1. 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 Unit Hanover Medical School, D-30625 Hannover, Germany P77

2. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.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 US 2  Predominant causes in Europe: Traffic accidents, falls from great height, sports injury 1 1 Bühren, V 2001 2 Buchowski, JM 2008

3. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.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 Germany 1  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 1 Richter, M 2007

4. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Results: Spinal injuries (0,53%) (0,28%) (0,31%)

5. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Results: Age mean: 35.5 y 35.1 y 37.0 y 38.4 y

6. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Results: Collision type

7. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Results: Impact velocity (delta-v) (0,53%) (0,28%) (0,31%)

8. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Results: Injury Severity (AIS *1 )/ Additional Injuries 1 Automotive Assoc., 1990

9. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.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

10. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.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 1 Winslow, JE 2006 2 Ball, ST 2000

11. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.mhh-unfallchirurgie.de Summary  Cervical spine injuries are the most frequentspinal injuries in traffic accidents  Concomitant injuries are frequent in patients with cervical spine fracture  Side impacts, rollovers and multiple collisions are disproportionately frequent causes

12. Unfallchirurgische Klinik Prof. Dr. C. Krettek,FRACS www.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.