Cervical spine injuries in motor vehicle accidents

C. W. Müller, D. Otte,C. Haasper, J. Nehmzow, C. Probst, T. Stübig,T. Hüfner and C. Krettek

Trauma Departement and Accident Research UnitHanover Medical School, D-30625 Hannover, Germany

P77

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Introduction: Epidemiology of spinal trauma

10.000 severe spinal injuries in Germany per year (20% cervical spine)1

150.000 traumatic vertebral fractures and 10 to 17.000 spinal cord injuries per year in the US2

Predominant causes in Europe: Traffic accidents, falls from great height, sports injury 1

1Bühren, V 2001 2Buchowski, JM 2008

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

M&M: Study Design

Within 20 years a local accident research unit recorded technical and medical details of 18.353 traffic accidents according to a sample plan representative for all traffic accidents in Germany1

The data bank was screened for front passengers with spinal injuries Hospital charts and x-rays were reviewed

Patterns of injuries and technical details were analyzed

1Richter, M 2007

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Results: Spinal injuries

Incidence of spinal injuries in 30421 front passengers

161

8495

209

117 122

0

50

100

150

200

250

cervical thoracic lumbar

patients

fractures

(0,53%)(0,53%)

(0,28%)(0,28%)(0,31%)(0,31%)

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Results: Age

0%10%20%30%40%50%60%70%80%90%

100%

30421 161 84 95

all frontpassengers

cervical fx thoracic fx lumbar fx

unknown

Elderly (>64a)

Adults (18-64a)

Adolescents (13-17a)

School kids (6-12a)

Infants (<6a)

mean: 35.5 y 35.1 y 37.0 y 38.4 y

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Results: Collision type

0%10%20%30%40%50%60%70%80%90%

100%

30421 161 84 95

all frontpassengers

Fx cervical sp. Fx throracic sp. Fx lumbar sp.

unknown

other

multiple

isolated roll-over

rear

side

front

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Results: Impact velocity (delta-v)

(0,53%)(0,53%)

(0,28%)(0,28%)(0,31%)(0,31%)

delta-v

21,1

50

40 40

0

10

20

30

40

50

60

all front passengers cervical fx thoracic fx lumbar fx

km/h

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Results: Injury Severity (AIS*1)/ Additional Injuries

Abbreviated Injury Score (AIS)

0,0

1,0

2,0

3,0

4,0

5,0

cervical fx. thoracic fx. lumbar fx. no vertebral fx.

1Automotive Assoc., 1990

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Discussion: Injury mechanism

Side impacts, rollovers and multiple collisions are more frequent injury mechanisms

Head is insufficiently protected in these situations

High torsion forces of the cervical spine

Side airbags might be helpful but were infrequent in this cohort

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Discussion:Trauma severity &

concomitant injuries Nearly all patients with fractures of the cervical spine had concomitant injuries, including additional spinal fractures

Winslow: Injury of the cervical spine doubles risk for thoracolumbar fractures 1

Ball: 57% concomitant intraabdominal injuries in spine fractures following frontal impact 2

1Winslow, JE 2006 2Ball, ST 2000

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Summary

Cervical spine injuries are the most frequent spinal injuries in traffic accidents

Concomitant injuries are frequent in patients with cervical spine fracture

Side impacts, rollovers and multiple collisions are disproportionately frequent causes

Unfallchirurgische KlinikProf. Dr. C. Krettek,FRACSwww.mhh-unfallchirurgie.de

Disclosure:The accident research unit is in part funded by a government institution (Bundesanstalt für Straßenwesen, BASt). None of the authors has any other potential conflicting interest to disclose.