[Lumbar dislocation fracture with paraplegia after pelvic seat belt injury. Case report].
This report details a traumatic spinal column lesion due to a lap seat belt. A healthy 22-year-old woman was involved in a car accident and suffered a lumbar luxation fracture at the level L1-L2. She developed acute transsectional symptoms with paraplegia and severe hyperpathia in her legs. Plain radiographs (antero-posterior and lateral projection) and lumbar CT scans demonstrated an instable flexion-distraction fracture with ventral compression of the vertebral body of L2 and ventrolisthesis of L1 over L2. Surgical reposition of the luxation fracture and removal of a spinal epidural hematoma was performed 4 h after the trauma. Stabilization was achieved by monosegmental dorsal transpedicular spondylodesis with a fixateur interne. In follow-up the neurological deficits markedly improved. Six months after the trauma, the patient is able to walk, has no paresis and no genitourinary disturbances: only mild dysesthesia remains. This posttraumatic course confirms that spinal traumas below L1 which spare the conus have a favorable prognosis, because the peripheral nerves of the cauda equina are able to recover. This injured patient was the only one using a lap seat belt; the other four passengers in the same compact car-wearing lap and diagonal seat belts-suffered no harm. We conclude that lap seat belts are not acceptable as an adequate security standard in modern automobile technology.
Spetzger
U
U
Neurochirurgische Klinik, RWTH Aachen.
Weckesser
A
A
Bani
A
A
Gilsbach
J M
JM
D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D009460:Neurologic Examination; D010264:Paraplegia / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012622:Seat Belts / Q000009:adverse effects*; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed