This 10-year retrospective review of spinal injuries at a destination ski resort was done to determine the incidence and type of spinal and neurologic injury associated with alpine winter sports. Spinal injury patterns and outcomes in skiers and snowboarders over a period of 11 seasons at a destination resort were studied. One-fourth of cervical injuries were associated with a temporary neurologic deficit. Only 1 in 25 thoracic injuries had an associated neurologic deficit, and this was permanent. None of the lumbar injuries required surgery, nor were any associated with a neurologic deficit. There was approximately one significant spinal injury every 100,000 skier-days, and only 9% of spinal injuries required surgery. The incidence of death or associated permanent neurologic deficit is low (approximately one per two million skier-days). Skiing and snowboarding have a low incidence of significant spinal trauma.