Spinal Injuries from Equestrian Activity: A US Nationwide Study

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.