Sports-related Spinal Injury Research Articles

Litigation involving sports-related spinal injuries: a comprehensive review of reported legal claims in the United States in the past 70 years

Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (e.g. football) may be particularly prone to injury given the high-impact nature of these activities. Due to the oftentimes profound impact of sports-related spinal injuries on health and quality-of-life, they are also associated with a substantial risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and other strategies to minimize litigation risks. In addition, it may allow the spine surgeon to better recognize the health, socioeconomic, and legal challenges faced by this patient population. To provide a comprehensive assessment of reported legal claims involving sports-related spinal injuries, including a comparative analysis of legal outcomes between collision and non-collision sports. To discuss strategies to prevent sports-related spinal injuries and minimize litigation risks. Retrospective review. Athletes experiencing spinal injuries during sports. Outcomes included verdict outcome (defendant vs. plaintiff), legal claims, injuries sustained, clinical symptoms, and award payouts. The legal research database Westlaw Edge (Thomson Reuters) was queried for legal claims brought in the United States from 1950 to 2021 involving sports-related spinal injuries. Verdict or settlement outcomes were collected as well as award payouts, time to case closure, case year, and case location. Demographic data, including type of sport (ie collision vs. non-collision sport) and level of play were obtained. Legal claims, spinal injuries sustained, and clinical symptoms were also extracted. Furthermore, the nature of injury, injured spinal region, and treatment pursued were collected. Descriptive statistics were reported for all cases and independent-samples t-tests and chi-square tests were used to compare differences between collision and non-collision sports. Of the 840 cases identified on initial search, 78 met our criteria for in-depth analysis. This yielded 62% (n=48) defendant verdicts, 32% (n=25) plaintiff verdicts, and 6% (n=5) settlements, with a median inflation-adjusted award of $780,000 (range: $5,480-$21,585,000) for all cases. The most common legal claim was negligent supervision (n=38, 46%), followed by premises liability (n=23, 28%), and workers' compensation/no fault litigation (n=10, 12%). The most common injuries sustained were vertebral fractures (n=34, 44%) followed by disc herniation (n=14, 18%). Most cases resulted in catastrophic neurological injury (n=37, 49%), either paraplegia (n=6, 8%) or quadriplegia (n=31, 41%), followed by chronic/refractory pain (n=32, 43%). Non-collision sport cases had a higher percentage of premises liability claims (41% vs. 11%, p=.006) and alleged chronic/refractory pain (53% vs. 28%, p=.04). Conversely, collision sport cases had a higher proportion of workers' compensation/no fault litigation (23% vs. 4%, p=.03) and cases involving disc herniation (29% vs. 9%, respectively; p=.04). Sports-related spinal injuries are associated with multiple and complex health, socioeconomic, and legal consequences, with median inflation-adjusted award payouts nearing $800,000 per case. In our cohort, the most commonly cited legal claims were negligent supervision and premises liability, emphasizing the need for prevention guidelines for safe sports practice, especially in non-professional settings. Cases involving athletes participating in non-collision sports were significantly associated with claims citing chronic/refractory pain, highlighting the importance of long-term care in severely injured athletes.

Transient Quadriplegia: A Case-Based Approach to Cervical Trauma.

IntroductionSpinal cord injuries are a common reason for presentation to the emergency department (ED). Sports-related spinal injuries are one of the least common spinal injuries, falling behind vehicular accidents, acts of violence, and falls.Case ReportThis case report describes a case of transient quadriplegia in a 17-year-old male who presented to the ED after a helmet-to-helmet collision while participating in football.ConclusionEmergency physicians should be cognizant of potential spinal cord injury using clinical decision tools and radiologic imaging to properly disposition a patient presenting with cervical spine injury.

Prevalence of sports-related spinal injury stratified by competition level and return to play guidelines.

Spinal injury is among the most severe and feared injuries an athlete may face. We present an up-to-date review of the recent literature, stratifying recommendations based on injury location (cervical, thoracic, and lumbar spine) and type, as well as, the level of competitive play (high school, collegiate, professional). A literature search was completed to identify all publications reporting return to play guidelines for athletic injuries or injury-related surgery irrespective of the study design. Publication dates were not restricted by year. Search terms used included "return to play" and "spinal injury" on National Library of Medicine (PubMed) and Google Scholar. Selection criteria for literature included axial spine injury guidelines for athletic participation post-injury or post-surgery. Literature found from the search criteria was sorted based on level of competition and location of axial spine injury involved. It was found that professional athletes are more likely to suffer severe spinal injuries, require surgery, and necessitate a longer return to play (RTP), with high school and college athletes usually returning to play within days or weeks. Injuries occur mainly within contact sports and concordance exists between initial and subsequent spinal injuries. Adequate rest, rehabilitation, and protective equipment alongside the education of athletes and coaches are recommended. In conclusion, a multidisciplinary approach to patient management is required with consideration for the emotional, social, and perhaps financial impact that spinal injury may have upon the athlete. Consensus from the literature states that in order for an athlete to safely return to play, that athlete should not be actively suffering from pain, should have a full range of motion, and complete return of their strength in the absence of neurological deficit.

Morbidity after traumatic spinal injury in pediatric and adolescent sports-related trauma.

Sports injuries present a considerable risk of debilitating spinal injury. Here, the authors sought to profile the epidemiology and clinical risk of traumatic spinal injuries (TSIs) in pediatric sports injuries. The authors conducted a retrospective cohort analysis of pediatric patients who had experienced a sports-related TSI, including spinal fractures and spinal cord injuries, encoded in the National Trauma Data Bank in the period from 2011 to 2014. Included in the analysis were 1723 cases of pediatric sports-related TSI, which represented 3.7% of all pediatric sports-related trauma. The majority of patients with TSI were male (81%), and the median age was 15 years (IQR 13-16 years). TSIs arose most often from cycling accidents (47%) and contact sports (28%). The most frequently fractured regions were the thoracic (30%) and cervical (27%) spine. Among patients with spinal cord involvement (SCI), the cervical spine was involved in 60% of cases.The average length of stay for TSIs was 2 days (IQR 1-5 days), and 32% of the patients required ICU-level care. Relative to other sports-related trauma, TSIs without SCI were associated with an increased adjusted mean length of stay by 1.8 days (95% CI 1.6-2.0 days), as well as the need for ICU-level care (adjusted odds ratio [aOR] 1.6, 95% CI 1.3-1.9). Also relative to other sports-related trauma, TSIs with SCI had an increased length of stay by 2.1 days (95% CI 1.8-2.6 days) and the need for ICU-level care (aOR 3.6, 95% CI 2.6-4.8).TSIs without SCI were associated with discharge to or with rehabilitative services (aOR 1.7, 95% CI 1.5-2.0), as were TSIs with SCI (aOR 4.0, 95% CI 3.2-4.9), both relative to other sports-related trauma. Among the patients with TSIs, predictors of the need for rehabilitation at discharge were having a laminectomy or fusion, concomitant lower-extremity injury, head injury, and thoracic injury. Although TSIs affected 4% of the study cohort, these injuries were present in 8% of patients discharged to or with rehabilitation services and in 17% of those who died in the hospital. Traumatic sports-related spinal injuries cause significant morbidity in the pediatric population, especially if the spinal cord is involved. The majority of TSI cases arose from cycling and contact sports accidents, underscoring the need for improving education and safety in these activities.

Traumatic Spinal Injuries Cause Disproportionate Morbidity in Sports-Related Pediatric Trauma

Abstract INTRODUCTION American football injuries have placed a spotlight on the effects of contact sports on traumatic injury to the central nervous system. We sought to study the epidemiology and outcomes for traumatic sports-related spinal injuries. METHODS We conducted a retrospective cohort analysis of pediatric patients who experienced a sports-related TSI, including spinal fractures and spinal cord injuries (SCIs), encoded within the National Trauma Data Bank from 2011 to 2014. RESULTS We included 1723 cases of pediatric sports-related TSI, which represented 3.7% of all sports-related pediatric trauma (81% male, median age [IQR] 15 yr[13-17]). Traumatic spinal injuries arose most often from cycling accidents (47%) and contact sports (28%). The most frequently fractured regions were the thoracic (30%) and cervical spine (27%). Of patients with SCI, the cervical spine was involved in 60% of cases. The average length of stay for TSIs was 2 d (IQR 1-5) and 32% of these patients required ICU-level care. Relative to other sports-related trauma, TSIs without spinal cord involvement were associated with increased adjusted length of stay by 1.8 d (95% CI 1.6-2.0), as well as ICU-level need (adjusted odds ratio [aOR] = 1.7; 95% CI 1.4-2.0). 6.8% and 1.4% required laminectomy and fusion, respectively. Discharge to rehabilitative care or home with rehabilitative services was associated with elevated odds ratios for TSIs without SCI (aOR = 1.7; 95% CI 1.5-2.0) and TSIs with SCI (aOR = 4.0; 95% CI 3.2-5.0). Predictors of requiring rehabilitation at discharge were having a laminectomy or fusion, lower extremity injury, head injury, and thoracic injury. Although TSIs represented 4% of this cohort, they were present in 8% of patients discharged with rehabilitation and 17% of in-hospital deaths. CONCLUSION Traumatic sports-related spinal injuries present significant morbidity in the pediatric population, especially with spinal cord involvement. The majority of cases arose from cycling and contact sports accidents, underscoring the need for improving education and safety in these activities.

A 10-year review of sports-related spinal injuries

The incidence of traumatic spinal cord injury varies in different countries from 2.5 to 57.8 per million per annum, with sport accounting for 8-12.7% of these injuries. Spinal injuries associated with recreational sport often result in long-term permanent disability in otherwise active individuals. The aetiology, pattern and mechanism of the 196 sports-related spinal injuries treated in the National Spinal Injuries unit in Ireland from 1993 to 2003 is reviewed in this article. Sports-related spinal injuries accounted for 11% of all spinal injury admissions. There were 145 (74%) males and 51 (26%) females, with an average age of 30.2 years (range 14-72 years). The most common sport responsible for a spinal injury was equestrian events (41.8%), rugby (16.3%), diving (15.3%), Gaelic football and hurling (9.6%), cycling (4.2%), and miscellaneous (12.7%). Injury distribution was cervical spine (118 patients, 60%), thoracic (41 patients, 21%), lumbar spine (37 patients, 19%). In 18 patients (9.25%) more than one region was affected. In 78 patients (40%) more than one vertebral level was affected. On admission 71 patients (36%) had a neurological deficit with 46 patients (65%) incomplete and 25 (35%) complete, of which 6 patients (23%) were paraplegic and 19 (77%) were tetraplegic. Sport is an important cause of spinal injury among young people in Ireland. This study contributes to our understanding of these injuries aetiology, pattern and mechanism of injury and allows constructive recommendations for injury prevention and management.

Magnetic resonance imaging of sports injuries of the spine.

Spinal injuries are relatively frequent events in professional athletes. Greater popularity of recreational athletic activities has increased the occurrence of sports-related spinal injuries in the general population. The demand of high-intensity sports places a constant load on the vertebral column. Several studies have demonstrated higher prevalence of spinal abnormalities in athletes than nonathletes. Direct correlation of the number and extent of injuries with the length in years of sports activity has been established. Diagnostic imaging, particularly magnetic resonance imaging (MRI), plays a crucial role in evaluating and detecting sports-related spinal injuries. Subtle bone marrow, soft-tissue, and spinal cord abnormalities, which may not be apparent on other imaging modalities, can be readily detected on MRI. Early detection often leads to prompt accurate diagnosis and expeditious management, in many cases avoiding unnecessary procedures. This article reviews the technical aspects of MRI for evaluation of the spine and the role of MRI in the assessment of sports-related spinal injuries.