Global Spine J 2016; 06(07): 721-734
DOI: 10.1055/s-0036-1586744
EBSJ Special Section: Systematic Review
Georg Thieme Verlag KG Stuttgart · New York

Catastrophic Cervical Spine Injuries in Contact Sports

Michael James Hutton1, Robert A. McGuire2, Robert Dunn3, Richard Williams4, Peter Robertson5, Bruce Twaddle6, Patrick Kiely7, Andrew Clarke8, Keyvan Mazda9, Paul Davies10, Krystle T. Pagarigan11, Joseph R. Dettori11
  • 1Department of Spine Surgery, Princess Elisabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
  • 2Department of Orthopedics, University of Mississippi Medical Center, Jackson, Mississippi, United States
  • 3Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
  • 4Department of Orthopaedics, Queensland University, Brisbane, Australia
  • 5Department of Orthopaedics, Auckland City Hospital, Grafton, Auckland, New Zealand
  • 6Department of Orthopaedic Trauma, Auckland City Hospital, Grafton, Auckland, New Zealand
  • 7Sports Surgery Clinic, Dublin, Ireland
  • 8Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
  • 9Pediatric Orthopaedic Department, Robert Debré Hospital, Paris, France
  • 10Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, United Kingdom
  • 11Spectrum Research, Inc., Tacoma, Washington, United States
Further Information

Publication History

04 April 2016

21 June 2016

Publication Date:
01 September 2016 (eFirst)


Study Design Systematic review.

Objectives To determine the incidence of catastrophic cervical spine injuries (CCSIs) among elite athletes participating in contact team sports and whether the incidence varies depending on the use of protective gear or by player position.

Methods Electronic databases and reference lists of key articles published from January 1, 2000, to January 29, 2016, were searched.

Results Fourteen studies were included that reported CCSI in rugby (n = 10), American football (n = 3), and Irish hurling (n = 1). Among Rugby Union players, incidence of CCSI was 4.1 per 100,000 player-hours. Among National Football League players, the CCSI rate was 0.6 per 100,000 player-exposures. At the collegiate level, the CCSI rate ranged from 1.1 to 4.7 per 100,000 player-years. Mixed populations of elite and recreational rugby players in four studies report a CCSI rate of 1.4 to 7.2 per 100,000 player-years. In this same population, the scrum accounted for 30 to 51% of total reported CCSIs in Rugby Union versus 0 to 4% in Rugby League. The tackle accounted for 29 to 39% of injuries in Rugby Union and 78 to 100% of injuries in Rugby League. Making a tackle was responsible for 29 to 80% of injuries in American football.

Conclusion CCSIs are infrequent among elite athletes. There is insufficient evidence to determine the effect of protective gear (e.g., helmets, padding) on CCSI incidence. Scrum and tackle in rugby and tackling in American football account for the majority of CCSIs in each respective sport.


Michael James Hutton: Personal fees (DePuy/Synthes); Nonfinancial support (Lindare Medical, NuVasive)

Robert A. McGuire: Other (President AO North America)

Robert Dunn: Fellowship/speaker stipend (Medtronic, DePuy/Synthes, AOSpine)

Richard Williams: none

Peter Robertson: Consulting (Medtronic, NuVasive)

Bruce Twaddle: none

Patrick Kiely: Nonfinancial support (DePuy/Synthes)

Andrew Clarke: none

Keyvan Mazda: none

Paul Davies: none

Krystle T. Pagarigan: none

Joseph R. Dettori: none

Supplementary Material