Transportation, or automotive accidents – either being a passenger during an automotive crash or a pedestrian hit by a vehicle – is one of the most common causes of traumatic SCI in children (Anissipour et al. 2017; Astur et al. 2013; Carreon et al. 2004; Dauleac et al. 2019; German et al. 2007; Leonard et al. 2007; Mulligan et al. 2007; Odetola & Gebremariam 2016; Vander Have et al. 2009). Compared to older children, younger children are more likely to experience SCI, especially severe injuries, as a result of transport accidents (Brown & Bilston 2009; Eleraky et al. 2000; Finch & Barnes 1998; Khanna & El-Khoury 2007; Nadarajah et al. 2018; Zuckerbraun et al. 2004). SCI due to motor vehicle accidents most frequently impact the cervical spine region (Carreon et al. 2004; Chan et al. 2013; Eleraky et al. 2000; Hoy & Cole 1993; Mortazavi et al. 2011; Pieretti-Vanmarcke et al. 2009; Polk-Williams et al. 2008; Poorman et al. 2019; Ribeiro da Silva et al. 2016; Turgut et al. 1996). Among pediatric patients with cervical SCI, an insult to the upper cervical spine occur most frequently, and children between the age of 0 -9 years seem to be at the highest risk (Babu et al. 2016; Bilston & Brown 2007; Boese et al. 2015; Knox et al. 2014; Leonard et al. 2014; Meyer et al. 2005; Mohseni et al. 2011; Nitecki & Moir 1994; Poorman et al. 2019).
The extent of SCI due to transport incidents varies between neurologically complete and incomplete injury, with a serious injury even leading to paraplegia and permanent deficits (Brown et al. 2001; Carreon et al. 2004; Dogan et al. 2006; Ruge et al. 1988; Santschi et al. 2005; Trigylidas et al. 2011). In addition, some incidences of SCI due to vehicular accidents saw spinal cord without radiological abnormality (SCIWORA) (Brauge et al. 2020; Finch & Barnes 1998; Kim et al. 2016). Improperly restrained children involved in motor vehicle collisions are at higher risk of sustaining SCI (Achildi et al. 2007). Furthermore, studies have indicated that injury patterns may be affected by the child’s age and the type of restraint used at the time of the collision. For example, Zuckerbraun and colleagues (2004) work, revealed younger children had an increased incidence of permanent cord deficit compared to older children, even when they wore restraint devices. In addition, upon evaluating 11 cases of pediatric trauma caused by automotive air-bag deployments during low-speed collisions, Marshall et al. (1998) found that cervical spine trauma occurred in older children traveling restrained, improperly restrained, or unrestrained in the vehicle’s front passenger seat.