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Spinal Injury Patterns Resulting From Car and Motorcycle Accidents

Robertson, Angus BSc, MRCS (Ed); Branfoot, Toby FRCSEd (Tr & Orth), MSc; Barlow, Ian F.; Giannoudis, Peter V. MD, EEC (Orth)


Study Design. Retrospective data analysis.

Objectives. To determine spinal injury patterns and clinical outcomes in patients involved in automotive accidents.

Summary of Background Data. The records of 22,858 patients collected prospectively as part of the Trauma Audit Research Network (UK) Database (1993–2000).

Methods. Analysis of the records of 1121 motorcyclists and 2718 car occupants involved in automotive trauma.

Results. Spinal injury occurred in 126 (11.2%) motorcyclists and 383 (14.1%) car occupants. Victims were predominantly young (mean ages: motorcycle 30.2 years, car 37.8 years) and male (motorcycle 88.9%, car 60.6%). The mean Injury Severity Scores were 18.8 and 15.1, respectively. Isolated spinal injuries occurred in 30 (23.8%) motorcyclists and 130 (33.9%) car occupants. The thoracic spine was most commonly injured in motorcyclists (54.8%), and the cervical spine was most commonly injured in car occupants (50.7%). Multiple regions were injured in 14 (10.3%) motorcyclists and 33 (8.5%) car occupants. Nine motorcyclists and 43 car occupants required spinal surgery. Median hospital stays were 11.5 days (range 0–235 days) and 10 days (range 0–252 days) in the motorcyclists and car occupants, respectively. There were 13 (10.3%) motorcycle- and 26 (6.8%) car-related deaths.

Conclusion. Spinal injury patterns may reflect differing mechanisms of injury between the restrained car occupant and unrestrained motorcyclist. The motorcyclists were more severely injured, had more extremity trauma, a higher mortality rate, and a spinal injury pattern consistent with forced hyperflexion of the thoracic spine. The predominance of cervical injuries and higher incidence of neck and facial injuries in car occupants may reflect abdominothoracic seat belt restraint. The high frequency of multilevel injuries reaffirms the need for vigilance in patient assessment.

From the Department of Trauma and Orthopaedic Surgery, St. James’s University Hospital, Leeds, United Kingdom.

Acknowledgment date: December 19, 2001.

First revision date: April 22, 2002.

Acceptance date: May 13, 2002.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Angus Robertson, BSc, MRCS (Ed), 57 Bishopthorpe Road, York YO23 1NX, United Kingdom; E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.