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Clinical registries typically gather comprehensive trauma data from living patients but often exclude autopsy data from scene\u2010of\u2010injury fatalities, leaving the pathology of acute TSCI underexplored. To address this gap, we reviewed autopsy records from the New York City Office of the Chief Medical Examiner spanning a 15\u2010year period (2003\u20132018) to characterize the demographic, forensic, and neuropathological features of lethal acute blunt TSCI. Cases were excluded if post\u2010injury survival occurred beyond the acute phase, if there was pre\u2010existing spinal disease or if there was a non\u2010blunt trauma mechanism of injury. A total of 220 cases met inclusion criteria, with a mean age of 48.37\u2009years (range 2\u201396). Most spinal injuries were accidental and resulted from motor vehicle collisions, falls from standing height, or descents from height. Ethanol was present in approximately one\u2010third of cases. Atlanto\u2010axial dislocation occurred in 14.5% of cases, predominantly among younger individuals who were involved in motor vehicle collisions. Lethal spinal injuries were most commonly single\u2010level fractures. Neuropathological data were available for 184 cases, of which 147 (80%) had concomitant acute spinal cord injury, with cord transections, contusions, and parenchymal softening being the most frequent. Extra\u2010axial hemorrhages involving the epidural and subdural spaces were the most common spinal hemorrhages related to blunt trauma.<\/jats:p>","DOI":"10.1111\/1556-4029.70305","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T04:00:53Z","timestamp":1773115253000},"page":"1255-1263","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Forensic and neuropathological characteristics of lethal acute blunt traumatic spinal cord injury"],"prefix":"10.1111","volume":"71","author":[{"given":"Noemi","family":"Wachtler","sequence":"first","affiliation":[{"name":"Department of Pharmacology Yale School of Medicine  New Haven Connecticut USA"},{"name":"School of Medicine and Health Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Roman","sequence":"additional","affiliation":[{"name":"New York City Office of the 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