Over the past three decades ice hockey has changed, particularly the severity of the injuries. Our objectives in this study are to give a historical overview and examine the nature and incidence of major spinal and head injuries sustained while playing ice hockey. Using a retrospective review of questionnaires returned by physicians, we have previously reported 241 cases of fracture or dislocation of the spine, up to the end of 1993. Between 1982 and 1993 an average of 16.8 ice hockey related major spinal injuries were reported each year, from Canada primarily. Most of these injuries occurred to the cervical spine of players 16 to 20 years of age who were playing in supervised games. Our latest study, now nearing completion, will add more cases to our registry, up to the end of 1996. These include a recent dramatic increase in spinal fractures reported by USA Hockey. In addition, we have included concussions in our latest survey because a lack of consistent adherence to hockey rules and to a respectful attitude may impact upon both spinal and head injury and the etiology may be overlapping in some cases.