Epidemiology of Thoracolumbar Spine Injuries Associated with Speedboat Travelling without Collision: A Unique Spine Injury Mechanism

Abstract

Objective: To evaluate the epidemiology of thoracolumbar spine injuries following speedboat travelling at our coastal tertiary trauma center, and to identify injury patterns and mechanism of injury of these specific injuries and to determine the association of position on board with the risk of thoracolumbar injury in this type of transportation. Materials and Methods:A retrospective review of a consecutive series of 80 patients sustaining thoracolumbar spine injuries following speed boating was conducted. The enrolled patients were treated at Level II trauma center over a 2-year period since July 1, 2016 to May 31, 2018. All the victims were unrestrained passengers on board a speedboat travelling at high speed without any safety regulation. Initially full evaluation with advance trauma life support protocol on arrival was performed. Plain radiographs, computed thermography or MRI study was obtained individually. Number, level and type of thoracolumbar injury were recorded and reported base on CT scan and Thoracolumbar Injury Classification by AO group. The association of the position on board with incidence of thoracolumbar spine injury was then analysed and compared relatively.Results: All spinal fractures are single level injury. The level of injury is mainly at thoracolumbar area that involved 6 cases (7.5%) of T11 vertebra, 20 cases (25%) of T12 vertebra, 44 cases (55%) of L1 vertebra and 10 cases (12.5%) of L2 vertebra respectively. No injury of cervical and sacral region has been reported. A spinal cord/nerve root injury occurred in the lumbar region in 1 patient (1.25%). All of 80 injuries patterns are type A injury (compression type), classified by AO Spine Thoracolumbar Injury Classification, including of 32 levels (40%) of subtype A1, 18 levels (22.5%) of subtype A2, 8 levels (10%) of subtype A3 and 22 levels (27.5%) of subtype A4. Patients who sat in the front row seat were significantly at higher risk for thoracolumbar spine injury (p < 0.05; odds ratio = 41.83; 95%CI: 15.24, 114.8). No patient who sat at the rear was reported having this kind of injury. Conclusion:Our data show the high incidence of this unique compressive type of thoracolumbar spine injury in the patient who sat in the front row seat while on boarding speed boat traveling. As a result of increasing recognition of these regional-specific injuries, practitioners who take responsibility for trauma patient on the coastal area should be aware of the high prevalence of these injuries. Proper universal spinal precaution must be followed to optimize treatment outcome. Current safety regulations including of speed limitation, proper safety restrain technique, bracing position on board and marine rescuers should be reviewed or changed to minimize the number of the victim and degree of damage.