Incidence and mechanism of neurological deficit after thoracolumbar fractures sustained in motor vehicle collisions

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>To determine the incidence of and assess the risk factors associated with neurological injury in motor vehicle occupants who sustain fractures of the thoracolumbar spine.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>In this study, the authors queried medical, vehicle, and crash data elements from the Crash Injury Research and Engineering Network (CIREN), a prospectively gathered multicenter database compiled from Level I trauma centers. Subjects had fractures involving the T1–L5 vertebral segments, an Abbreviated Injury Scale (AIS) score of ≥ 3, or injury to 2 body regions with an AIS score of ≥ 2 in each region. Demographic parameters obtained for all subjects included age, sex, height, body weight, and body mass index. Clinical parameters obtained included the level of the injured vertebra and the level and type of spinal cord injury. Vehicular crash data included vehicle make, seatbelt type, and usage and appropriate use of the seatbelt. Crash data parameters included the principal direction of force, change in velocity on impact (ΔV), airbag deployment, and vehicle rollover. The authors performed a univariate analysis of the incidence and the odds of sustaining spinal neurological injury associated with major thoracolumbar fractures with respect to the demographic, clinical, and crash parameters.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Neurological deficit associated with thoracolumbar fracture was most frequent at extremes of age; the highest rates were in the 0- to 10-year (26.7% [4 of 15]) and 70- to 80-year (18.4% [7 of 38]) age groups. Underweight occupants (OR 3.52 [CI 1.055–11.7]) and obese occupants (OR 3.27 [CI 1.28–8.31]) both had higher odds of sustaining spinal cord injury than occupants with a normal body mass index. The highest risk of neurological injury existed in crashes in which airbags deployed and the occupant was not restrained by a seatbelt (OR 2.35 [CI 0.087–1.62]). Reduction in the risk of neurological injuries occurred when 3-point seatbelts were used correctly in conjunction with the deployment of airbags (OR 0.34 [CI 1.3–6.6]) compared with the occupants who were not restrained by a seatbelt and for whom airbags were not deployed. Crashes with a ΔV greater than 50 km/hour had a significantly higher risk of spinal cord injury (OR 3.45 [CI 0.136–0.617]) than those at lower ΔV values.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Deployment of airbags was protective against neurological injury only when used in conjunction with 3-point seatbelts. Vehicle occupants who were either obese or underweight, very young or elderly, and those in crashes with a ΔV greater than 50 km/hour were at higher risk of thoracolumbar neurological injury. Neurological injury at thoracic and lumbar levels was associated with multiple factors, including the incidence of fatality, occupant factors such as age and body habitus, energy at impact, and direction of impact. Current vehicle safety technologies are geared toward a normative body morphology and need to be reevaluated for various body morphologies and torso compliances to lower the risk of neurological injury resulting from thoracolumbar fractures.</jats:p></jats:sec>

Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

“…In a multicenter database called Crash Injury Research and Engineering Network, 28 the authors searched the incidence of neurological deficits in motor vehicle collisions. Neurological deficits were more common in pediatric ages (0-10 years, 26.7%) and geriatric ages (70-80 years, 18.4%).…”

“…They need to be reevaluated for various body morphologies and torso compliances to lower the risk of neurological injury resulting from thoracolumbar fractures. 28 Epidemiological studies on motor vehicle accidents in Finland have stressed that seat belts and airbags have created a different environment for automotive trauma. 29 The high-energy deaths tended to occur pretty quickly.…”

Sex, age, role and geographic differences in traumatic spinal fractures caused by motor vehicle collisions: a multicentre retrospective study

“…In most of the studies on spinal fractures, researchers have simply reported that MVCs were the main cause of spinal fracture and indicated trends regarding related MVCs but have not discussed the specific epidemiological characteristics of the MVCs 7 – 13 . Reports from studies on spinal fracture caused by MVCs have included discussions of only some aspects of MVCs 14 – 21 , such as injured front-seat occupants 14 , paediatric passengers 18 or elderly subjects 19 , traumatic spinal injury associated with orthopaedic fractures 15 , thoracoabdominal injuries 16 , and thoracolumbar fractures 17 , 20 . Although much is known about the characteristics of TSFs, TSFs caused by MVCs have not been discussed in depth according to different sexes, age groups, roles and geographic locations in a single study.…”

One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures

“…Blunt trauma is associated with an incidence of 1.9% thoracic fractures [ 4 ]. Notably, up to 27% of thoracolumbar junction injury cases develop neurological deficits, resulting in a substantial socioeconomic burden [ 7 ]. Numerous spine injury classification systems have been introduced to date, while for the thoracolumbar spine, fracture classification is frequently done utilizing the AOSpine Trauma Classification system for spinal trauma [ 8 ].…”