Drivers and front-seat passengers who have airbags but do not use seatbelts are much more likely to sustain a spinal injury in frontal crashes than drivers and front-seat passengers with airbags who do use seatbelts, according to a study by the Pitt School of Medicine’s Department of Orthopaedic Surgery’s Division of Spinal Surgery.

“If you do not wear a seatbelt, the airbag can be a weapon, a source of injury. If you do wear a seatbelt, the airbag most likely will be helpful,” said study coauthor William F. Donaldson III, a Pitt associate professor of orthopaedic surgery and neurological surgery and chief of the Division of Spinal Surgery. “By not buckling your seatbelt, you increase the likelihood of a spinal fracture and spinal cord injury when your airbag deploys in a frontal collision.”

The research team studied the outcomes of 86,000 patients who were drivers or passengers in frontal collisions occurring in Pennsylvania between 1990 and 2002, according to data from the Pennsylvania Trauma Systems Foundation.

Drivers who had airbags but were not wearing seatbelts were 1.7 times more likely to sustain a cervical spine fracture and 2.4 times more likely to have a spinal cord injury than those drivers who used airbags and seatbelts. Front-seat passengers had even more significant results: The passengers with airbags alone and no seatbelt restraint were 6.7 times more likely to sustain a fracture with spinal cord injury than those passengers who were protected with an airbag and seatbelt.

“What prompted us to do the study was the number of injuries we were seeing in the UPMC orthopaedic spine clinic that we attributed to potentially out-of-position and unrestrained victims of motor vehicle crashes in which airbag deployment may have caused spinal injury,” said Donaldson. “This concerns us, because 25 percent of Pennsylvania drivers still do not wear seatbelts regularly.”

Although airbags are credited with saving thousands of lives and preventing thousands of serious injuries each year, the safety of airbags revolves around proper use, according to Donaldson. “Hundreds of cases of serious injury and deaths have occurred when car occupants were unrestrained and in an unplanned position or were too close to the airbag when it deployed during a crash,” he said. The airbag deploys at about 140 to 220 miles per hour and rapidly deflates.

Of the 86,000 patients studied, 12,678 had spinal injuries and 5,506 had cervical spine injuries. Of those 5,506, 203 used both airbags and seatbelts, 187 used an airbag only, 1,658 used a seatbelt only, and 3,458 were unprotected. The drivers who were unbelted with no airbag were 1.3 times more likely to have a cervical spine fracture and 1.8 times more likely to sustain a cervical spine fracture with a spinal cord injury than those drivers who were protected by both an airbag and seatbelt. As for the passengers who were unbelted with no airbag, they were 7.9 times more likely to have a fracture with spinal cord injury compared to those passengers with airbags and seatbelts.

“Fortunately, new airbag technology that will improve various aspects of the effectiveness and safety of the airbags is on the horizon, but even new technological advances cannot replace common sense—a person needs to buckle their seatbelt,” said Donaldson.