title: Thoracolumbar junction injuries after rollover crashes: difference between belted and unbelted front seat occupants.
abstract: Motor vehicle collision (MVC) is one of the most common causes of thoracolumbar junction (TLJ) injury. Although it is of no doubt that the use of seatbelt reduces the incidence and severity of MVC-induced TLJ injury, how it is protective for front-seat occupants of an automobile after rollover crashes is unclear. Among 200 consecutive patients with a major TLJ (Th11-L2) injury due to high-energy trauma admitted from 2000 to 2004, 22 patients were identified as front-seat occupants of a four-wheel vehicle when a rollover crash occurred. The 22 patients were divided into two groups: 10 who were belted, and 12 who were unbelted. Patients' demographics including the mean Injury Severity Score (ISS), incidence of neurologic deficit, level of TLJ injury, and type of TLJ injury according to the AO fracture classification were compared between the two groups. Neurologic deficit was present exclusively in the unbelted group, and the difference in the incidence was statistically significant (P = 0.04). Similarly, AO type B/C injury was present exclusively in the unbelted group. The belted group had a significantly lower mean ISS than the unbelted group (P < 0.01). Comparison between the ejected and non-ejected victims within the unbelted group revealed no statistical difference in the incidence of neurologic deficit or type of injury. It is likely that the high incidence of neurologic deficit in the unbelted group was due to the high incidence of AO type B/C injury. This study indirectly proves the efficacy of seatbelt in reducing the severity of rollover-induced TLJ injury. Because of the limited number of cases, it is uncertain whether ejection from vehicle, which occurs exclusively in the unbelted victims, is a crucial factor in determining the severity or type of injury after rollover crashes.
authors.affiliation: Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL, USA. ginamasu@aol.com
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Guiot
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D001334:Automobile Driving / Q000706:statistics & numerical data; D001696:Biomechanical Phenomena; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000503:physiopathology; D013124:Spinal Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D013898:Thoracic Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D055815:Young Adult
references.citation: Accid Anal Prev. 1991 Dec;23(6):557-60
references.pmid: 1772557
references.citation: J Trauma. 1991 Jan;31(1):60-7
references.pmid: 1986134
references.citation: J Trauma. 1995 Apr;38(4):547-56
references.pmid: 7723094
references.citation: J Neurosurg Spine. 2007 Sep;7(3):311-4
references.pmid: 17877265
references.citation: J Spinal Disord. 2000 Aug;13(4):297-304
references.pmid: 10941888
references.citation: Accid Anal Prev. 2002 Jul;34(4):477-85
references.pmid: 12067110
references.citation: Accid Anal Prev. 2006 Nov;38(6):1081-6
references.pmid: 16756930
references.citation: J Spinal Disord. 1997 Aug;10(4):325-8
references.pmid: 9278918
references.citation: J Trauma. 1993 Nov;35(5):794-9
references.pmid: 8230348
references.citation: Spine (Phila Pa 1976). 1992 May;17(5):528-40
references.pmid: 1621152
references.citation: J Trauma. 1995 May;38(5):692-6
references.pmid: 7760394
references.citation: Acad Emerg Med. 2006 Apr;13(4):427-34
references.pmid: 16531597
references.citation: Eur Spine J. 1994;3(4):184-201
references.pmid: 7866834
references.citation: Accid Anal Prev. 2006 Sep;38(5):835-42
references.pmid: 16540073
references.citation: J Trauma. 2005 Jul;59(1):117-31
references.pmid: 16096551
references.citation: Spine (Phila Pa 1976). 2004 Feb 15;29(4):386-9; discussion Z2
references.pmid: 15094534
references.citation: Spine (Phila Pa 1976). 2002 Dec 15;27(24):2825-30
references.pmid: 12486355