Advertisement

World Journal of Pediatrics

, 7:311 | Cite as

Preventing motor vehicle crashes related spine injuries in children

  • Mohammad R. Rasouli
  • Vafa Rahimi-Movaghar
  • Radin Maheronnaghsh
  • Ali Yousefian
  • Alexander R. Vaccaro
Review Article

Abstract

Background

Spinal cord injury (SCI) is a devastating event that results in permanent disability for injured children. Among all etiologies of SCI, motor vehicle crashes (MVCs) are the leading cause and account for 29% of all traumatic SCIs in children. We tried to evaluate types and mechanisms of MVC-related spinal column and spinal cord injuries, risk factors, safety issues and legislation.

Data sources

A literature review was performed using PubMed from 1966 to 12th April 2010 with the following key words: children OR pediatric, spine, injury OR trauma, restraint, seat belt, motor vehicle, road OR traffic, collision OR crash, safety. Cross referencing of discovered articles was also performed.

Results

Risk factors for MVC-related SCI include single vehicle crashes, vehicle rollover, and ejection of the passenger from the vehicle. Any anatomic region of the spinal cord may be injured as a result of MVC and may vary according to the type of accident and restraint system usage. Increasing use of three-point seat belts, which are more protective than isolated lap seat belts, has decreased the incidence of MVC-related SCI. There is evidence that airbag use without seatbelt use is associated with an increased risk of cervical spine fractures with or without SCI. Vehicle designers need to give more attention to the prevention of vehicle rollover and to improve occupant protection when rollover occurs.

Conclusions

MVC is a common cause of SCI in children; therefore, paying attention to risk factors and modes of prevention is important. As MVC-related SCI can lead to permanent disability, prevention and education play an important role in decreasing childrens’ morbidity and mortality. Making behavior, roads and vehicles safer can significantly reduce MVC-related SCI in children.

Key words

children injury motor vehicle crash spinal cord 

References

  1. 1.
    Rahimi-Movaghar V. Efficacy of surgical decompression in the setting of complete thoracic spinal cord injury. J Spinal Cord Med 2005;28:415–420.PubMedGoogle Scholar
  2. 2.
    Rahimi-Movaghar V, Saadat S, Vaccaro AR, Ghodsi SM, Samadian M, Sheykhmozaffari A, et al. The efficacy of surgical decompression before 24 hours versus 24 to 72 hours in patients with spinal cord injury from T1 to L1-with specific consideration on ethics: a randomized controlled trial. Trials 2009;10:77–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Rahimi-Movaghar V, Yazdi A, Karimi M, Mohammadi M, Firouzi M, Zanjani LO, et al. Effect of decompression on complete spinal cord injury in rats. Int J Neurosci 2008;118:1359–1373.PubMedCrossRefGoogle Scholar
  4. 4.
    Saadat S, Javadi M, Divshali BS, Tavakoli AH, Ghodsi SM, Montazeri A, et al. Health-related quality of life among individuals with long-standing spinal cord injury: a comparative study of veterans and non-veterans. BMC Public Health 2010;10:6.PubMedCrossRefGoogle Scholar
  5. 5.
    Taghipoor KD, Arejan RH, Rasouli MR, Saadat S, Moghadam M, Vaccaro AR, et al. Factors associated with pressure ulcers in patients with complete or sensory-only preserved spinal cord injury: is there any difference between traumatic and nontraumatic causes? J Neurosurg Spine 2009;11:438–444.PubMedCrossRefGoogle Scholar
  6. 6.
    Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg 2004;39:607–612.PubMedCrossRefGoogle Scholar
  7. 7.
    Leucht P, Fischer K, Muhr G, Mueller EJ. Epidemiology of traumatic spine fractures. Injury 2009;40:166–172.PubMedCrossRefGoogle Scholar
  8. 8.
    Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AF, et al. World report on child injury prevention. Peden M, eds. Geneva: World Health Organization, 2008.Google Scholar
  9. 9.
    O’Connor P. Injury to the spinal cord in motor vehicle traffic crashes. Accid Anal Prev 2002;34:477–485.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Connor PJ, Brown D. Relative risk of spinal cord injury in road crashes involving seriously injured occupants of light passenger vehicles. Accid Anal Prev 2006;38:1081–1086.PubMedCrossRefGoogle Scholar
  11. 11.
    Fife D, Kraus J. Anatomic location of spinal cord injury. Relationship to the cause of injury. Spine 1986;11:2–5.Google Scholar
  12. 12.
    Thurman DJ, Burnett CL, Beaudoin DE, Jeppson L, Sniezek JE. Risk factors and mechanisms of occurrence in motor vehicle-related spinal cord injuries: Utah. Accid Anal Prev 1995;27:411–415.PubMedCrossRefGoogle Scholar
  13. 13.
    Stawicki SP, Holmes JH, Kallan MJ, Nance ML. Fatal child cervical spine injuries in motor vehicle collisions: analysis using unique linked national datasets. Injury 2009;40:864–867.PubMedCrossRefGoogle Scholar
  14. 14.
    Shkrum MJ, Green RN, Nowak ES. Upper cervical trauma in motor vehicle collisions. J Forensic Sci 1989;34:381–390.PubMedGoogle Scholar
  15. 15.
    Alker GJ Jr, Oh YS, Leslie EV. High cervical spine and craniocervical junction injuries in fatal traffic accidents: a radiological study. Orthop Clin North Am 1978;9:1003–1010.PubMedGoogle Scholar
  16. 16.
    Winslow JE 3rd, Hensberry R, Bozeman WP, Hill KD, Miller PR. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma 2006;61:686–687.PubMedCrossRefGoogle Scholar
  17. 17.
    Waters RL, Sie I, Adkins RH, Yakura JS. Injury pattern effect on motor recovery after traumatic spinal cord injury. Arch Phys Med Rehabil 1995;76:440–443.PubMedCrossRefGoogle Scholar
  18. 18.
    Ersmark H, Lowenhielm P. Factors influencing the outcome of cervical spine injuries. J Trauma 1988;28:407–410.PubMedCrossRefGoogle Scholar
  19. 19.
    Osenbach RK, Menezes AH. Pediatric spinal cord and vertebral column injury. Neurosurgery 1992;30:385–390.PubMedCrossRefGoogle Scholar
  20. 20.
    Muzumdar D, Ventureyra EC. Spinal cord injuries in children. J Pediatr Neurosci 2006;1:43–48.CrossRefGoogle Scholar
  21. 21.
    Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 1965;47:1295–1309.PubMedGoogle Scholar
  22. 22.
    Papavasiliou V. Traumatic subluxation of the cervical spine during childhood. Orthop Clin North Am 1978;9:945–954.PubMedGoogle Scholar
  23. 23.
    Huelke DF, Mackay GM, Morris A. Vertebral column injuries and lap-shoulder belts. J Trauma 1995;38:547–556.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaneoka K, Ono K, Inami S, Hayashi K. Motion analysis of cervical vertebrae during whiplash loading. Spine 1999;24:763–769.PubMedCrossRefGoogle Scholar
  25. 25.
    Maak TG, Ivancic PC, Tominaga Y, Panjabi MM. Side impact causes multiplanar cervical spine injuries. J Trauma 2007;63:1296–1307.PubMedCrossRefGoogle Scholar
  26. 26.
    Reddy SP, Junewick JJ, Backstrom JW. Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role? Pediatr Radiol 2003;33:776–781.PubMedCrossRefGoogle Scholar
  27. 27.
    Inamasu J, Guiot BH. Thoracolumbar junction injuries after motor vehicle collision: are there differences in restrained and nonrestrained front seat occupants? J Neurosurg Spine 2007;7:311–314.PubMedCrossRefGoogle Scholar
  28. 28.
    Inamasu J, Guiot BH. Thoracolumbar junction injuries after rollover crashes: difference between belted and unbelted front seat occupants. Eur Spine J 2009;18:1464–1468.PubMedCrossRefGoogle Scholar
  29. 29.
    Dogan S, Safavi-Abbasi S, Theodore N, Chang SW, Horn EM, Mariwalla NR, et al. Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 2007;106:426–433.PubMedGoogle Scholar
  30. 30.
    Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 2001;36:1107–1114.PubMedCrossRefGoogle Scholar
  31. 31.
    Buldini B, Amigoni A, Faggin R, Laverda AM. Spinal cord injury without radiographic abnormalities. Eur J Pediatr 2006;165:108–111.PubMedCrossRefGoogle Scholar
  32. 32.
    Ferguson J, Beattie TF. Occult spinal cord injury in traumatized children. Injury 1993;24:83–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Betz RR, Mulcahey MJ, D’Andrea LP, Clements DH. Acute evaluation and management of pediatric spinal cord injury. J Spinal Cord Med 2004;27:S11–S15.PubMedGoogle Scholar
  34. 34.
    Rahimi-Movaghar V, Zarei MR, Saadat S, Rasouli MR, Nouri M. Road traffic crashes in Iran from 1997 to 2007. Int J Inj Contr Saf Promot 2009;16:179–181.PubMedCrossRefGoogle Scholar
  35. 35.
    Rasouli MR, Nouri M, Zarei MR, Saadat S, Rahimi-Movaghar V. Comparison of road traffic fatalities and injuries in Iran with other countries. Chin J Traumatol 2008;11:131–134.PubMedGoogle Scholar
  36. 36.
    Shams M, Rahimi-Movaghar V. Risky driving behaviors in Tehran, Iran. Traffic Inj Prev 2009;10:91–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Viano DC, Parenteau CS, Edwards ML. Rollover injury: effects of near- and far-seating position, belt use, and number of quarter rolls. Traffic Inj Prev 2007;8:382–392.PubMedCrossRefGoogle Scholar
  38. 38.
    Bahling GS, Bundorf RT, Moffatt EA, Orlowski KF. The influence of increased roof strength on belted and unbelted dummies in rollover and drop tests. J Trauma 1995;38:557–563.PubMedCrossRefGoogle Scholar
  39. 39.
    Viano DC, Parenteau CS. Ejection and severe injury risks by crash type and belt use with a focus on rear impacts. Traffic Inj Prev 2010;11:79–86.PubMedCrossRefGoogle Scholar
  40. 40.
    Sturzenegger M, DiStefano G, Radanov BP, Schnidrig A. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology 1994;44:688–693.PubMedGoogle Scholar
  41. 41.
    Himmetoglu S, Acar M, Bouazza-Marouf K, Taylor AJ. Energyabsorbing car seat designs for reducing whiplash. Traffic Inj Prev 2008;9:583–591.PubMedCrossRefGoogle Scholar
  42. 42.
    Kaale BR, Krakenes J, Albrektsen G, Wester K. Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 2005;22:1294–1302.PubMedCrossRefGoogle Scholar
  43. 43.
    Viano DC, Parenteau CS. Severe injury to near- and far-seated occupants in side impacts by crash severity and belt use. Traffic Inj Prev 2010;11:69–78.PubMedCrossRefGoogle Scholar
  44. 44.
    Orzechowski KM, Edgerton EA, Bulas DI, McLaughlin PM, Eichelberger MR. Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome. J Trauma 2003;54:1094–1101.PubMedCrossRefGoogle Scholar
  45. 45.
    Lennon A, Siskind V, Haworth N. Rear seat safer: seating position, restraint use and injuries in children in traffic crashes in Victoria, Australia. Accid Anal Prev 2008;40:829–834.PubMedCrossRefGoogle Scholar
  46. 46.
    Henary B, Sherwood CP, Crandall JR, Kent RW, Vaca FE, Arbogast KB, et al. Car safety seats for children: rear facing for best protection. Inj Prev 2007;13:398–402.PubMedCrossRefGoogle Scholar
  47. 47.
    Johnston C, Rivara FP, Soderberg R. Children in car crashes: analysis of data for injury and use of restraints. Pediatrics 1994;93:960–965.PubMedGoogle Scholar
  48. 48.
    Campbell H, Macdonald S, Richardson P. High levels of incorrect use of car seat belts and child restraints in Fife—an important and under-recognised road safety issue. Inj Prev 1997;3:17–22.PubMedCrossRefGoogle Scholar
  49. 49.
    Bull MJ, Stroup KB, Gerhart S. Misuse of car safety belts. Pediatrics 1988;81:98–101.PubMedGoogle Scholar
  50. 50.
    Rivara FP, Bennett E, Crispin B. Booster seats for child passengers: lessons for increasing their use. Inj Prev 2001;7:210–213.PubMedCrossRefGoogle Scholar
  51. 51.
    Martin M, Holden J, Chen Z. Child passenger safety for inner-city Latinos: new approaches from the community. Inj Prev 2006;12:99–104.PubMedCrossRefGoogle Scholar
  52. 52.
    Karlsson G, Halldin J, Leifman A, Bergman H, Romelsjö A. Hospitalization and mortality succeeding drunk driving and risky driving. Alcohol Alcohol 2003;38:281–286.PubMedGoogle Scholar
  53. 53.
    Bina M, Graziano F, Bonino S. Risky driving and lifestyles in adolescence. Accid Anal Prev 2006;38:472–481.PubMedCrossRefGoogle Scholar
  54. 54.
    Navin F, Zein S, Felipe E. Road safety engineering: an effective tool in the fight against whiplash injuries. Accid Anal Prev 2000;32:271–275.PubMedCrossRefGoogle Scholar
  55. 55.
    Hu J, Lee JB, Yang KH, King AI. Injury patterns and sources of non-ejected occupants in trip-over crashes: a survey of NASSCDS database from 1997 to 2002. Annu Proc Assoc Adv Automot Med 2005;49:119–132.PubMedGoogle Scholar
  56. 56.
    Forman J, Lopez-Valdes F, Lessley D, Kindig M, Kent R, Ridella S, et al. Rear seat occupant safety: an investigation of a progressive force-limiting, pretensioning 3-point belt system using adult PMHS in frontal sled tests. Stapp Car Crash J 2009;53:49–74.PubMedGoogle Scholar
  57. 57.
    Viano DC. Restraint effectiveness, availability and use in fatal crashes: implications to injury control. J Trauma 1995;38:538–546.PubMedCrossRefGoogle Scholar
  58. 58.
    Zaglia E, De Leo D, Lanzara G, Urbani U, Dolci M. Occipital condyle fracture: an unusual airbag injury. J Forensic Leg Med 2007;14:231–234.PubMedCrossRefGoogle Scholar
  59. 59.
    Smith JA, Siegel JH, Siddiqi SQ. Spine and spinal cord injury in motor vehicle crashes: a function of change in velocity and energy dissipation on impact with respect to the direction of crash. J Trauma 2005;59:117–131.PubMedCrossRefGoogle Scholar
  60. 60.
    Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA 2003;289:2835–2840.PubMedCrossRefGoogle Scholar
  61. 61.
    Burke DC. Spinal cord injuries and seat belts. Med J Aust 1973;2:801–806.PubMedGoogle Scholar
  62. 62.
    Wang MC, Pintar F, Yoganandan N, Maiman DJ. The continued burden of spine fractures after motor vehicle crashes. J Neurosurg Spine 2009;10:86–92.PubMedCrossRefGoogle Scholar
  63. 63.
    Donaldson WF 3rd, Hanks SE, Nassr A, Vogt MT, Lee JY. Cervical spine injuries associated with the incorrect use of airbags in motor vehicle collisions. Spine 2008;33:631–634.PubMedCrossRefGoogle Scholar
  64. 64.
    Brixey S, Ravindran K, Guse CE. Legislating child restraint usage—its effect on self-reported child restraint use rates in a central city. J Safety Res 2010;41:47–52.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Mohammad R. Rasouli
    • 1
    • 3
  • Vafa Rahimi-Movaghar
    • 1
    • 2
    • 4
  • Radin Maheronnaghsh
    • 1
  • Ali Yousefian
    • 1
  • Alexander R. Vaccaro
    • 3
  1. 1.Sina Trauma and Surgery Research CenterTehran University of Medical SciencesTehranIran
  2. 2.Research Centre for Neural RepairUniversity of TehranTehranIran
  3. 3.Department of Orthopaedics and NeurosurgeryThomas Jefferson University and the Rothman InstitutePhiladelphiaUSA
  4. 4.Neurosurgery, Sina Trauma and Surgery Research Center, Sina Hospital, Hassan-Abad SquareTehran University of Medical SciencesTehranIran

Personalised recommendations