2005
N = 52

Australia

1997-2002
All acute, Football related SCI (lasting) from 6 SCI units that were major referral centers for SCI

Males = 100% 45 adults, 7 schoolboys.

Average age at injury=24.4 (RU), 25.9 (RL), 23.4 (ARF), 26.0 (soccer)

Frankel grade A n=12
Frankel grade B n=1
Frankel grade C n=2 Frankel grade D n=24
Frankel grade E n=11

Rugby: 66% (n=34)

Australian Football 26% (n=14)

Soccer 8% (n=4)

Prevalence:

Per 100,000 players:

Rugby: 4.7

8.7 cases per year of football-related SCI

Roe et al. 2003
N=34

New South Wales, Australia

1976-1996 Admissions to 2 SCI units in Sydney due to horse riding.

Males=62% Mean age= 39.3±18.4 years Mean years of riding experience= 25.7±21.8

Cervical=15 (44%) Thoracic=8 (24%) Lumbro-sacral=11 (32%) Complete=13 (38%) Incomplete=21 (62%)

Horse riding: 100% (n=34)

Spinecare Foundation 2003
N = 80

Queensland and New South Wales, Australia

1986-1996
All acute, Football related SCI (lasting) from 6 SCI units that were major referral centers for SCI

Males = 100% Average age at injury =23.5 (15- 49) years; 62 adults, 18 schoolboys.

C4/5 or C5/6 n=38 Frankel grades A B C n=42
Frankel grade D n=24

Frankel grade F n=8 37 complete
43 incomplete
T11 n=1

Deaths n=6

Rugby: 100% (n=80)

Prevalence:

Per 100,000 players: 5.9

7.3 cases per year of rugby related SCI

O’Connor
2002
N = 265

Australia

1998-1999 Australian Spinal Cord Injury Register (ASCIR) for persons 15 years and older. All adult SCI cases are reported to the ASCIR Transient neural deficits were excluded.

76 % male
No other demographics given

C4 n=47
C5 n=45
C6 n=22
L1 n=30
T12 n=17 Incomplete tetraplegia n=101 Incomplete paraplegia n=64 Complete tetraplegia n=51 Complete paraplegia n=48

Sports: 5% (n=13)

Rotem et al. 1998
N=115

New South Wales (NSW), Australia

1984-1996
Admission to 2 SCI units in Sydney with cervical spinal injuries from rugby union and league football. Exclusion Criteria: Patients transferred from outside NSW

Males = 100% Median age = 22 (14-37) years Mortality=2 (2%)

Complete tetraplegia: 26 (46%)
C2-3=1 C3-4=2 C4-5=14 C5-6=6 C6-7=3

Complete tetraplegia: 23 (39%)
C3-4=2
C4-5=8
C5-6=6
C6-7=6
Unknown level=1

Rugby Union: 48.7% (n=56)

Prevalence: Tetraplegia/ 10,000/player/year
1.2 (1984-87)
0.3 (1988-91)
0.5 (1992-96)

Rugby League: 51.3% (n=59)

Prevalence: Tetraplegia/ 10,000/player/year
0.2 (1984-87)
0.2 (1988-91)
0.1 (1992-96)

Maharaj 1996 N=75

Fiji

1985-1994
Medical records of spinal cord paralysis patients admitted to the Medical Rehabilitation Unit at Tamavua Hospital

Males = 87% Mean age=38.3 (6-76) years
10 (13%) female 45 (60%) Fijian 26 (35%) Indian

Tetraplegia = 53% (n=40) Paraplegia=47% (n= 35)

Complete = 61% (n= 46) Incomplete=39% (n= 29)

Sports: 20% (n=15)

Dixon et al. 1993
N=164

New Zealand

1988
SCI cases in Health Services Statistics files.

Males=73.2% Males aged 15- 29 years=46%

C1-C4=49 (30%) C5-C7=30 (18%) T1-T6=19 (12%) T7-T12-19 (12%)

Sports: 11% (n=18)

Ring et al. 1986
N=202

New South Wales, Australia

1977-1978 Admissions to New South Wales hospitals with spinal injury; death certificates that involved spinal injury. 99% of cases had neurological involvement.

Males=81%
≤1 years=2 (1%) 2-14 years=13 (6%)
15-24 years=84 (42%)
25-44 years=58 (29%)
45-64 years=30 (15%)
≥65 years=15 (7%) Mortality=69 (39%)

Glasgow Outcome Scale:
Severe disability=98(49%) Moderate disability=19(9%) Good recovery=13(6%) Not recorded=3(1%)

Diving/ Swimming: 9.4% (n=19)

Ring et al. 1986
N=202

New South Wales, Australia

1977-1978 Admissions to New South Wales hospitals with spinal injury; death certificates that involved spinal injury. 99% of cases had neurological involvement.

Males=81% 15-24 years=84 (42%)
25-44 years=58 (29%)
45-64 years=30 (15%)
≥65 years=15 (7%) Mortality=69 (39%)

Glasgow Outcome Scale:
Severe disability =98(49%) Moderate disability =19(9%)

Good recovery =13(6%)
Not recorded =3(1%)

Sports (excluding diving):
9.4%
(n=19)

Africa

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: %(n of
cases)
Hermanus et
al 2010
N=183
South Africa 1980-2007
Data from an
inventory of rugbyrelated SCIs that
occurred in South
Africa
All Male
Mean age= 21
years
Weight range=
70-79 kg
Median height=
179cm
C4/C5- 38%
C5/C6- 31%
Rugby specific:
n=183
Vlok et al.
2010
N=46
South Africa All patients admitted
to ASCI unit at Groote
Schur Hospital from
April 19, 2003 – Feb
8, 2009 with diving related injuries
91% male
mean age: 23
years old
Neurological status:
25 incomplete,
13 complete,
8 had no neurological
fallout
C4 & C5 most
common
Shallow Water
Diving:
Sea (20)
Swimming pools
(13)
Rivers (7)
Tidal pools (4)
Location unknown
(2)
Obalum et al.
2009
N=468
Lagos,
Nigeria
1992-2006
Registrars at the
emergency room and
wards from the Lagos
University Teaching
Hospital (receives the
majority of SCI
patients in Lagos)
Males= 70.1%
66.2% were ages
40 years and
below. Peak age
incidence = 21-30
years.
ASIA A n=230
ASIA B n=45
ASIA C n=36
ASIA D n=41
ASIA E n= 34
Death n=82
Lumbar n=278
Cervical n=142
Thoracic n=48
Sports:
1.7%
(n=8)
Noakes et al.
1999
N=67
Western
Cape,
South Africa
1990-1997
All rugby related SCI
at the SC Unit at
Conradie Hospital.
Males= 100%
54 adults
13 schoolboy
rugby players
32% C4/5
42% C5/6
8% death
48% tetraplegia
35% recovery
Rugby:
100%
(n=67)
Jakoet and
Noakes
1998N=416
SCI=1
South Africa 1995
Played in the Rugby
World Cup
No information
provided
Ligament/joint injuries
= 34%(Neck (including SCI)
=4%)
Lacerations=27%
Muscle/contusions
=24%
Fractures/
Dislocations=11
Concussions=3
Rugby:
0.24%
(n=1)Incidence:
4.5/10,000 player
hours
Kew et al.
1991
N=117
Cape
Province,
South Africa
1963-1989
Major SCI unit in
South Africa; rugby
listed as cause of SCI
Males = 100%
81 adults, 36
schoolboys. No
other
demographics
given.
C3/C4 n=4
C4/C5 n=43
C5/C6 n=38
C6/C7 n=11
T1-18 n=6
>T8 n=1
Rugby:
100%
(n=117)
21.3% scrum
17.9% ruck and
maul
20.5% tackling
29.9% tackled
1.7% foul play
0.9% line out
7.7% unknown

South America

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: %(n of
cases)
Secin et al.
1999
N=18
Argentina 1977-1997
All rugby reported
cervical injuries in
Argentina. Injuries
could be permanent
or transient.
Mean age =22
(range 15-27)
years. No other
demographics
given.
Complete recovery
n=2
Tetraplegia n=15
Death = 1
Rugby:
100% (n=18)
61.1% scrum
16.7% tackling
11.1% tackled
11.1% maul
0.9 cases per year
of rugby related SCI
da Paz et al.
1992
N=1255
(SCI=108)
Brazil 1988
36 public hospitals
from 7 Brazilian
capitals (represents
6.2% of all hospitals
and 9.2% of the total
hospital bed capacity
Males = 80.6%
Mean age=30.3
(range 6-56)
years
5.6% high
education
Complete =
94 (87.0%)
Paraplegia = 61
(64.9%)
Quadriplegia = 33
(35.1%)
Diving:
9.3%
(n=10)
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