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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

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Lap-belt injury with complete avulsion of the spinal cord and cauda equina

R Shane Tubbs1, Blake Golden, Scott Doyle

  • 1Department of Cell Biology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA. rstubbs@uab.edu

Clinical Anatomy (New York, N.Y.)
|November 12, 2005
PubMed

Insights

A lap belt can cause severe spinal cord transection and herniation, even in children. This case highlights the devastating outcomes of Chance fractures from lap belt injuries.

Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Pediatric Traumatology

Background:

  • Automobile accidents are a leading cause of pediatric trauma.
  • Lap belts are standard restraints, but their biomechanics in pediatric spinal injuries require further understanding.
  • Chance fractures are uncommon but severe injuries associated with lap belt use.

Observation:

  • A child sustained an L4 Chance-type fracture and L4-L5 ligamentous disruption after an automobile accident while restrained by a rear seat lap belt.
  • Surgical exploration revealed complete transection of the cauda equina and lower spinal cord.
  • The spinal cord fragments had herniated into the extraspinal space through a disrupted thoracolumbar fascia.

Findings:

  • Radiological examination confirmed an L4 Chance-type fracture and associated ligamentous disruption.
  • Intraoperative findings demonstrated a completely transected spinal cord and cauda equina.
  • Herniation of spinal cord elements through a disrupted thoracolumbar fascia was observed.

Implications:

  • Clinicians must recognize the potential for severe spinal cord injury in pediatric lap belt-related Chance fractures.
  • This case underscores the critical need for appropriate restraint systems and injury prevention strategies in children.
  • Understanding the mechanism of lap belt-induced spinal trauma is crucial for effective management and improved patient outcomes.

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