Spine and spinal cord injuries are the most debilitating and costly of serious injuries sustained by downhill skiers. We present a series of 126 skiers with spine and spinal cord injuries drawn from 636 consecutive injured skiers evaluated at one center over an 11-year period. The incidence of spinal injury was very low (0.001/1000 skier-days). Eighteen (17%) patients had spinal cord injuries associated with their fractures; injuries in the cervical region were most likely to involve the spinal cord. The most commonly fractured levels were C6, T12 and L1; the most common fracture pattern was compression (38%). One-third of all patients had multisystem trauma; those with thoracolumbar injuries were much more likely to sustain torso and extremity trauma than those with cervical injuries. Information about injury patterns in skiers with spinal injuries should aid in the triage and initial evaluation of this blunt trauma population.