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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related 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.

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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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Correspondence to Anna N. Miller MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was not required.

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Doud, A.N., Weaver, A.A., Talton, J.W. et al. Has the Incidence of Thoracolumbar Spine Injuries Increased in the United States From 1998 to 2011?. Clin Orthop Relat Res 473, 297–304 (2015).

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