Citation

Lin MS, Lin HY, Hung KS, Lin TJ, Wang YC, Chiu WT, Kung WM. Spine 2013; 38(25): E1624-7.

Affiliation

1Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan 2Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan 3Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 4Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan 5Department of Emergency, Taipei Hospital, Department of Health, Taipei, Taiwan 6Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan 7Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan 8Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan 9Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan, Taiwan #Co-first Authors: Muh-Shi Lin and Hsin-Ying Lin.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/01.brs.0000435023.57940.43

PMID

24026149

Abstract

Study Design. Case report.

Objective. To describe the surgical technique and outcome of two cases of lap-shoulder belt injury involving burst fracture at L5 and cauda equina syndrome.Summary of Background Data. Lap-shoulder belts have largely replaced lap belts in the front seats of cars, and therefore the concept of seat belt injury needs reevaluation.

Methods. Two adults, the driver and front seat passenger in the same car involved in a collision, sustained lap-shoulder belt injury. One developed L5 Denis type A burst fracture and the other developed L5 Denis type B burst fracture. Both had cauda equina syndrome. They were surgically managed by decompression of the spinal canal which included removal of retropulsed fragments without impacting them. Both patients received short-segment transpedicle screws and rod system instrumentation without the fractured vertebra being included.

Results. The percentage of preoperative degree of canal displacement of the retropulsed fragment was 60% in one patient and 55% in the other based on computed tomography. The mechanism of injury in both patients might be axial loading. After surgical intervention, the cauda equina syndrome including lower leg weakness/numbness and bladder/bowel dysfunction clinically improved in both patients.

Conclusions. Two adults in the same car involved in a collison were wearing lap-shoulder belts and one had Denis type A burst fracture at L5 and the other had Denis type B burst fracture at L5. Both developed cauda equina syndrome after the accident. Both patients had a good clinical outcome after surgical treatment.

Language: en