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Seats have become stronger over the past two decades and remain more upright in rear impacts. While head restraints are higher and more forward providing support for the head and neck, serious-to-fatal injuries to the thoracic and cervical spine have been seen in occupants with spinal disorders, such as DISH (diffuse idiopathic skeletal hyperostosis), ankylosis, spondylosis and/or osteophytes that ossify the joints in the spine. This case study addresses the influence of spinal disorders on fracture-dislocation and spinal cord injury in rear impacts with relatively upright seats. Nineteen field accidents were investigated where serious-to-fatal injuries of the thoracic and cervical spine occurred with the seat remaining upright or slightly reclined. The occupants were lap-shoulder belted, some with belt pretensioning and cinching latch plate.