Neurosurgical Injuries Associated with Recreational Horseback Riding: A 6-year Retrospective Analysis.

Overview

• This study analyzed the types and outcomes of neurosurgical injuries resulting from recreational horseback riding over a six-year period.
• It identified patterns in head and spinal injuries, treatment requirements, and patient recovery levels after such accidents.

Study Purpose and Design

• The research aimed to characterize the spectrum and severity of neurosurgical injuries associated with falls during recreational horseback riding.
• A retrospective review was conducted by examining cases recorded in the University of Puerto Rico neurosurgery database from 2018 to 2023.
• Patients included were those who sustained injury after falling off a horse during recreational activities and received neurosurgical consultation.
• Descriptive statistics were applied to summarize frequency data and median values for key variables.

Patient Demographics

• A total of 112 patients were identified within the six-year period.
• Majority were males, with 98 patients (87.5% male).
• The median age was 31.5 years, with an interquartile range (IQR) from 22 to 40 years, indicating most patients were young adults.

Types of Injuries

• Head injuries were the most common type, occurring in 89 patients (79.5%).
• Spinal injuries accounted for 19 patients (17%).
• A smaller group, 4 patients (3.5%), suffered from combined head and spine injuries.
• These distributions highlight that isolated head trauma is the primary neurosurgical concern from horseback riding accidents.

Hospitalization and Surgical Intervention

• Forty percent of patients required admission to inpatient care.
• The median hospital stay was 7 days, with an IQR of 3-17 days, suggesting varied length of hospitalization depending on injury severity.
• Twenty-four patients (21%) underwent surgical procedures, indicating a significant subset needed operative management.

Causes of Injury

• In 15% of cases, the fall was triggered when the horse was struck by a motor vehicle, adding a complex external factor contributing to injury severity.
• This highlights a potentially preventable mechanism of injury related to road safety around horses.

Outcomes Assessed by Modified Rankin Scale (mRS)

• The modified Rankin Scale was used to evaluate functional outcomes at discharge, which measures disability or dependence in daily activities.
• 86.6% of patients had favorable outcomes with mRS scores between 0-2, indicative of no to slight disability.
• 3.6% had moderate disability (mRS 3), 1.8% had moderately severe disability (mRS 4), and another 1.8% had severe disability (mRS 5).
• Seven patients (6%) died (mRS 6), indicating a mortality rate related to these injuries.
• Overall, approximately 10% of patients faced poor outcomes (mRS 4-6) upon discharge, demonstrating that while many recover well, a significant minority experience substantial disability or death.

Conclusions and Implications

• Neurosurgical injuries from recreational horseback riding commonly involve isolated head trauma but can also affect the spine or both regions.
• The study shows that a meaningful proportion of patients require hospital admission and surgical intervention.
• Mortality and severe disability occur in a notable fraction of cases, underscoring the riskiness of horseback riding without adequate safety precautions.
• Awareness of injury mechanisms, like motor vehicle collisions involving horses, could inform preventive strategies.
• These findings highlight the need for targeted neurosurgical and trauma management protocols and possibly enhanced safety education for riders.