title: Seat belt syndrome with cauda equina syndrome: two unique cases in the same motor vehicle accident.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To describe the surgical technique and outcome of 2 cases of lap-shoulder belt injury involving burst fracture at L5 and cauda equina syndrome (CES).
  
  
  BACKGROUND
  Lap-shoulder belts have largely replaced lap belts in the front seats of cars, and therefore the concept of seat belt injury needs re-evaluation.
  
  
  METHODS
  Two adults, the driver and front seat passenger in the same car involved in a collision, sustained lap-shoulder belt injury. One developed L5 Denis type A burst fracture and the other developed L5 Denis type B burst fracture. Both had CES. They were surgically managed by decompression of the spinal canal, which included removal of retropulsed fragments without impacting them. Both patients received short-segment transpedicle screws and rod system instrumentation without the fractured vertebra being included.
  
  
  RESULTS
  The percentage of preoperative degree of canal displacement of the retropulsed fragment was 60% in one patient and 55% in the other based on computed tomography. The mechanism of injury in both patients might be axial loading. After surgical intervention, the CES including lower leg weakness/numbness and bladder/bowel dysfunction clinically improved in both patients.
  
  
  CONCLUSIONS
  Two adults in the same car involved in a collision were wearing lap-shoulder belts, and 1 had Denis type A burst fracture at L5 and the other had Denis type B burst fracture at L5. Both developed CES after the accident. Both patients had a good clinical outcome after surgical treatment.
authors.affiliation: *Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan †Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ‡Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan §Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan ¶Department of Emergency, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan ‖Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan **Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan ††Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; and ‡‡Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan, Taiwan.
authors.forename: Muh-Shi
authors.initials: MS
authors.lastname: Lin
authors.forename: Hsin-Ying
authors.initials: HY
authors.lastname: Lin
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Hung
authors.forename: Tien-Jen
authors.initials: TJ
authors.lastname: Lin
authors.forename: Yao-Chin
authors.initials: YC
authors.lastname: Wang
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
authors.forename: Woon-Man
authors.initials: WM
authors.lastname: Kung
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001336:Automobiles; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011128:Polyradiculopathy / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011859:Radiography; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome