Twelve cases of spinal cord injury (SCI) resulting from recreational off-road vehicle (ORV) accidents seen during a three-year period at a spinal cord injury center were analyzed using structured interviews and record reviews. Seven accidents involved three-wheel all-terrain vehicles (ATVs), one involved a four-wheel ATV, and four involved two-wheel trailbikes. The analysis of accident victim characteristics showed that all age groups are at risk, and that most victims were young adult men vehicle drivers with experience and wearing helmets. Spinal injury levels were cervical, three; thoracic, three; and thoracolumbar, six. Categorized accident hazard patterns were loss of control, six; tipover, four; and hidden obstacle, two. Contributing causative factors to the accident occurrence were poor driver judgment, seven, and vehicle instability, eight. Speeding was the most frequent primary cause of ORV accidents. We discuss vehicle and driver performance characteristics as they relate to risk of accident occurrence. The frequency of ORV accidents as an etiology of traumatic SCI at our center was 8%, compared to 8% for diving accidents and 11% for motorcycle accidents. We recommend, in view of the high risk of severe injury, widespread public education about ORV accident prevention.