Spinal Injuries from Equestrian Activity: A US Nationwide Study

Abstract

Background/Objectives: Equestrian activities can result in spine injuries. Most studies are from single centers, and none use a national database. It was the purpose of this study to describe the demographics, injury mechanisms, and types of equestrian-associated spinal injuries using a US national ED database. Methods: The National Electronic Injury Surveillance System database was queried for equestrian-related spine injuries from 2000-2023. ED disposition was categorized as discharged or not discharged. Statistical analyses accounted for the weighted, stratified nature of the data to obtain national estimates. Results: There were an estimated 54,830 patients, having an average age of 42 years. Most were female (73.6%) and White (93.7%); one-half (51.1%) were not discharged from the ED. The spine level was the lumbar (49.1%), thoracic (24.4%), sacrococcygeal (15.5%), and cervical (11.0%) spine. Multiple spine fractures occurred in 4.0%. A simple fall off a horse occurred in 53.6% of the injuries, and the patient was bucked/thrown/kicked off the horse in 39.7%. Neurologic injury was rare (1.8%). Hospital admission was highest in the cervical group (74.3%) and lowest in the sacrococcygeal group (33.5%). The cervical group had the highest percentage of males (43.7%) compared to the thoracic, lumbar, and sacrococcygeal groups (22.8%, 27.3%, 16.8%, respectively). There were proportionally fewer females in those over 50 years of age, where the male percentage was 11.7%, 25.6%, and 31.6% for those <18 years, 18-50 years, and >50 years old, respectively. Conclusions: This large study can be used as baseline data to evaluate further changes in equestrian injuries, especially the impact of further prevention strategies, education protocols, and legislative/governmental regulations of public equestrian localities.

Keywords: demographics; emergency department; equestrian; fracture; spine.

Figure 1

The location of the most proximal spine fracture in 770 patients due to horse-related injuries.

Figure 2

Differences by spinal level, C = cervical, T = thoracic, L = lumbar, and SC = sacrococcygeal: (a) by disposition from the ED (p < 10⁻⁴). (b) by patient’s sex (p = 0.0001). (c) by injury mechanism (p = 0.031).

Figure 3

Differences by sex: (a) by three major age groups (p = 0.008), (b) by race (p = 0.036), and (c) by injury mechanism (p = 0.009).

Figure 4

Spine injury location by age group: (a) both male and female (p = 0.16), (b) for males (p = 0.73), and (c) for females (p = 0.097).

Figure 5

Anatomic location of the 219 associated fractures. The fracture at the 12 o’clock position is the face (4 cases); the pie slices then move clockwise as shown in the legend, with the sternum at 11:59 (1 case), right after the 96 cases of rib(s) fractures.