OBJECTIVE: To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amidst high energy breaking waves.
METHODS: Single-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York. A systematic review following the PRISMA guidelines was also performed.
RESULTS: Nineteen patients (age 17-79 years) sustained cervical injury from high energy breaking waves while in shallow beach water. Six patients dove into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in non-specified recreational activity. All 7 patients with Subaxial Cervical AO Spine Injury Score (AO-SIS) scores higher than 10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS score > 10, and cord signal change all predicted significant disability or death at 12 months (p<0.01). The present study and 7 additional studies reporting on 534 patients (mean age: 45.4 years) were analyzed. Within reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow up, an estimated 64.8% of patients had permanent neurological injury and 12.5% had permanent quadriplegia.
CONCLUSIONS: We offer the first description of cervical injuries sustained in water-related recreational activity using the AOSpine scoring system. The morphology of injuries varied significantly and appeared to depend upon body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS scores higher than 10 are likely to have poor functional recovery.