Clinical Orthopaedics and Related Research®

, Volume 473, Issue 1, pp 297–304 | Cite as

Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011?

  • Andrea N. Doud
  • Ashley A. Weaver
  • Jennifer W. Talton
  • Ryan T. Barnard
  • J. Wayne Meredith
  • Joel D. Stitzel
  • Preston Miller
  • Anna N. MillerEmail author
Clinical Research



While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design.


We questioned whether the incidence of thoracolumbar spine injuries increased in the United States population with time (between 1998 and 2011), and if there was an increased incidence of thoracolumbar injuries, whether there were identifiable compensatory “trade-off injury” patterns, such as reductions in sacropelvic injuries.

Patients and Methods

Institutional review board approval was obtained for retrospective review of three national databases: the National Trauma Databank® (NTDB®), 2002–2006, National Automotive Sampling System (NASS), 2000–2011, and National Inpatient Sample (NIS), 1998–2007. In each database, the total number of MVC-related injuries and the number of MVC-related thoracolumbar injuries per year were identified using appropriate Abbreviated Injury Scale (AIS) or ICD-9 codes. Sacropelvic injuries also were identified to evaluate their potential as trade-off injuries. Poisson regression models adjusting for age were used to analyze trends in the data with time.


All databases showed increases in MVC-related thoracolumbar spine injuries when adjusting for age with time. These age-adjusted relative annual percent increases ranged from 8.22% (95% CI, 5.77%–10.72%; p < 0.001) using AIS of 2 or more (AIS2 +) injury codes in the NTDB®, 8.59% (95% CI, 5.88%-11.37%; p < 0.001) using ICD-9 codes in the NTDB®, 8.12% (95% CI, 7.20%–9.06%; p < 0.001) using ICD-9 codes in the NIS, and 8.10 % (95% CI 5.00%–11.28%; p < 0.001) using AIS2+ injury codes in the NASS. As these thoracolumbar injuries have increased, there has been no consistent trend toward a compensatory reduction in terms of sacropelvic injuries.


While other studies have shown that rates of many MVC-related injuries are declining with time, our data show increases in the incidence of thoracolumbar injury. Although more sensitive screening tools likely have resulted in earlier and increased recognition of these injuries, it cannot be stated for certain that this is the only driver of the increased incidence observed in this study. As seatbelt use has continued to increase, this trend may be the result of thoracolumbar injuries as trade-offs for other injuries, although in our study we did not see a compensatory decrease in sacropelvic injuries. Investigation evaluating the root of this pattern is warranted.


Abbreviate Injury Scale Motor Vehicle Crash Sacral Fracture Thoracolumbar Fracture Pelvic Ring Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



NTDB® data were provided by the Committee on Trauma, American College of Surgeons, NTDB® Version 7.1 Chicago, IL, 2007. The content reproduced from the NTDB® remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.


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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Andrea N. Doud
    • 1
  • Ashley A. Weaver
    • 2
  • Jennifer W. Talton
    • 3
  • Ryan T. Barnard
    • 3
  • J. Wayne Meredith
    • 1
  • Joel D. Stitzel
    • 2
  • Preston Miller
    • 1
  • Anna N. Miller
    • 4
    Email author
  1. 1.Department of General SurgeryWake Forest School of MedicineWinston-SalemUSA
  2. 2.Virginia Tech-Wake Forest School of Biomedical Engineering SciencesWinston-SalemUSA
  3. 3.Division of Public Health SciencesWake Forest School of MedicineWinston-SalemUSA
  4. 4.Department of Orthopaedic SurgeryWake Forest School of MedicineWinston-SalemUSA

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