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. 2024 Jul 3;11(1):30.
doi: 10.1186/s40621-024-00506-4.

Cervical vertebral and spinal cord injuries in rollover occupants

Loay Al-Salehi  1 , Shannon G Kroeker  2 , Jason R Kerrigan  3 , Peter A Cripton  1 , Matthew B Panzer  3 , Gunter P Siegmund  4   5
Affiliations

Cervical vertebral and spinal cord injuries in rollover occupants

Loay Al-Salehi et al. Inj Epidemiol. .

Abstract

Background: Rollover crashes continue to be a substantial public health issue in North America. Previous research has shown that the cervical spine is the most injured spine segment in rollovers, but much of the past research has focused on risk factors rather than the actual cervical spine injuries. We sought to examine how different types of cervical spine injuries (vertebral and/or cord injury) vary with different occupant-related factors in rollovers and to compare these with non-rollovers.

Methods: We obtained crash and injury information from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) for 2005-2015 and Crash Investigation Sampling System (CISS) for 2017-2022. Based on weighted data, we calculated relative risks to assess how occupant sex, seat belt use, ejection status, and fatal outcome relate to the rate of different cervical spine injuries in rollovers and non-rollovers.

Results: In NASS-CDS occupants with cervical spine injuries (N = 111,040 weighted cases), about 91.5% experienced at least one vertebral injury whereas only 11.3% experienced a spinal cord injury (most of which had a concomitant vertebral fracture). All types of cervical spine injuries we examined were 3.4-5.2 times more likely to occur in rollovers compared to non-rollovers. These relative risks were similar for both sexes, belted and unbelted, non-ejected, and non-fatal occupants. The number of weighted CISS occupants with cervical spine injuries (N = 42,003) was smaller than in the NASS analysis, but cervical spine injuries remained 6.25 to 6.36 times more likely in rollovers compared to non-rollovers despite a more modern vehicle fleet.

Conclusions: These findings underscore the continued need for rollover-specific safety countermeasures, especially those focused on cervical spine injury prevention, and elucidate the frequency, severity and other characteristics of the specific vertebral and spinal cord injuries being sustained in rollovers. Our findings suggest that countermeasures focused on preventing cervical vertebral fractures will also effectively prevent most cervical spinal cord injuries.

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Conflict of interest statement

Author GPS is an owner and director of MEA Forensic Engineers & Scientists, and both he and the company may benefit from being associated with this research.

Figures

Fig. 1
Fig. 1
NASS-CDS proportions, standard errors, relative risks (RR), and 95th percentile confidence intervals for RR for all cervical spinal cord injuries (All-CI group) in rollovers (dark bars) and non-rollovers (white bars) stratified by the associated vertebral injury mechanisms (x-axis). All relative risks were not significantly different from one
Fig. 2
Fig. 2
Model years of crash-involved vehicles for NASS-CDS and CISS. The raw numbers of vehicles per model year are shown for NASS-CDS (2005–2015) and CISS (2017–2022) data. The inset graph shows a zoomed in view of the All-Injuries groups in both analyses
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