U.S.A. - Motorcycle Helmets and Neck Injuries

A few months ago, we replied to a question from a public health official that asked whether or not wearing motorcycle helmets increased the incidence of spinal injuries. We indicated that we had not come across evidence that it did, and in fact, we believed that the ability of motorcycle helmets to reduce traumatic brain injury (TBI) far outweighed the risk of spinal injuries. Now, in a recent article in The Journal of Trauma, Goslar and her colleagues have documented that there is no statistical relationship between helmet use and cervical and thoracic fractures.

Goslar used trauma registry data from a series of 11,000 trauma admissions, 422 of which involved motorcycle crashes. Age, sex, and blood alcohol levels were typical for motorcycle crashes. About 40% of the injured wore helmets. In Arizona, where this study was conducted, helmets are required only for those less than 18 years old.

The protective effect of helmets was apparent. TBI occurred at a rate twice as high in motorcyclists not wearing helmets, and unhelmeted riders were three times more likely to die than helmeted ones. These rates are consistent with other helmet studies.

Depending on whether in the cervical or lumbrosacral regions of the spine, fractures occurred in between 13 and 17% of all motorcycle crashes. The rate of cervical spinal fractures was similar for both helmeted and unhelmeted road traffic crash victims. Thoracic fractures were slightly more common in helmeted victims. The reverse was true for lumbrosacral fractures (i.e., lower in helmeted victims). None of the differences were statistically significant. In other words, helmeted and unhelmeted motorcyclists experienced about the same rate of spinal fractures.

This real life observation is in contrast to cadaver and biomechanical computer modeling that indicates the extra weight added by a helmet to the head and neck can exacerbate hyperflexion and hyperextension injury to the neck.

What did seem to affect spinal fractures was the speed the motorcyclist was traveling at the time of the crash; the faster the speed, the more likely spinal fractures occurred – in both unhelmeted and helmeted motorcyclists.

Goslar PW, Crawford NR, Peterson SR, et al. Helmet use and associated spinal fractures in motorcycle crash victims. J Trauma 2008;64:190-196.

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