Research that highlights a worrying trend between cycling and spinal trauma has recently been published in The Surgeon. Although the authors of the paper, M P Broe (Mater Misericordiae University Hospital, Dublin, Ireland) and colleagues, state that, “It is not the intention of the authors to deter participants from engaging in this sport”, the data presented convey evidence of the potential for high velocity trauma and associated major injuries. cyclists
The health benefits of cycling have been widely reported; a factor contributing to the sport’s large increase in popularity worldwide, according to Broe et al. Alongside an increase in the number of commuter cyclists, competitive road cycling and competitive long distance events have also grown in popularity, with the authors reporting triathlon being the fastest growing sport in Britain, at 10% per year.
In relation to the ever increasing popularity of cycling, the study investigators write: “There is significant benefit to be gained from research in this field for clinicians, officials and the general public.” Currently, the literature regarding cycling accidents is biased towards traumatic brain injury and the use of helmets. Therefore, the authors note a limited number of studies that examine spinal trauma in cyclists—as there are fewer looking into the nature of spinal injury and spinal management in this cohort.
Using the number of referrals to a national referral centre for spinal trauma, Broe and colleagues took a retrospective approach in order to examine such patients. Additionally, the authors investigated whether the growing popularity of cycling (particularly at a competitive level) is linked to a significant increase in spinal trauma.
Almost all cases of spinal column disease (including trauma, degenerative and malignancy) in the Republic of Ireland are referred to the authors’ affiliated institution for either transfer or advice in relation to optimal management. A template document for each patient was completed and made available for the institution, containing the following details: cause of injury, medical history, physical examination (objectified by the American Spinal Injury Association [ASIA] score), level of injury and relevant imaging reports.
The retrospective analysis was carried out on this prospectively maintained database over a four-year period (2010–2013). Initially, the number of referrals and indications were analysed for patient referrals spanning all four years. However, further analysis was performed for patients referred in 2012–2013 only; this was not possible for the years prior due to incomplete data.
The initial analysis revealed that between 2010 and 2013, the number of referrals for bicycle related trauma increased by 200%. To put this figure in context, the authors reported that referrals for car road traffic accidents increased by 29% during the same time frame, and motorcycle accident referrals even reduced by 68%.
Following this, further analyses were carried out on 24 referrals for spinal trauma in cyclists, with 19 (79%) male and five (21%) female patients, with a mean age of 44.3 years (range 16–81 years). Overall, the authors found that the majority of injuries were incurred to the cervical spine (71%), with 29% to thoracic spine and no lumbar or sacral spine injuries. Five patients (20.8%) had neurological deficit with 12.5% complete paralysis ASIA A score. The spinal fixation rate was 29.1%, with 16.6% managed with a HALO device. Additionally, the analysis revealed that the most seriously injured patients (complete spinal cord injury) were injured whilst training on a racer style bicycle.
Although the data presented highlight a worrying trend, showing an increase in spinal trauma secondary to bicycle use, Broe et al note some important limitations of the current study; the main being the use of a single-institution. The study therefore lacks power due to the relatively small number of patients compared to countries with larger populations. Furthermore, there were incomplete data for the years 2010–2011, which limited the further analysis of these patients.
However, irrespective of the study’s shortcomings, the findings remain in-line with previous retrospective analyses. For example, according to the authors, the largest study that looked at competitive cycling (using 107 patients from 1995–2007) also found that the majority of injuries (73%) were of the cervical spine. Additionally, epidemiological studies from France maintain that spinal cord injury due to cycling is on the rise; Lieutaud and colleagues (Service d’Anesthésie Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France) found a 77% increase within six years (2003–2008).
In conclusion to their own findings, Broe et al report a significant increase in spinal trauma due to cycling accidents over the four-year period, with competitive cycling a factor in the most severely injured patients. Therefore, they advocate for an increased emphasis on cyclist safety through public awareness campaigns aimed at those participating in the sport.
Specifically, the authors suggest that campaigns “can be used to raise awareness for competitive cyclists about maintaining their vision on the road ahead to minimise the risk of collision and severe injury.” Yet, Broe and colleagues maintain that further large, multicentre studies examining injuries associated with cycling accidents and the impact of educational programmes would still be beneficial.