The authors describe injuries to the nervous system and spine from downhill skiing accidents through a review of the charts of downhill skiers admitted over 5 years to the three teaching hospitals of the University of Calgary. The office of the chief medical examiner provided details about accidental deaths from downhill skiing in which nervous system trauma occurred. During the study period, 145 downhill skiers suffered injury to the nervous system or spine. There were five deaths from nervous system trauma. The mean age of the injured skiers was 23.8 years, and these injuries were three times more common in men than in women. Eighty-eight skiers sustained a head injury, 25 had spinal fractures alone, 20 had spinal cord or nerve root injury and 12 had peripheral nerve injury. A simple fall on the hill was the commonest method of injury, followed in frequency by collision with a tree, which caused the most severe injuries. Reckless skiing, design of ski runs and man-made snow were contributing factors. The serious nature and number of these injuries must be recognized, and further study is needed on causal factors and preventive measures.