Beach Breaking Waves and Related Cervical Spine Injuries: A Level One Trauma Center Experience and Systematic Review

Daniel W. Griepp, Rafael De la Garza Ramos, Jason Lee, Aaron Miller, Meenu Prasad, Yaroslav Gelfand, Sara Cardozo-Stolberg, Saikiran G. Murthy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves. Methods: Single-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. Results: Nineteen 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. Conclusions: We 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.

Original languageEnglish (US)
Pages (from-to)e471-e480
JournalWorld Neurosurgery
StatePublished - Apr 2022


  • Beach wave injury
  • Cervical spine
  • Diving injury
  • Shallow water
  • Spinal cord injury
  • Traumatic fracture

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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