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Purpose: This study presents cases of fracture-dislocation of the thoracic spine in extension during severe rear impacts. The mechanism of injury was investigated. Methods: Four crashes were investigated where a lap-shoulder-belted, front-seat occupant experienced fracture-dislocation of the thoracic spine and paraplegia in a severe rear impact. Police, investigator and medical records were reviewed, the vehicle was inspected and the seat detrimmed. Vehicle dynamics, occupant kinematics and injury mechanisms were determined in this case study. Results: Each case involved a lap-shoulder-belted occupant in a high retention seat with ≻1,700 Nm moment or ≻5.5 kN strength for rearward loading. The crashes were offset rear impacts with 40-56 km/h delta V involving under-ride or override by the impacting vehicle and yaw of the struck vehicle. In each case, the occupant's pelvis was restrained on the seat by the open perimeter frame of the seatback and lap belt.