SportSmart Canada maintains a registry of spinal injuries in hockey and has documented 214 cases of fracture or dislocation of the spine, occurring mainly in North America since 1966. The current annual incidence is approximately 15 cases per year and may be declining as a result of intense prevention programs. Most of the injuries have been to the cervical spine in players 16 to 20 years of age playing supervised games. Checking from behind causing impact of the head against boards has been an important cause of injury, especially for those injuries resulting in neurological deficit.