Injuries of the thoracolumbar spine associated with restraint use in head-on motor vehicle accidents

Many authors have described spinal and bodily injuries associated with seat belt use. However, most reports have focused primarily on lap seat belts a nd resultant flexion-distraction injuries. This retrospective chart review studies the relation between the specific type of restraint or air bag and the resultant thoracolumbar spinal injury subtype and associated bodily inj uries. The charts of 221 patients who had sustained thoracolumbar fractures in motor vehicle accidents during a 10-year period were reviewed, and 37 p atients were identified whose accidents were clearly described as a frontal collision and whose specific form of restraint was recorded. Among the 15 patients who used a shoulder strap and lap belt device (three-point restrai nt), 12 patients sustained burst fractures (80%) compared with 4 of the 14 patients (28.6%) restrained with lap seat belts alone. Life-threatening int raabdominal injuries occurred in 57.1% of lap-belted victims and in 26.7% o f patients who used three-point restraints, and the character of these inju ries also differed. No patients in an automobile in which an air bag deploy ed sustained major associated bodily injuries. Among restrained occupants o f head-on motor vehicle accidents who have sustained a thoracolumbar fractu re, patients using lap belts are more Likely to sustain the classic flexion -distraction injury patterns, whereas patients using three-point restraints may sustain a higher incidence of burst fractures. In addition, three-poin t restraints are associated with a decreased risk of intraabdominal injury compared with lap seat belts.