The epidemiology of recreation-related cervical and thoracic fractures

Context: Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking.

Purpose: To characterize cervical and thoracic fractures associated with recreational activities.

Study design/setting: Retrospective cohort study.

Patient sample: The National Electronic Injury Surveillance System (NEISS) database.

Outcome measure and comparisons: Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics.

Methods: The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity.

Results: Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38-3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18-64 (95% CI 1.85-2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68-2.22). Recreation-related cervical fracture rates in individuals 18-64 was 1.186 (95% CI 1.14-1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09-1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18-64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%).

Conclusions: This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football.

Level of evidence: Level III.