Response of Thoraco-Abdominal Tissue in High-Rate Compression.

Body armor is used to protect the human from penetrating injuries, however, in the process of defeating a projectile, the back face of the armor can deform into the wearer at extremely high rates. This deformation can cause a variety of soft and hard tissue injuries. Finite element modeling (FEM) represents one of the best tools to predict injuries from this high-rate compression mechanism. However, the validity of a model is reliant on accurate material properties for biological tissues. In this study, we measured the stress-strain response of thoraco-abdominal tissue during high-rate compression (1000 and 1900 s-1) using a split Hopkinson pressure bar (SHPB). High-rate material properties of porcine adipose, heart, spleen, and stomach tissue were characterized. At a strain rate of 1000 s-1, adipose (E = 4.7 MPa) had the most compliant stress-strain response, followed by spleen (E = 9.6 MPa), and then heart tissue (E = 13.6 MPa). At a strain rate of 1900 s-1, adipose (E = 7.3 MPa) had the most compliant stress-strain response, followed by spleen (E = 10.7 MPa), heart (E = 14.1 MPa), and stomach (E = 32.6 MPa) tissue. Only adipose tissue demonstrated a consistent rate dependence for these high strain rates, with a stiffer response at 1900 s-1 compared to 1000 s-1. However, comparison of all these tissues to previously published quasi-static and intermediate dynamic experiments revealed a strong rate dependence with increasing stress response from quasi-static to dynamic to high strain rates. Together, these findings can be used to develop a more accurate finite element model of high-rate compression injuries.

Biomechanical tolerance of whole lumbar spines in straightened posture subjected to axial acceleration.

Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12-L5) were dynamically loaded using a custom-built drop tower. Twenty-three specimens were tested at sub-failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p < 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty-percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9-5.2 kN), and 16 (13-19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2-L5 spinal levels. In general, force-based tolerance was consistent with previous shorter-segment lumbar spine testing (3-5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:1747-1756, 2018.

Influence of bone microstructure on the mechanical properties of skull cortical bone - A combined experimental and computational approach.

The strength and compliance of the dense cortical layers of the human skull have been examined since the beginning of the 20th century with the wide range in the observed mechanical properties attributed to natural biological variance. Since this variance may be explained by the difference in structural arrangement of bone tissue, micro-computed tomography (µCT) was used in conjunction with mechanical testing to study the relationship between the microstructure of human skull cortical coupons and their mechanical response. Ninety-seven bone samples were machined from the cortical tables of the calvaria of ten fresh post mortem human surrogates and tested in dynamic tension until failure. A linear response between stress and strain was observed until close to failure, which occurred at 0.6% strain on average. The effective modulus of elasticity for the coupons was 12.01 ± 3.28GPa. Porosity of the test specimens, determined from µCT, could explain only 51% of the variation of their effective elastic modulus. Finite element (FE) models of the tested specimens built from µCT images indicated that modeling the microstructural arrangement of the bone, in addition to the porosity, led to a marginal improvement of the coefficient of determination to 54%. Modulus for skull cortical bone for an element size of 50µm was estimated to be 19GPa at an average. Unlike the load bearing bones of the body, almost half of the variance in the mechanical properties of cortical bone from the skull may be attributed to differences at the sub-osteon (< 50µm) level. ANOVA tests indicated that effective failure stress and strain varied significantly between the frontal and parietal bones, while the bone phase modulus was different for the superior and inferior aspects of the calvarium. The micro FE models did not indicate any anisotropy attributable to the pores observable under µCT.

Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy.

BACKGROUND: Lumbar back pain and radiculopathy are common diagnoses. Unfortunately, conventional magnetic resonance imaging (MRI) findings and clinical symptoms do not necessarily correlate in the lumbar spine. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to improvements in diagnosis. MATERIALS AND METHODS: Seventeen adults (10 asymptomatic and 7 symptomatic volunteers) provided their informed consent and participated in the study. A 0.6T upright MRI scan was performed on each adult in the seated position. Parameters were obtained from the L2/3 level to the L5/S1 level including those pertaining to the foramen [cross-sectional area (CSA), height, mid-disc width, width, thickness of ligamentum flavum], disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle). Each parameter was compared based on the spinal level and volunteer group using two-factor analysis of variance (ANOVA). Bonferroni post hoc analysis was used to assess the differences between individual spinal levels. RESULTS: Mid-disc width accounted for 56% of maximum foramen width in symptomatic volunteers and over 63% in asymptomatic volunteers. Disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. CSA was generally smaller in symptomatic volunteers compared to asymptomatic volunteers, particularly at the L4-L5 and L5-S1 spinal levels. Thickness of ligamentum flavum (TLF) generally increased from the cranial to caudal spinal levels where the L4-L5 and L5-S1 spinal levels were significantly thicker than the L1-L2 spinal level. CONCLUSIONS: The data implied that upright MRI could be a useful diagnostic option, as it can delineate pertinent differences between symptomatic volunteers and asymptomatic volunteers, especially with respect to foraminal geometry.

Lumbar spine endplate fractures: Biomechanical evaluation and clinical considerations through experimental induction of injury.

Lumbar endplate fractures were investigated in different experimental scenarios, however the biomechanical effect of segmental alignment was not outlined. The objectives of this study were to quantify effects of spinal orientation on lumbar spine injuries during single-cycle compressive loads and understand lumbar spine endplate injury tolerance. Twenty lumbar motion segments were compressed to failure. Two methods were used in the preparation of the lumbar motion segments. Group 1 (n = 7) preparation maintained pre-test sagittal lordosis, whereas Group 2 (n = 13) specimens had a free-rotational end condition for the cranial vertebra, allowing sagittal rotation of the cranial vertebra to create parallel endplates. Five Group 1 specimens experienced posterior vertebral body fracture prior to endplate fracture, whereas two sustained endplate fracture only. Group 2 specimens sustained isolated endplate fractures. Group 2 fractures occurred at approximately 41% of the axial force required for Group 1 fracture (p < 0.05). Imaging and specimen dissection indicate endplate injury consistently took place within the confines of the endplate boundaries, away from the vertebral periphery. These findings indicate that spinal alignment during compressive loading influences the resulting injury pattern. This investigation identified the specific mechanical conditions under which an endplate breach will take place. Development of endplate injuries has significant clinical implication as previous research identified internal disc disruption (IDD) and degenerative disc disease (DDD) as long-term consequences of the axial load-shift that occurs following a breach of the endplate. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1084-1091, 2016.

Characterization of Lumbar Spine Annular Disruption in PMHS Using MRI, Cryomicrotomy and Histology Techniques.

Internal intervertebral disc disruption is involved in the onset of a wide range of spinal dysfunction, ultimately affecting not only the disc itself but the surrounding osseous and neural structures as well. The ability of disc to withstand and effectively distribute axial load is dependent upon whether peripherally located annular fibers provide the support necessary to contain and corral the pressure sensitive nucleus. Any alteration in the structures immediate to the nucleus jeopardize this ability. While annular tears and fissures have been thoroughly investigated, one form of internal disc disruption is less well-understood. A network of elastin cross-bridges provides resistance to delamination of the collagenous sheets that comprise the annulus. The current investigation utilized a Nitrogen gas-induced pressure mechanism to disrupt elastin cross links that exist between annular lamellae. Twenty five cadaveric lumbar spine motion segments (mean age: 52±12 yr.) were subjected to the annular disruption protocol. Damage to the annulus was assessed using MRI, cryomicrotome and histological staining procedures. MRI images were compared to cryomicrotome images to determine the ability of standard clinical MRI scans to determine annular damage. In many cases MRI was moderately revealing in terms of damage. Future studies will quantify biomechanical consequences of these low level annular disruptions relative to segmental stability.

Variation of bone layer thicknesses and trabecular volume fraction in the adult male human calvarium.

The human calvarium is a sandwich structure with two dense layers of cortical bone separated by porous cancellous bone. The variation of the three dimensional geometry, including the layer thicknesses and the volume fraction of the cancellous layer across the population, is unavailable in the current literature. This information is of particular importance to mathematical models of the human head used to simulate mechanical response. Although the target geometry for these models is the median geometry of the population, the best attempt so far has been the scaling of a unique geometry based on a few median anthropometric measurements of the head. However, this method does not represent the median geometry. This paper reports the average three dimensional geometry of the calvarium from X-ray computed tomography (CT) imaging and layer thickness and trabecular volume fraction from micro CT (µCT) imaging of ten adult male post-mortem human surrogates (PMHS). Skull bone samples have been obtained and µCT imaging was done at a resolution of 30 µm. Monte Carlo simulation was done to estimate the variance in these measurements due to the uncertainty in image segmentation. The layer thickness data has been averaged over areas of 5mm(2). The outer cortical layer was found to be significantly (p < 0.01; Student's t test) thicker than the inner layer (median of thickness ratio 1.68). Although there was significant location to location difference in all the layer thicknesses and volume fraction measurements, there was no trend. Average distribution and the variance of these metrics on the calvarium have been shown. The findings have been reported as colormaps on a 2D projection of the cranial vault.

Rate-dependent fracture characteristics of lumbar vertebral bodies.

Experimental testing incorporating lumbar columns and isolated components is essential to advance the understanding of injury tolerance and for the development of safety enhancements. This study incorporated a whole column axial acceleration model and an isolated vertebral body model to quantify compression rates during realistic loading and compressive tolerance of vertebrae. Eight lumbar columns and 53 vertebral bodies from 23 PMHS were used. Three-factor ANOVA was used to determine significant differences (p<0.05) in physiologic and failure biomechanics based on compression rate, spinal level, and gender. Results demonstrated a significant increase in ultimate force (i.e., fracture) from lower to higher compression rates. Ultimate stress also increased with compression rate. Displacement and strain to failure were consistent at both compression rates. Differences in ultimate mechanics between vertebral bodies obtained from males and females demonstrated non-significant trends, with female vertebral bodies having lower ultimate force that would be associated with decreased injury tolerance. This was likely a result of smaller vertebrae in that population. Combined with existing literature, results presented in this manuscript contribute to the understanding of lumbar spine tolerance during axial loading events that occur in both military and civilian environments with regard to effects of compression rate and gender.

Effects of acceleration level on lumbar spine injuries in military populations.

BACKGROUND CONTEXT: Clinical studies have indicated that thoracolumbar trauma occurs in the civilian population at its junction. In contrast, injury patterns in military populations indicate a shift to the inferior vertebral levels of the lumbar spine. Controlled studies offering an explanation for such migrations and the associated clinical biomechanics are sparse in literature. PURPOSE: The goals of this study were to investigate the potential roles of acceleration loading on the production of injuries and their stability characteristics using a human cadaver model for applications to high-speed aircraft ejection and helicopter crashes. STUDY DESIGN: Biomechanical laboratory study using unembalmed human cadaver lumbar spinal columns. METHODS: Thoracolumbar columns from post-mortem human surrogates were procured, x-rays taken, intervertebral joints and bony components evaluated for degeneration, and fixed using polymethylmethacrylate. The inferior end was attached to a platform via a load cell and uniaxial accelerometer. The superior end was attached to the upper metal platform via a semi-circular cylinder. The pre-flexed specimen was preloaded to simulate torso mass. The ends of the platform were connected to the vertical post of a custom-designed drop tower. The specimen was dropped inducing acceleration loading to the column. Axial force and acceleration data were gathered at high sampling rates, filtered, and peak accelerations and inertia-compensated axial forces were obtained during the loading phase. Computed tomography images were used to identify and classify injuries using the three-column concept (stable vs. unstable trauma). RESULTS: The mean age, total body mass, and stature of the five healthy degeneration-free specimens were 42 years, 73 kg, and 167 cm. The first two specimens subjected to peak accelerations of approximately 200 m/sec(2) were classified as belonging to high-speed aircraft ejection-type and the other three specimens subjected to greater amplitudes (347-549 m/sec(2)) were classified as belonging to helicopter crash-type loadings. Peak axial forces for all specimens ranged from 4.8 to 7.2 kN. Ejection-type loaded specimens sustained single-level injuries to the L1 vertebra; one injury was stable and the other was unstable. Helicopter crash-type loaded specimens sustained injuries at inferior levels, including bilateral facet dislocation at L4-L5 and L2-L4 compression fractures, and all specimens were considered unstable at least at one spinal level. CONCLUSIONS: These findings suggest that the severity of spinal injuries increase with increasing acceleration levels and, more importantly, injuries shift inferiorly from the thoracolumbar junction to lower lumbar levels. Acknowledging that the geometry and load carrying capacity of vertebral bodies increase in the lower lumbar spine, involvement of inferior levels in trauma sparing the superior segments at greater acceleration inputs agree with military literature of caudal shift in injured levels. The present study offers an experimental explanation for the clinically observed caudal migration of spinal trauma in military populations as applied to high-speed aircraft ejection catapult and helicopter crashes.

Implementation and validation of probabilistic models of the anterior longitudinal ligament and posterior longitudinal ligament of the cervical spine.

The objective of this investigation was to develop probabilistic finite element (FE) models of the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) of the cervical spine that incorporate the natural variability of biological specimens. In addition to the model development, a rigorous validation methodology was developed to quantify model performance. Experimental data for the geometry and dynamic properties of the ALL and PLL were used to create probabilistic FE models capable of predicting not only the mean dynamic relaxation response but also the observed experimental variation of that response. The probabilistic FE model uses a quasilinear viscoelastic material constitutive model to capture the time-dependent behaviour of the ligaments. The probabilistic analysis approach yields a statistical distribution for the model-predicted response at each time point rather than a single deterministic quantity (e.g. ligament force) and that response can be statistically compared to experimental data for validation. A quantitative metric that compares the cumulative distribution functions of the experimental data and model response is computed for both the ALL and PLL throughout the time histories and is used to quantify model performance.

Risk of lumbar spine injury from cyclic compressive loading.

STUDY DESIGN: Survival analyses of a large cohort of published lumbar spine compression fatigue tests. OBJECTIVE: To produce the first large-scale evaluation of human lumbar spine tolerance to repetitive compressive loading and to evaluate and improve guidelines for human exposure to whole-body vibration and repeated mechanical shock environments. SUMMARY OF BACKGROUND DATA: Several studies have examined the effects of compressive cyclic loading on the lumbar spine. However, no previous effort has coalesced these studies and produced an injury risk analysis with an expanded sample size. Guidelines have been developed for exposure limits to repetitive loading (e.g., ISO 2631-5), but there has been no large-scale verification of the standard against experimental data. METHODS: Survival analyses were performed using the results of 77 male and 28 female cadaveric spinal segment fatigue tests from 6 previously published studies. Segments were fixed at each end and exposed to axial cyclic compression. The effects of the number of cycles, load amplitude, sex, and age were examined through the use of survival analyses. RESULTS: Number of cycles, load amplitude, sex, and age all are significant factors in the likelihood of bony failure in the spinal column. Using a modification of the risk prediction parameter from ISO 2631-5, an injury risk model was developed, which relates risk of vertebral failure to repeated compressive loading. The model predicts lifetime risks less than 7% for industrial machinery exposure from axial compression alone. There was a 38% risk for a high-speed planing craft operator, consistent with epidemiological evidence. CONCLUSION: A spinal fatigue model which predicts the risk of in vitro lumbar spinal failure within a narrow confidence interval has been developed. Age and sex were found to have significant effects on fatigue strength, with sex differences extending beyond those accounted for by endplate area disparities.

A new PMHS model for lumbar spine injuries during vertical acceleration.

Ejection from military aircraft exerts substantial loads on the lumbar spine. Fractures remain common, although the overall survivability of the event has considerably increased over recent decades. The present study was performed to develop and validate a biomechanically accurate experimental model for the high vertical acceleration loading to the lumbar spine that occurs during the catapult phase of aircraft ejection. The model consisted of a vertical drop tower with two horizontal platforms attached to a monorail using low friction linear bearings. A total of four human cadaveric spine specimens (T12-L5) were tested. Each lumbar column was attached to the lower platform through a load cell. Weights were added to the upper platform to match the thorax, head-neck, and upper extremity mass of a 50th percentile male. Both platforms were raised to the drop height and released in unison. Deceleration characteristics of the lower platform were modulated by foam at the bottom of the drop tower. The upper platform applied compressive inertial loads to the top of the specimen during deceleration. All specimens demonstrated complex bending during ejection simulations, with the pattern dependent upon the anterior-posterior location of load application. The model demonstrated adequate inter-specimen kinematic repeatability on a spinal level-by-level basis under different subfailure loading scenarios. One specimen was then exposed to additional tests of increasing acceleration to induce identifiable injury and validate the model as an injury-producing system. Multiple noncontiguous vertebral fractures were obtained at an acceleration of 21 g with 488 g/s rate of onset. This clinically relevant trauma consisted of burst fracture at L1 and wedge fracture at L4. Compression of the vertebral body approached 60% during the failure test, with -6,106 N axial force and 168 Nm flexion moment. Future applications of this model include developing a better understanding of the vertebral injury mechanism during pilot ejection and developing tolerance limits for injuries sustained under a variety of different vertical acceleration scenarios.

Effects of tissue preservation temperature on high strain-rate material properties of brain.

Postmortem preservation conditions may be one of factors contributing to wide material property variations in brain tissues in literature. The objective of present study was to determine the effects of preservation temperatures on high strain-rate material properties of brain tissues using the split Hopkinson pressure bar (SHPB). Porcine brains were harvested immediately after sacrifice, sliced into 2 mm thickness, preserved in ice cold (group A, 10 samples) and 37°C (group B, 9 samples) saline solution and warmed to 37°C just prior to the test. A SHPB with tube aluminum transmission bar and semi-conductor strain gauges were used to enhance transmitted wave signals. Data were gathered using a digital acquisition system and processed to obtain stress-strain curves. All tests were conducted within 4 h postmortem. The mean strain-rate was 2487±72 s(-1). A repeated measures model with specimen-level random effects was used to analyze log transformed stress-strain responses through the entire loading range. The mean stress-strain curves with ±95% confidence bands demonstrated typical power relationships with the power value of 2.4519 (standard error, 0.0436) for group A and 2.2657 (standard error, 0.0443) for group B, indicating that responses for the two groups are significantly different. Stresses and tangent moduli rose with increasing strain levels in both groups. These findings indicate that storage temperatures affected brain tissue material properties and preserving tissues at 37°C produced a stiffer response at high strain-rates. Therefore, it is necessary to incorporate material properties obtained from appropriately preserved tissues to accurately predict the responses of brain using stress analyses models, such as finite element simulations.

Determination of normative neck muscle morphometry using upright MRI with comparison to supine data.

BACKGROUND: Neck muscles are important in the static and dynamic stability of the head-neck complex. Deep neck muscles act to maintain upright posture and superficial muscles are responsible for gross movements. Previous studies have quantified neck muscle geometry using traditional supine magnetic resonance imaging (MRI). However, supine orientation removes the vertical load on the cervical spine from the head-neck complex and changes the relative orientation of the spine and neck muscles. Therefore, the purpose of this study was to demonstrate the feasibility of upright MRI to obtain neck muscle morphometric data on a spinal level-by-level basis for subjects in upright seated positions. METHODS: Upright MRI scans were obtained of the neck region for six younger male volunteers in neutral and flexed positions. Planar images were oriented parallel to the intervertebral disc space at each level. Cross-sectional area (CSA) and orientation of neck muscles were quantified at four spinal levels. RESULTS: Area and position of all four muscles were significantly dependent upon spinal level. Average CSA of the sternocleidomastoid, longus colli, levator scapulae, and trapezius muscles in neutral position were 512, 113, 281, and 174 mm2. Head-neck position significantly affected area and position of the sternocleidomastoid and position of posterior neck muscles. DISCUSSION: Comparison of neck muscle areas from the present study to a previous study incorporating supine MRI demonstrated differing trends between anterior and posterior neck muscles that may be attributable to upright orientation of volunteers and planar image orientation in the present study. Differences between supine and upright MRI identified in the present study may warrant incorporation of this technique in future spinal imaging studies.

Kinematic response of the spine during simulated aircraft ejections.

INTRODUCTION: Military aviators are susceptible to spinal injuries during high-speed ejection scenarios. These injuries commonly arise as a result of strains induced by extreme flexion or compression of the spinal column. This study characterizes the vertebral motion of two postmortem human surrogates (PMHS) during a simulated catapult phase of ejection on a horizontal decelerator sled. METHODS: During testing, the PMHS were restrained supinely to a mock ejection seat and subjected to a horizontal deceleration profile directed along the local z-axis. Two midsized males (175.3 cm, 77.1 kg; 185.4 cm, 72.6 kg) were tested. High-rate motion capture equipment was used to measure the three-dimensional displacement of the head, vertebrae, and pelvis during the ejection event. RESULTS: The two PMHS showed generally similar kinematic motion. Head injury criterion (HIC) results were well below injury threshold levels for both specimens. The specimens both showed compression of the spine, with a reduction in length of 23.9 mm and 45.7 mm. Post-test autopsies revealed fractures in the C5, T1, and L1 vertebrae. DISCUSSION: This paper provides an analysis of spinal motion during an aircraft ejection.The injuries observed in the test subjects were consistent with those seen in epidemiological studies. Future studies should examine the effects of gender, muscle tensing, out-of-position (of head from neutral position) occupants, and external forces (e.g., windblast) on spinal kinematics during aircraft ejection.

Ejection injury to the spine in small aviators: sled tests of manikins vs. post mortem specimens.

INTRODUCTION: This study presents the results of seven aerospace manikin and three post mortem human surrogate (PMHS) horizontal deceleration sled tests. The objective of this study was to establish a body of baseline data that examines the ability of small (fifth percentile) manikins to predict whole-body kinematics associated with aircraft ejection, and whether currently available head and neck injury criteria are applicable in these situations. METHODS: Subjects were exposed to a short-duration local z-axis sled pulse while horizontally seated and restrained in an ejection seat. Test subjects included instrumented fifth percentile female and male manikins, and two small (163.8 cm, 48.3 kg; 143.5 cm, 48.6 kg) female and one small (166.2 cm, 54.3 kg) male PMHS. RESULTS: The anterior (local x-axis) translations of the PMHS heads were less than those observed in the manikin tests, but the local z-axis translations of the PMHS heads were greater than those of the manikins. Z-axis translations of the manikins' T1 were generally similar to those of the PMHS T1, but the anterior x-axis translations of T1 were greater in the PMHS. The neck injury criterion (Nij) tended to under-predict observed injury (primarily ruptures of the posterior ligaments at C4-5, T2-3), and the Beam Criterion (BC) tended to over-predict observed injury for small occupants. The USN/USAF neck injury criteria (NIC) performed best in predicting the observed injuries. DISCUSSION: Present manikin designs do not predict the kinematics of PMHS in ejection tests. Further refinement of existing injury criteria is required to accurately predict location and severity of ejection-induced injuries.

Physical effects of ejection on the head-neck complex: demonstration of a cadaver model.

Vertebral fracture is the most common severe injury during high-speed pilot ejection. However, the loading paradigm experienced by pilots may also lead to soft-tissue spinal injuries that are more difficult to quantify and can lead to long-term deficits. This manuscript describes a new experimental protocol to simulate the effects of pilot ejection on the tissues of the head-neck complex. The model permits precise control of head-neck complex initial positioning, detailed analysis of head and spinal kinematics and upper and lower neck loads, and the ability to thoroughly investigate and identify soft-tissue injuries through upper and lower neck injury criteria, radiography, manual palpation, and cryomicrotomy. For the current test, peak acceleration of +14.8 Gz was similar to actual ejection events and duration of the acceleration pulse was approximately 100 ms. The specimen was oriented in flexion prior to initiation of inferior-to-superiorly directed acceleration. Subfailure ligamentum flavum injuries were sustained at the C4-C5 and C5-C6 cervical spinal levels and identified by increased segmental motions during the simulated ejection, increased laxity following testing, and cryomicrotomy. Upper and lower neck injury criteria did not predict these soft-tissue injuries. This experimental model can be used for detailed analysis of the effects of gender, head-neck orientation, helmet instrumentation, and acceleration pulse characteristics on cervical spine injury potential during pilot ejection events.

Gender dependent cervical spine anatomical differences in size-matched volunteers - biomed 2009.

The objective was to examine significant differences in the bony structure of cervical spine vertebrae based on gender and spinal level that may influence injury risk in women following automotive rear impact. Male and female subjects were recruited for a separate study and data from two subsets were selected for inclusion in this study. Subjects were size-matched based on sitting height (17 males, 11 females) and head circumference (9 males, 18 females). Axial CT scans were obtained of the cervical spine from the C1 through C6. Bony boundaries of cervical vertebrae were defined using image-analysis software and biomechanically-relevant dimensions were derived at spinal levels C2 through C6. Six of seven vertebral dimensions were significantly dependent upon gender and spinal level in both subgroups. Male vertebrae had larger dimensions for each metric. Depth dimensions were greatest at caudal and cranial extents, whereas width dimensions were smallest at C2 and increased caudally. Greater linear and areal dimensions in size-matched male subjects indicates a more stable cervical spinal column that may be more capable of resisting inertial loading of the head-neck complex during automotive rear impacts. Although the explanation for greater injury susceptibility in females is likely multi-factorial, including differences in spinal material properties, soft tissue tolerance thresholds, occupant-seatback orientation, and neck muscle size/orientations, the present study has identified significant differences in cervical spine anatomical dimensions that may contribute to greater rates of whiplash injury in that population.

Normative segment-specific axial and coronal angulation corridors of subaxial cervical column in axial rotation.

STUDY DESIGN: In contrast to clinical studies wherein loading magnitudes are indeterminate, experiments permit controlled and quantifiable moment applications, record kinematics in multiple planes, and allow derivation of moment-angulation corridors. Axial and coronal moment-angulation corridors were determined at every level of the subaxial cervical spine, expressed as logarithmic functions, and level-specificity of range of motion and neutral zones were evaluated. HYPOTHESIS: segmental primary axial and coupled coronal motions do not vary by level. SUMMARY OF BACKGROUND DATA: Although it is known that cervical spine responses are coupled, segment-specific corridors of axial and coronal kinematics under axial twisting moments from healthy normal spines are not reported. METHODS: Ten human cadaver columns (23-44 years, mean: 34 +/- 6.8) were fixed at the ends and targets were inserted to each vertebra to obtain kinematics in axial and coronal planes. The columns were subjected to pure axial twisting moments. Range of motion and neutral zone for primary-axial and coupled-coronal rotation components were determined at each spinal level. Data were analyzed using factorial analysis of variance. Moment-rotation angulations were expressed using logarithmic functions, and mean +/-1 standard deviation corridors were derived at each level for both components. RESULTS: Moment-angulations responses were nonlinear. Each segmental curve for both components was well represented by a logarithmic function (r2 > 0.95). Factorial analysis of variance indicated that the biomechanical metrics are spinal level-specific (P < 0.05). CONCLUSION: Axial and coronal angulations of cervical spinal columns show statistically different level-specific responses. The presentation of moment-angulation corridors for both metrics forms a dataset for the normal population. These segment-specific nonlinear corridors may help clinicians assess dysfunction or instability. These data will assist mathematical models of the spine in improved validation and lead to efficacious design of stabilizing systems.

Anatomical gender differences in cervical vertebrae of size-matched volunteers.

STUDY DESIGN: Clinical literature consistently identifies women as more susceptible to trauma-related neck pain, commonly resulting from soft tissue cervical spine injury. Structural gender differences may explain altered response to dynamic loading in women leading to increased soft tissue distortion and greater injury susceptibility. OBJECTIVE: Identify anatomic gender differences in cervical spinal geometry that contribute to decreased column stability in women. SUMMARY OF BACKGROUND DATA: Previous studies investigating male and female vertebral and vertebral body geometry demonstrated female vertebral dimensions were smaller. However, populations were not size matched and parameters related to biomechanical stability were not reported. METHODS: Computed tomography scans of the cervical spine were obtained from size-matched young healthy volunteers. Geometrical dimensions were obtained at the C4 level and analysis of variance determined significant gender differences. RESULTS: Two volunteer subsets were size matched based on sitting height and head circumference. All geometrical measures were greater in men for both subsets. Vertebral width and disc-facet depth were significantly greater in men. Additionally, segmental support area, combining interfacet width and disc-facet depth, was greater in men, indicating more stable intervertebral coupling. CONCLUSION: Present results of decreased linear and areal cervical dimensions leading to decreased column stability may partially explain increased traumatic injury rates in women.