Occupant and Crash Characteristics in Thoracic and Lumbar Spine Injuries Resulting From Motor Vehicle Collisions (original) (raw)

Abstract

Background context-Motor vehicle collisions (MVC) are a leading cause of thoracic and lumbar (T and L) spine injuries. Mechanisms of injury in vehicular crashes that result in thoracic and lumbar fractures and the spectrum of injury in these occupants have not been extensively studied in the literature. Purpose-The objective was to investigate the patterns of T and L spine injury following MVC; correlate these patterns with restraint use, crash characteristics and demographic variables; and study the associations of these injuries with general injury morbidity and fatality. Study design/Setting-Retrospective study of a prospectively gathered database. Patient sample-Six hundred and thirty-one occupants with T and L (T1-L5) spine injuries from 4572 occupants included in the Crash Injury Research and Engineering Network (CIREN) database between 1996 and 2011. Outcome measures-No clinical outcome measures were evaluated in this study. Methods-The CIREN database includes moderate to severely injured occupants from MVC involving vehicles manufactured recently. Demographic, injury and crash data from each patient was analyzed for correlations between pattern of T and L spine injury, associated extra-spinal injuries and overall injury severity score (ISS), type and use of seat belts, and other crash characteristics. T and L spine injury pattern was categorized using a modified Denis classification, to include extension injuries as a separate entity. Results-T and L spine injuries were identified in 631 of 4572 vehicle occupants, of whom 299 sustained major injuries (including 21 extension injuries) and 332 sustained minor injuries. Flexion-distraction injuries were more prevalent in children and young adults, and extension injuries in older adults (mean age 65.7 years). Occupants with extension injuries had a mean BMI of 36.0 and a fatality rate of 23.8%, much higher than the fatality rate for the entire cohort (10.9%). The most frequent extra-spinal injuries (Abbreviated Injury Scale grade 2 or more) associated with T and L spine injuries involved the chest (seen in 65.6% of 631 occupants). In contrast to occupants with major T and L spine injuries, those with minor T and L spine injuries showed a strikingly greater association with pelvic and abdominal injuries. Occupants with minor T and L spine injuries had a higher mean ISS (27.1) than those with major T and L spine injuries (25.6). Among occupants wearing a three-point seat belt, 35.3% sustained T and L spine injuries, while only 11.6% of the unbelted occupants sustained T and L spine injuries. Three-point belted individuals were more likely to sustain burst fractures, while two-point belted occupants sustained flexion-distraction injuries most often, and unbelted occupants had a predilection for fracture-dislocations of the T and L spine. Three-point seat belts were protective against neurologic injury, higher ISS and fatality. Conclusions—T and L spine fracture patterns are influenced by age of occupant and type and use of seat belts. Despite a reduction in overall injury severity and mortality, seat belt use is associated with an increased incidence of T and L spine fractures. Minor T and L spine fractures were associated with an increased likelihood of pelvic and abdominal injuries and higher ISS scores, demonstrating their importance in predicting overall injury severity. Extension injuries occurred in older, obese individuals, and were associated with a high fatality rate. Future advancements in automobile safety engineering should address the need to reduce T and L spine injuries in belted occupants.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

References (40)

  1. Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976). 1992 May; 17(5):528-540. [PubMed: 1621152]
  2. Hu R, Mustard CA, Burns C. Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976). 1996 Feb 15; 21(4):492-499. [PubMed: 8658254]
  3. Jansson KA, Blomqvist P, Svedmark P, et al. Thoracolumbar vertebral fractures in Sweden: An analysis of 13,496 patients admitted to hospital. Eur J Epidemiol. 2010 Jun; 25(6):431-437. [PubMed: 20449637]
  4. U.S. Department of Transportation. Traffic Safety Facts 2009. Washington, DC: 2011. National Highway Traffic Safety Administration National Center for Statistics and Analysis. Report No.: DOT HS 811-402
  5. Yoganandan N, Haffner M, Maiman DJ, et al. Epidemiology and injury biomechanics of motor vehicle related trauma to the human spine. SAE Transactions. 1990; 98(6):1790-1807.
  6. Inamasu J, Guiot BH. Thoracolumbar junction injuries after motor vehicle collision: Are there differences in restrained and nonrestrained front seat occupants? J Neurosurg Spine. 2007 Sep; 7(3): 311-314. [PubMed: 17877265]
  7. Ball ST, Vaccaro AR, Albert TJ, Cotler JM. Injuries of the thoracolumbar spine associated with restraint use in head-on motor vehicle accidents. J Spinal Disord. 2000 Aug; 13(4):297-304. [PubMed: 10941888]
  8. Huelke DF, Mackay GM, Morris A. Vertebral column injuries and lap-shoulder belts. J Trauma. 1995 Apr; 38(4):547-556. [PubMed: 7723094]
  9. Richards D, Carhart M, Raasch C, Pierce J, Steffey D, Ostarello A. Incidence of thoracic and lumbar spine injuries for restrained occupants in frontal collisions. Annu Proc Assoc Adv Automot Med. 2006; 50:125-139. [PubMed: 16968633]
  10. Miniaci A, McLaren AC. Anterolateral compression fracture of thoracolumbar spine. A seat belt injury. Clin Orthop Relat Res. 1989 Mar.(240):153-156. (240). [PubMed: 2917428]
  11. Wang MC, Pintar F, Yoganandan N, Maiman DJ. The continued burden of spine fractures after motor vehicle crashes. J Neurosurg Spine. 2009 Feb; 10(2):86-92. [PubMed: 19278320]
  12. Gennarelli, TA., Wodzin, E. The abbreviated injury scale 2005 -update 2008. Barrington, IL: Association for the Advancement of Automotive Medicine; 2008.
  13. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar; 14(3):187- 196. [PubMed: 4814394]
  14. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983 Nov-Dec;8(8):817-831. [PubMed: 6670016]
  15. Stein DM, Kufera JA, Ho SM, et al. Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions. J Trauma. 2011 Feb; 70(2):299-309. [PubMed: 21307725]
  16. Evans L. Safety-belt effectiveness: The influence of crash severity and selective recruitment. Accid Anal Prev. 1996 Jul; 28(4):423-433. [PubMed: 8870769]
  17. Houston DJ, Richardson LE Jr. Traffic safety and the switch to a primary seat belt law: The California experience. Accid Anal Prev. 2002 Nov; 34(6):743-751. [PubMed: 12371779]
  18. Marine WM, Kerwin EM, Moore EE, Lezotte DC, Baron AE, Grosso MA. Mandatory seatbelts: Epidemiologic, financial, and medical rationale from the Colorado matched pairs study. J Trauma. 1994 Jan; 36(1):96-100. [PubMed: 8295257]
  19. Orsay EM, Turnbull TL, Dunne M, Barrett JA, Langenberg P, Orsay CP. Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents. JAMA. 1988 Dec 23-30; 260(24):3598-3603. [PubMed: 3193590]
  20. Kaplan BH, Cowley RA. Seatbelt effectiveness and cost of noncompliance among drivers admitted to a trauma center. Am J Emerg Med. 1991 Jan; 9(1):4-10. [PubMed: 1985648]
  21. Reath DB, Kirby J, Lynch M, Maull KI. Injury and cost comparison of restrained and unrestrained motor vehicle crash victims. J Trauma. 1989 Aug.29(8):1173, 6. discussion 1176-7. [PubMed: 2760959]
  22. Nelson DE, Peterson TD, Chorba TL, Devine OJ, Sacks JJ. Cost savings associated with increased safety belt use in Iowa, 1987-1988. Accid Anal Prev. 1993 Oct; 25(5):521-528. [PubMed: 8397654]
  23. Claytor B, MacLennan PA, McGwin G Jr, Rue LW 3rd, Kirkpatrick JS. Cervical spine injury and restraint system use in motor vehicle collisions. Spine (Phila Pa 1976). 2004 Feb 15; 29(4):386- 389. [PubMed: 15094534]
  24. Porter RS, Zhao N. Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: Seat belt syndrome revisited. Ann Emerg Med. 1998 Oct; 32(4): 418-424. [PubMed: 9774924]
  25. Smith JA, Siegel JH, Siddiqi SQ. Spine and spinal cord injury in motor vehicle crashes: A function of change in velocity and energy dissipation on impact with respect to the direction of crash. J Trauma. 2005 Jul; 59(1):117-131. [PubMed: 16096551]
  26. Cummins JS, Koval KJ, Cantu RV, Spratt KF. Do seat belts and air bags reduce mortality and injury severity after car accidents? Am J Orthop (Belle Mead NJ). 2011 Mar; 40(3):E26-E29. [PubMed: 21720604]
  27. Anderson PA, Henley MB, Rivara FP, Maier RV. Flexion distraction and chance injuries to the thoracolumbar spine. J Orthop Trauma. 1991; 5(2):153-160. [PubMed: 1861190]
  28. Howland WJ, Curry JL, Buffington CB. Fulcrum fractures of the lumbar spine. Transverse fracture induced by an improperly placed seat belt. JAMA. 1965 Jul 19.193:240-241. [PubMed: 14310340]
  29. Burke DC. Hyperextension injuries of the spine. J Bone Joint Surg Br. 1971 Feb; 53(1):3-12. [PubMed: 5578765]
  30. De Oliveira JC. A new type of fracture-dislocation of the thoracolumbar spine. J Bone Joint Surg Am. 1978 Jun; 60(4):481-488. [PubMed: 670270]
  31. Matejka J. Hyperextension injuries of the thoracolumbar spine. Zentralbl Chir. 2006 Feb; 131(1): 75-79. [PubMed: 16485215]
  32. Denis F, Burkus JK. Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine (Phila Pa 1976). 1992 Feb; 17(2):156-161. [PubMed: 1553586]
  33. Saboe LA, Reid DC, Davis LA, Warren SA, Grace MG. Spine trauma and associated injuries. J Trauma. 1991 Jan; 31(1):43-48. [PubMed: 1986132]
  34. Pouw MH, Deunk J, Brink M, et al. Is a pelvic fracture a predictor for thoracolumbar spine fractures after blunt trauma? J Trauma. 2009 Nov; 67(5):1027-1032. [PubMed: 19901664]
  35. Sturm JT, Perry JF Jr. Injuries associated with fractures of the transverse processes of the thoracic and lumbar vertebrae. J Trauma. 1984 Jul; 24(7):597-599. [PubMed: 6748119]
  36. Henderson RL, Reid DC, Saboe LA. Multiple noncontiguous spine fractures. Spine (Phila Pa 1976). 1991 Feb; 16(2):128-131. [PubMed: 2011766]
  37. Blair JA, Patzkowski JC, Schoenfeld AJ, et al. Are spine injuries sustained in battle truly different? Spine J. 2012 Sep; 12(9):824-829. [PubMed: 22000726]
  38. Joaquim AF, Fernandes YB, Cavalcante RA, Fragoso RM, Honorato DC, Patel AA. Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma. Spine (Phila Pa 1976). 2011 Jan 1; 36(1):33-36. [PubMed: 20479700]
  39. Brito LM, Chein MB, Marinho SC, Duarte TB. Epidemiological evaluation of victims of spinal cord injury. Rev Col Bras Cir. 2011 Sep-Oct;38(5):304-309. [PubMed: 22124640]
  40. Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: Guidelines for diagnosis and imaging. Injury. 2003 Jun; 34(6):426-433. [PubMed: 12767788]