OBJECT To determine the incidence of and assess the risk factors associated with neurological injury in motor vehicle occupants who sustain fractures of the thoracolumbar spine. METHODS In this study, the authors queried medical, vehicle, and crash data elements from the Crash Injury Research and Engineering Network (CIREN), a prospectively gathered multicenter database compiled from Level I trauma centers. Subjects had fractures involving the T1–L5 vertebral segments, an Abbreviated Injury Scale (AIS) score of ≥ 3, or injury to 2 body regions with an AIS score of ≥ 2 in each region. Demographic parameters obtained for all subjects included age, sex, height, body weight, and body mass index. Clinical parameters obtained included the level of the injured vertebra and the level and type of spinal cord injury. Vehicular crash data included vehicle make, seatbelt type, and usage and appropriate use of the seatbelt. Crash data parameters included the principal direction of force, change in velocity on impact (ΔV), airbag deployment, and vehicle rollover. The authors performed a univariate analysis of the incidence and the odds of sustaining spinal neurological injury associated with major thoracolumbar fractures with respect to the demographic, clinical, and crash parameters. RESULTS Neurological deficit associated with thoracolumbar fracture was most frequent at extremes of age; the highest rates were in the 0- to 10-year (26.7% [4 of 15]) and 70- to 80-year (18.4% [7 of 38]) age groups. Underweight occupants (OR 3.52 [CI 1.055–11.7]) and obese occupants (OR 3.27 [CI 1.28–8.31]) both had higher odds of sustaining spinal cord injury than occupants with a normal body mass index. The highest risk of neurological injury existed in crashes in which airbags deployed and the occupant was not restrained by a seatbelt (OR 2.35 [CI 0.087–1.62]). Reduction in the risk of neurological injuries occurred when 3-point seatbelts were used correctly in conjunction with the deployment of airbags (OR 0.34 [CI 1.3–6.6]) compared with the occupants who were not restrained by a seatbelt and for whom airbags were not deployed. Crashes with a ΔV greater than 50 km/hour had a significantly higher risk of spinal cord injury (OR 3.45 [CI 0.136–0.617]) than those at lower ΔV values. CONCLUSIONS Deployment of airbags was protective against neurological injury only when used in conjunction with 3-point seatbelts. Vehicle occupants who were either obese or underweight, very young or elderly, and those in crashes with a ΔV greater than 50 km/hour were at higher risk of thoracolumbar neurological injury. Neurological injury at thoracic and lumbar levels was associated with multiple factors, including the incidence of fatality, occupant factors such as age and body habitus, energy at impact, and direction of impact. Current vehicle safety technologies are geared toward a normative body morphology and need to be reevaluated for various body morphologies and torso compliances to lower the risk of neurological injury resulting from thoracolumbar fractures.

Angiosarcomas are rare malignant tumors of vascular origin that occur commonly in the skin followed by soft tissues and viscera. These tumors have rarely been described to arise at the site of synthetic vascular grafts even after a long period of latency. The exact etiology of such foreign body-associated sarcomas is not known although their occurrence has been described under both experimental (in rats) and clinical conditions (in humans). Of four such angiosarcoma cases described in clinical literature originating at the site of a vascular graft, three of them had an epithelioid morphology. Of these three cases, one originated from the abdominal aorta and the other two from the iliac artery and the femoral artery respectively. We herein describe the fourth case of epithelioid angiosarcoma developing from the site of the left brachial artery 16 years after the placement of a polytetrafluoroethylene (PTFE) vascular graft. The patient, a 47-year-old man on chronic hemodialysis presented in our hospital with a 3-week history of pain and nodularity at the site of the prosthesis which was initially thought to be an aneurysmal degeneration of the graft. Excision and subsequent histopathologic examination of the graft and surrounding tissue however revealed a locally invasive 1.4 cm epithelioid angiosarcoma consisting of packed highly pleomorphic tumor cells with an epithelioid morphology, clear nuclei, and prominent nucleoli. On immunohistochemistry, the tumor was positive for CD31 and pancytokeratin and negative for CD68, SMA, melan A, and CD34. A wide local excision of the graft area was subsequently done and the patient was treated with adjuvant radiotherapy. Although rare, this aggressive variant of angiosarcoma should be a concern among surgeons inserting artificial vascular grafts in patients with advanced vascular disease and end-stage renal disease and also among pathologists handling such explanted graft specimens.