It is obvious from the above that there are several independent mechanisms in the production of the various types of lumbar fractures. The details of these mechanisms must be fully understood in each case of lumbar vertebral injury. The cases reviewed in the present paper show that similar if not identical lumbar injuries can occur in car occupants wearing or not wearing lap belts at the time of the crash. Thus, cauxally relating a lumbar injury to the lap seat belt is in error. Only distraction injuries located between 1-2 and 1-4 with no evidence of either compression or anterior wedging can be causally related to a lap belt. Even some injuries with this typical confuguration have been observed in persons who were not belted (10). Thus, without knowledge of details of the crunch, lumbar fractures could mistakenly related to use of the lap belt. Thoraculumbar injuries have been senn in patients who were ejected from the car some time during the crash event. Relating the ejection event to the lumbar fracture must be done with great caution. As has been shown by Roaf (48) and by Kaufer and Hayes (33), the type and location of the lumbar spine injury can frequently and indicatory of load application. Other body injuries, or lack thereof, are often good clues to determine the point of load application causing lumbar injury. In addition, it has been recomended that additional details of the injury and of the accident be obtained for accuracy reporting of seat belt injuries.