Background: Introduction of mandatory safety belt laws significantly increased survival in car crash victims. However, misuse of safety belts may increase the risk of severe injuries. Proper position of driver/passenger is a necessary condition when using safety belts. We describe a case of cervical spine injury caused by improper use of safety belts and tilted seat.
Case report: At the moment of car crash, when the seat was tilted back and the safety belts were on, the victim was propelled forward, thus ‘slipping’ underneath the lap part of the belt towards the floor of the car. Then, the shoulder part of the safety belt was blocked at the level of neck, causing damage to spinal ligaments and tear of spinal cord.
Conclusions: Upon car crash, misuse of safety belts and/or improper position of seats may result in equally severe injuries as while driving without safety belts. Only proper position of car seats and appropriate use of safety belts may lead to reduction of car crash- related harm and better survival.

Keywords: car crash victims, safety belts, spinal injury