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Spinal injury in car crashes: crash factors and the effects of occupant age
  1. Lynne E Bilston1,3,
  2. Elizabeth C Clarke1,2,
  3. Julie Brown1,4
  1. 1Neuroscience Research Australia, Sydney, Australia
  2. 2George Institute for International Health, Sydney, Australia
  3. 3Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
  4. 4School of Medical Sciences, University of New South Wales, Sydney, Australia
  1. Correspondence to Prof Lynne E Bilston, Neuroscience Research Australia, Barker St, Randwick, NSW 2031, Australia; l.bilston{at}


Objective Motor vehicle crashes are the leading cause of serious spinal injury in most developed nations. However, since these injuries are rare, systematic analyses of the crash factors that are predictive of spinal injury have rarely been performed. This study aimed to use a population-reference crash sample to identify crash factors associated with moderate to severe spinal injury, and how these vary with occupant age.

Methods The US National Automotive Sampling System Crashworthiness Data System (NASS) data for 1993–2007 were analysed using logistic regression to identify crash factors associated with Abbreviated Injury Scale (AIS)2+ spinal injury among restrained vehicle passengers.

Results Risk of moderate or severe spinal injury (AIS2+) was associated with higher severity crashes (OR=3.5 (95% CI 2.6 to 4.6)), intrusion into an occupant's seating position (OR=2.7 (95% CI 1.9 to 3.7)), striking a fixed object rather than another car (OR=1.7 (95% CI 1.3 to 2.1)), and use of a shoulder-only belt (OR=2.7 (95% CI 1.5 to 4.8)). Older occupants (65 years or older) were at higher risk of spinal injury than younger adults in frontal, side and rollover crashes. Children under 16 were at a lower risk of spinal injury than adults in all crash types except frontal crashes.

Conclusions While the risk of serious spinal injury in motor vehicle crashes is low, these injuries are more common in crashes of higher severity or into fixed objects, and in the presence of intrusion. There are elevated risks of spinal injury for older occupants compared with younger adults, which may reflect changes in biomechanical tolerances with age. Children appear to be at lower risk of serious spinal injury than adults except in frontal crashes.

  • Spinal injuries
  • motor vehicle crashes
  • road safety
  • intrusion
  • crash severity
  • older occupants
  • MVTC
  • passenger
  • restraint
  • spinal cord

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  • Funding This research was supported by a grant from the Spine Care Foundation of NSW. LEB is supported by an NHMRC senior research fellowship. JB is supported by an ARC Postdoctoral Fellowship. ECC is supported by an NHMRC Training fellowship.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.