[Lumbar dislocation fracture with paraplegia after pelvic seat belt injury. Case report]

This report details a traumatic spinal column lesion due to a lap seat belt. A healthy 22-year-old woman was involved in a car accident and suffered a lumbar luxation fracture at the level L1-L2. She developed acute transsectional symptoms with paraplegia and severe hyperpathia in her legs. Plain radiographs (antero-posterior and lateral projection) and lumbar CT scans demonstrated an instable flexion-distraction fracture with ventral compression of the vertebral body of L2 and ventrolisthesis of L1 over L2. Surgical reposition of the luxation fracture and removal of a spinal epidural hematoma was performed 4 h after the trauma. Stabilization was achieved by monosegmental dorsal transpedicular spondylodesis with a fixateur interne. In follow-up the neurological deficits markedly improved. Six months after the trauma, the patient is able to walk, has no paresis and no genitourinary disturbances: only mild dysesthesia remains. This posttraumatic course confirms that spinal traumas below L1 which spare the conus have a favorable prognosis, because the peripheral nerves of the cauda equina are able to recover. This injured patient was the only one using a lap seat belt; the other four passengers in the same compact car-wearing lap and diagonal seat belts-suffered no harm. We conclude that lap seat belts are not acceptable as an adequate security standard in modern automobile technology.