All Terrain Vehicles and Associated Spinal Injuries
From: Spine. 2008 Aug 15;33(18):1982-5
All terrain vehicles are associated with a higher incidence of axial compression and burst-type fracture morphologies. Although relatively safe and enjoyable when used properly, all terrain vehicles are associated with thousands of spinal injuries each year.
All terrain vehicles are currently experiencing enormous popularity in the United States. It has been estimated that there are currently over 7 million all terrain vehicles being operated at the present time in America. Although many drivers never get injured, All Terrain Vehicles have accounted for approximately 68,000 injuries and 270 deaths per year since 1985. In 2004 alone, injuries associated with all terrain vehicles use and misuse lead to 136,100 emergency room visits and 767 fatalities.
In 1988, an agreement was reached between the federal government and all terrain vehicle manufacturers that limited the production and sale of all terrain vehicles to only the 4-wheel or quad variety. This decree as well as state legislated helmet use has led to a decrease in the mortality rate. However, to date, there are only 21 states which mandate the use of helmets and other safety equipment. It has been shown in 2001, that in states without helmet laws, there is a 2-fold increase in all terrain vehicle related mortalities.
There have been numerous studies showing a correlation between driver experience and injuries associated with the use of all terrain vehicles. Some of these studies estimate that children under the age of 16 account for nearly 40% of all all terrain vehicle related injuries. Inexperience is just 1 identifiable risk factor. Alcohol intoxication and excessive speed as additional risk factors associated with all terrain vehicle accidents. Our study confirms these as risk factors for recreational use all terrain vehicle related injuries. In addition to driver impairment secondary to intoxication, excessive speeding, and driver inexperience, we also observed that use of these vehicles after dark was a frequent factor associated with vehicle roll over in this patient population.
Many authors have made suggestions to try to improve all terrain vehicle safety. There are some absolute recommendations that can be made in an attempt to reduce all terrain vehicle related injuries.
1. All individuals purchasing an all terrain vehicle should first be required to pass both a written and practical examination, where they can demonstrate a minimum amount of driving proficiency and safety.
2. There should be a minimal age requirement for obtaining the aforementioned license, similar to an automobile driver’s license. A limited license or permit may be issued to drivers under the age limit, who demonstrate a minimum amount driving proficiency and safety. This is similar to the requirements of some states for use of a personal recreational watercraft.
3. Every state should require the use of helmets and associated safety equipment of every driver of an all terrain vehicle.
In addition to these, there are some general guidelines that should be followed when operating these vehicles.
1. Never operate an all terrain vehicle while under the influence of any substance that may limit ones ability to mentally or physically control the vehicle.
2. Never operate the vehicle at times of the day or in areas where trails or paths cannot be well visualized because of darkness or shrub, tree, or obstacle interference.
3. Never operate vehicles at an unsafe or excessive speed.
4. Never allow anyone with little or no experience to operate the vehicle in an unsupervised or unassisted manor.
Although some of these may seem simple and obvious, this study clearly shows that these are not being followed. The United States government echoes these safety recommendations on their website, which can be found at: ATVSafety.gov.
While identifying certain associated risk factors, we were also able to better define the types of spinal cord injuries associated with all terrain vehicle accidents. All of our radiographically identified injuries can be classified according to the Denis classification, by injury morphology, as either axial compression versus burst injuries or as distraction type injuries. These types of morphologies are typically seen when the driver is either thrown from the vehicle or when the vehicle rolls over the driver pinning him/her against the ground. Approximately two third of the injuries occurred in the thoracolumbar spine, whereas the other one third occurred in the cervical spine. The trauma or emergency team treating a patient involved in an all terrain vehicle accident must have a high index of suspicion for these associated spine injuries.
Although limited by the retrospective nature of the study design, this study has been able to identify certain high risk behaviors leading to all terrain vehicle accidents and related injuries. Common spinal injury patterns have been demonstrated. In addition, some specific safety recommendations have been made. All terrain vehicles although highly dangerous leading to death or serious injury can be fun, enjoyable, and safe if proper regulations and safety precautions are followed.
