European Spine Journal

, Volume 19, Issue 4, pp 552–557 | Cite as

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients

  • Pierre-Yves Borius
  • Ismail Gouader
  • Philippe Bousquet
  • Louisa Draper
  • Franck-Emmanuel Roux
Original Article


Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5–C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.


Cervical trauma Diving accident Outcome Spine cord injury 


  1. 1.
    Aito S, D’Andrea M, Werhagen L (2005) Spinal cord injuries due to diving accidents. Spinal Cord 43:109–116CrossRefPubMedGoogle Scholar
  2. 2.
    Badman BL, Rechtine GR (2004) Spinal injury considerations in the competitive diver: a case report and review of the literature. Spine J 4:584–590CrossRefPubMedGoogle Scholar
  3. 3.
    Bailes JE, Herman JM, Quigley MR, Cerullo LJ, Meyer PR Jr (1990) Diving injuries of the cervical spine. Surg Neurol 34:155–158CrossRefPubMedGoogle Scholar
  4. 4.
    Bhide VM, Edmonds VE, Tahor CH (2000) Prevention of spinal cord injuries caused by diving: evaluation of the distribution and usage of a diving safety video in high schools. Inj Prev 6:154–156CrossRefPubMedGoogle Scholar
  5. 5.
    Blanksby BA, Wearne FK, Elliott BC, Blitrich JD (1997) Aetiology and occurrence of diving injuries. Sports Med 23:228–246CrossRefPubMedGoogle Scholar
  6. 6.
    Chang SK, Tominaga GT, Wong JH, Weldon EJ, Kaan KT (2006) Risk factors for water sports-related cervical spine injuries. J Trauma 60:1041–1046CrossRefPubMedGoogle Scholar
  7. 7.
    Damjan H, Turk PR (1995) Prevention of spinal injuries from diving in Slovenia. Paraplegia 33:246–249PubMedGoogle Scholar
  8. 8.
    Devivo MJ, Sekar P (1997) Prevention of spinal cord injuries that occur in swimming pools. Spinal Cord 35:509–515CrossRefPubMedGoogle Scholar
  9. 9.
    Griffiths ER (1980) Spinal injuries from swimming and diving treated in the spinal department of Royal Perth Rehabilitation Hospital. Paraplegia 18:105–117PubMedGoogle Scholar
  10. 10.
    Herman JM, Sonntag VK (1991) Diving accidents, mechanism of injury and treatment of the patient. Crit Care Nurs Clin North Am 3:331–337PubMedGoogle Scholar
  11. 11.
    Hwang V, Shofer FS, Durbin DR, Baren JM (2003) Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med 157:50–53PubMedGoogle Scholar
  12. 12.
    Karacan I, Koyuncu H, Pekel O, Sumbuloglu G, Kirnap M, Dursun H et al (2000) Traumatic spinal cord injuries in Turkey: a nation wide epidemiological study. Spinal Cord 38:697–701CrossRefPubMedGoogle Scholar
  13. 13.
    Kligman M, Vasili C, Roffman M (2000) The role of computed tomography in cervical spinal injury due to diving. Arch Orthop Trauma Surg 121:139–141CrossRefGoogle Scholar
  14. 14.
    Kluger Y, Jarosz D, Paul DB, Townsend RN, Diamond DL (1994) Diving injuries; a preventable catastrophe. J Trauma 36:349–351PubMedCrossRefGoogle Scholar
  15. 15.
    Korres DS, Benetos IS, Themistocleous GS, Mavrogenis AF, Nikolakakos L, Liantis PT (2006) Diving injuries of the cervical spine in amateur divers. Spine J 6:44–49CrossRefPubMedGoogle Scholar
  16. 16.
    Madhavan P, Monk J, Wilson-Macdonald J, Fairbank J (2001) Instability due to unrecognised fracture-subluxations after apparently isolated injuries of the cervical spine. J Bone Joint Surg Br 83(4):486–490CrossRefPubMedGoogle Scholar
  17. 17.
    Maynard FM, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB et al (1997) International standards for Neurological and functional classification of spinal cord injury. Spinal Cord 35:266–274CrossRefPubMedGoogle Scholar
  18. 18.
    Rapport de la Fédération des Professionnels de la Piscine Agence Dognin Communication (2008) Accessed 8 Nov 2008
  19. 19.
    Report Growing Demand for Swimming Pools and Pool Equipment in Spain (2003) Accessed 8 Nov 2008
  20. 20.
    Schmitt H, Gerner HJ (2001) Paralysis from sport and diving accidents. Clin J Sport Med 11:17–22CrossRefPubMedGoogle Scholar
  21. 21.
    Watson RS, Cummings P, Quan L, Bratton S, Weiss NS (2001) Cervical spine injuries among submersion victims. J Trauma 51:658–662CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Pierre-Yves Borius
    • 1
    • 2
  • Ismail Gouader
    • 1
  • Philippe Bousquet
    • 1
  • Louisa Draper
    • 1
  • Franck-Emmanuel Roux
    • 1
  1. 1.Pôle Neuroscience (Neurochirurgie), Centres Hospitalo-UniversitairesUniversité Paul-SabatierToulouseFrance
  2. 2.Service de NeurochirurgieCHU, ToulouseToulouseFrance

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