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 when travelling by speedboat to our coastal tertiary trauma center, and to identify injury patterns and mechanism of injury of these specific injuries and to determine the link of the position when seated 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 after travelling by speed boat was conducted. The enrolled patients were treated at a Level II trauma center over a 2-year period from 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 except a life jacket. Initially, a 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 based on CT scan and Thoracolumbar Injury Classification by AO group. The link to the position when seated on board with the incidence of thoracolumbar spine injury was then analyzed and compared relatively.

RESULTS:
There were a total of 80 patients in our study, 48 (60%) were men and 32 (40%) were women with a mean age of 47.50 years (Min 20, Max 71). All the spinal fractures were a single level injury. The injury occurred only at the thoracolumbar area, these 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 cervical or sacral region injury was observed nor other associated injuries such as traumatic brain injury, intra-abdominal organ injury or long bone fracture. A spinal cord/nerve root injury occurred in the lumbar region in 1 patient (1.25%). All of the 80 injuries were type A injury (compression type), classified by AO Spine Thoracolumbar Injury Classification, and included 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. 50 cases (62.5%) were treated non-operatively with bracing while 30 cases (37.5) were treated operatively with computer navigation spinal surgery using pedicle screws and rods construction before the patient was discharged or repatriated. 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 reported having had this kind of injury.

CONCLUSIONS:
Our data shows a high incidence of this unique compressive type of thoracolumbar spine injury in patients who sit in the front row seat while travelling on board a speed boat.
As a result of an increasing recognition of these regional-specific injuries, practitioners who take responsibility for trauma patients on the coastal area should be aware of the high prevalence of these injuries. Proper universal spinal precautions must be followed to optimize treatment outcomes. Current safety regulations including speed limits, proper safety restraining techniques, bracing position on board and marine rescuers should be reviewed or changed to minimize the number of injuries and degree of damage.