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The incidence and trends of diving-related spine injuries in the United States and risk factors associated with spinal cord injury

Spinal Cord volume 63, pages 352–358 (2025)Cite this article

Subjects

Abstract

Study design

Retrospective longitudinal cohort study.

Objectives

To characterize: (1) incidence and trends of diving-related spine injuries (DRSI) and diving-related spinal cord injury (DRSCI) in the United States and (2) risk-factors associated with DRSCI.

Setting

Using a large, national, multi-insurance administrative dataset of over 161 million patients, those who suffered a DRSIs were identified and characterized.

Methods

Persons who suffered a DRSIs were analyzed from 2010–2021. Estimated annual percentage change (EAPC) was calculated by log-linear regression. For those with DRSCI, risk-factors were assessed by multivariable logistic regression.

Results

Of 3829 persons who suffered DRSIs, the cervical spine was most frequently involved (53.0%). EAPCs of DRSIs at the cervical, thoracic, and lumbar spine significantly decreased over the studied years (−4.69, −6.81, and −4.88%, respectively; p < 0.05 for all), while DRSCI demonstrated a nonsignificant trend (p = 0.081). Among the 629 (16.4%) with DRSCI, risk-factors included: prior cervical spine surgery (OR 13.31, p < 0.001), history of cervical spondylolisthesis (OR 5.36, p < 0.001), male sex (OR 2.69, p < 0.001), history of cervical stenosis (OR 2.26, p < 0.001), coastal states (OR 1.38, p = 0.012), higher Elixhauser Comorbidity Index (OR 1.15, p < 0.001), and older age (OR 1.01, p = 0.029).

Conclusions

The rate of DRSIs of the cervical, thoracic, and lumbar spine has significantly decreased in recent years in the United States. However, the nonsignificant trend in DRSCI highlights the importance of continued public health initiatives. Among those with DRSCI, several unique risk-factors were identified, laying the foundation for the refinement of current diving injury prevention programs.

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Fig. 1: Annual trend in diving-related spine injuries for each vertebral level.
Fig. 2: Diving-related spine injuries (DRSI) characterized by the specific subsequent diagnoses for each vertebral level.
Fig. 3: Annual trend in diving-related spinal cord injury (DRSCI) per 1,000,000 covered lives in the dataset over the studied years.

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Data availability

The datasets analyzed during the current study can be found within the article supplementary files. Any additional data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA

    Anthony E. Seddio, Sahir S. Jabbouri, Rajiv S. Vasudevan, Michael J. Gouzoulis, Wesley Day, Gwyneth C. Maloy, Arya G. Varthi, Daniel R. Rubio & Jonathan N. Grauer

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  1. Anthony E. Seddio
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  2. Sahir S. Jabbouri
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  3. Rajiv S. Vasudevan
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  4. Michael J. Gouzoulis
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  5. Wesley Day
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  8. Daniel R. Rubio
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  9. Jonathan N. Grauer
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Contributions

AES/SSJ/RSV/MJG/WD/GCM/AGV/DRR/JNG: Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results; Drafted or revised the manuscript for important intellectual content; Approved the final version; Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jonathan N. Grauer.

Ethics declarations

Competing interests

JNG is the North American Spine Society Journal Editor-in-chief and Journal of American Academy of Orthopaedic Surgeons Deputy Editor.

Ethical approval

Our Institutional Review Board at the Yale School of Medicine found this study IRB exempt.

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Seddio, A.E., Jabbouri, S.S., Vasudevan, R.S. et al. The incidence and trends of diving-related spine injuries in the United States and risk factors associated with spinal cord injury. Spinal Cord 63, 352–358 (2025). https://doi.org/10.1038/s41393-025-01098-6

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