• Daniel W Griepp, Rafael De la Garza Ramos, Jason Lee, Aaron Miller, Meenu Prasad, Yaroslav Gelfand, Sara Cardozo-Stolberg, and Saikiran G Murthy.
• Division of Neurological Surgery, Nassau University Medical Center, Nassau County, New York, USA; Department of Surgery, Nassau University Medical Center, Nassau County, New York, USA; New York Institute of Technology, Old Westbury, New York, USA.
• World Neurosurg. 2022 Apr 1; 160: e471-e480.

ObjectiveTo analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves.MethodsSingle-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York, USA. A systematic review following the PRISMA guidelines was also performed.ResultsNineteen patients (age 17-79 years) sustained cervical injury from high-energy breaking waves while in shallow beach water. Six patients dived into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in nonspecified recreational activity. All 7 patients with subaxial cervical AO Spine Injury Score (AO-SIS) >10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS >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 the reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow-up, an estimated 64.8% of patients had permanent neurologic injury and 12.5% had permanent quadriplegia.ConclusionsWe offer the first description of cervical injuries sustained in water-related recreational activity using the AO-SIS. The morphology of injuries varied significantly and seemed to depend on body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS >10 are likely to have poor functional recovery.Copyright © 2022 Elsevier Inc. All rights reserved.

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