Study Design: This is a review article concerning rugby injuries resulting in tetraplegia between the years of 1965 and 2000. It is based on a review of worldwide literature. Objectives: The objective is to evaluate research that has taken place in the last 10 years. Setting: The author first became interested in this problem in 1965 when there were few papers on the subject. Understanding of these injuries has changed decade by decade and the number of spinal injuries has increased dramatically. For the first three decades the author was actively engaged in gathering material particularly at the National Spinal Injuries Centre. During the last 10 years there has been a greater understanding in the mechanism of these injuries. Methods: The following subjects were reviewed in the literature: (1) mechanism of injury; (2) the diameter of the spinal canal; (3) arthritis; (4) treatment; (5) fitness and (6) medico-legal aspects. Results: These injuries are no longer regarded as an Act of God or bad luck but mechanisms of injury have been clearly defined. Conclusion: To prevent these injuries occurring there is a need for: (1) better statistics; (2) enforcement of the laws; (3) improved standards of refereeing; (4) higher standards of fitness and training in particular to de-power the set scrum; (5) study of the cervical spine to look for abnormalities which would predispose the player to tetraplegia; (6) the use of MRI and CT scans to monitor the spinal cord anatomy; (7) the importance of pathology and the status of the cervical spine; (8) the awareness of the dangers to the cord of congenital and acquired abnormalities that could prejudice spinal cord function and (9) the awareness of the necessity for comprehensive insurance. Spinal Cord (2002) 40, 552-559. doi:10.1038/sj.sc.3101349 | 
