Lap-belt injury with complete avulsion of the spinal cord and cauda equina.

The authors report a child who was involved in an automobile accident. The patient was restrained by a rear seat lap belt. Radiological examination revealed an L4 Chance-type fracture and ligamentous disruption at the L4-L5 interval. During superficial dissection of the paraspinal muscles for a spinal fusion procedure, the cauda equina and the lower spinal cord (several centimeters) were visible, completely transected and herniated into the extraspinal space through a disrupted thoracolumbar fascia. The clinician should be aware of the potentially devastating results following a lap-belt injury in which a Chance fracture is produced.