Most spinal cord injuries (SCIs) are the result of motor vehicle accidents (MVAs). There are no published reports specifically addressing SCIs that occur in the workplace. We report a cohort survey study examining the frequency and etiology of SCI in the workplace. Through a cooperative program, an evaluation of all SCIs seen in Colorado during a 5 1/2-year period (January 1, 1986 through June 6, 1991) is presented. We report a detailed analysis of specific data of all SCIs occurring in the workplace. There were a total of 566, with 74 (13.1%) due to injuries that occurred during the course of employment. The most common cause of occupational SCI was falls, which occurred in 37 (50%), as compared with only 15.9% of non-occupational SCIs. Only 14 (18.9%) occupational SCIs resulted from MVAs, compared with 59.3% of non-occupational SCIs. Other major etiologies for occupational SCI included being hit by a falling object in 14 individuals (18.9%), gunshot wound in three (4%), skiing in one (1.4%), stabbing in one (1.4%), and other causes in four (5.4%). Construction occupations were over-represented in occupational SCIs with 41.9% of cases as compared with only 6.3% for the non-occupational group. Because of the large percentage of occupational SCIs, efforts should be aimed at educating workers in at-risk occupations to prevent this serious injury.