The diagnosis and treatment of pediatric lumbar spine injuries caused by rear seat lap belts

Over the past 3 years, during a time when seat belt use has increased, we have managed nine midlumbar spine fractures in children caused by standard rear seat lap belts. Children with a lap belt injury typically complained of abdominal and back pain, and the nature of their injuries was evident by the presence of a belt-shaped abrasion across the lower abdomen. Midlumbar spine fracture may be associated with paraplegia and life-threatening visceral injury. If the spine is analyzed as a beam, the full spectrum of the reported injuries is predictable. This study shows that the rear seat belts installed as standard equipment do not meet the special needs of children. Rear seat lap belts are better than no restraints, but the addition of a shoulder restraint is strongly advocated to reduce lumbar spine injury.