Blunt Injury

MOTOR VEHICLE-RELATED INJURIES Motor vehicle crashes usually result in acceleration-deceleration injuries. Multiple vertebral structures are subjected to the forces involved, including the anterior and posterior bony elements, disks, interspinous ligaments, and musculature. The cervical spine is the most susceptible to injury by this mechanism, but the thoracic and lumbar regions are also at risk. The majority of victims are involved in low-impact crashes. Most commonly, the soft tissues are injured. Patients complain of pain in the posterior neck and back. High-speed, high-energy crashes are more likely to result in structural damage to the spine. Lap-only seatbelts have been associated with thoracolumbar injuries.

Pedestrians struck by vehicles and motorcyclists are at considerable risk for multiple skeletal injuries, including spinal injuries. These patients have no protective structure surrounding them and are therefore subject to forces applied directly to their bodies.

The challenge to the emergency physician is to distinguish between minor injury and an unstable spine. Obvious neurologic deficits mandate emergent treatment for an unstable injury. In the absence of deficits, the mechanism of injury with an understanding of the forces involved should guide management. When in doubt, it is best initially to overtreat and overstudy in order to avoid missing a significant injury.

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