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.

Heart-rate tuned comb filters for processing photoplethysmogram (PPG) signals in pulse oximetry.

Calculation of peripheral capillary oxygen saturation [Formula: see text] levels in humans is often made with a pulse oximeter, using photoplethysmography (PPG) waveforms. However, measurements of PPG waveforms are susceptible to motion noise due to subject and sensor movements. In this study, we compare two [Formula: see text]-level calculation techniques, and measure the effect of pre-filtering by a heart-rate tuned comb peak filter on their performance. These techniques are: (1) "Red over Infrared," calculating the ratios of AC and DC components of the red and infrared PPG signals,[Formula: see text], followed by the use of a calibration curve to determine the [Formula: see text] level Webster (in: Design of pulse oximeters, CRC Press, Boca Raton, 1997); and (2) a motion-resistant algorithm which uses the Discrete Saturation Transform (DST) (Goldman in J Clin Monit Comput 16:475-83, 2000). The DST algorithm isolates individual "saturation components" in the optical pathway, which allows separation of components corresponding to the [Formula: see text] level from components corresponding to noise and interference, including motion artifacts. The comparison we provide here (employing the two techniques with and without pre-filtering) addresses two aspects: (1) accuracy of the [Formula: see text] calculations; and (2) computational complexity. We used both synthetic data and experimental data collected from human subjects. The human subjects were tested at rest and while exercising; while exercising, their measurements were subject to the impacts of motion. Our main conclusion is that if an uninterrupted high-quality heart rate measurement is available, then the "Red over Infrared" approach preceded by a heart-rate tuned comb filter provides the preferred trade-off between [Formula: see text]-level accuracy and computational complexity. A modest improvement in [Formula: see text] estimate accuracy at very low SNR environments may be achieved by switching to the pre-filtered DST-based algorithm (up to 6% improvement in [Formula: see text] level accuracy at -10 dB over unfiltered DST algorithm and the filtered "Red over Infrared" approach). However, this improvement comes at a significant computational cost.

Crew-Friendly Countermeasures Against Musculoskeletal Injuries in Aviation and Spaceflight.

Aviation and space medicine face many common musculoskeletal challenges that manifest in crew of rotary-wing aircraft (RWA), high-performance jet aircraft (HPJA), and spacecraft. Furthermore, many astronauts are former pilots of RWA or HPJA. Flight crew are exposed to recurrent musculoskeletal risk relating to the extreme environments in which they operate, including high-gravitational force equivalents (g-forces), altered gravitational vectors, vibratory loading, and interaction with equipment. Several countermeasures have been implemented or are currently under development to reduce the magnitude and frequency of these injuries. Cervical and lumbar spine, as well as extremity injuries, are common to aviators and astronauts, and occur in training and operational environments. Stress on the spinal column secondary to gravitational loading and unloading, ± vibration are implicated in the development of pain syndromes and intervertebral disk pathology. While necessary for operation in extreme environments, crew-support equipment can contribute to musculoskeletal strain or trauma. Crew-focused injury prevention measures such as stretching, exercise, and conditioning programs have demonstrated the potential to prevent pre-flight, in-flight, and post-flight injuries. Equipment countermeasures, especially those addressing helmet mass and center of gravity and spacesuit ergonomics, are also key in injury prevention. Furthermore, behavioral and training interventions are required to ensure that crew are prepared to safely operate when faced with these exposures. The common operational exposures and risk factors between RWA and HPJA pilots and astronauts lend themselves to collaborative studies to develop and improve countermeasures. Countermeasures require time and resources, and careful consideration is warranted to ensure that crew have access to equipment and expertise necessary to implement them. Further investigation is required to demonstrate long-term success of these interventions and inform flight surgeon decision-making about individualized treatment. Lessons learned from each population must be applied to the others to mitigate adverse effects on crew health and well-being and mission readiness.

Correlation of Cognitive Scores and the Onset of Hypoxia.

INTRODUCTION: The negative effects of hypoxia on human cognitive function have been well documented. In this study we assess the correlation of performance in the SynWin cognitive Multi-Task Battery (MTB) and the onset of hypoxia and describe the use of cognitive assessment scores for real-time hypoxia detection.METHODS: We performed a correlation analysis between MTB scores (Arithmetic, Memory, Audio Monitoring, Video Monitoring tasks) and blood oxygen saturation levels to discover if the scores are good candidates to detect hypoxia. Since this analysis showed positive correlation, we proceeded to develop a parallel decision fusion system that uses these cognitive scores for real-time hypoxia detection using the Neyman-Pearson criterion.RESULTS: We demonstrate that MTB scores have considerable hypoxia detection potential and can be used (if measurable passively) in a real-time detection framework. Analysis of receiver operating characteristic (ROC) curves established a hierarchy of importance of the various MTB modules. The Arithmetic task module had the most significant contribution toward correct hypoxia detection (improvement of ∼13.5% and ∼13.9% in detection accuracy under global false alarms of 0.1 and 0.05, respectively), followed by the Memory and Audio Monitoring modules. Fusion of multiple cognitive assessment scores resulted in significantly higher detection accuracy (>86%) than using any one of the scores by itself.DISCUSSION: When available, cognitive assessment scores can be a useful tool for real-time hypoxia detection. Since these MTB tests also assess neuropsychological functioning, study of distributed detection systems based on MTB scores could help in designing tests that are more useful for detecting hypoxic symptoms.Rajasekar A, Acharya S, Shender BS, Rorres C, Hrebien L, Kam M. Correlation of cognitive scores and the onset of hypoxia. Aerosp Med Hum Perform. 2019; 90(5):429-439.

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.

Cognitive Deterioration in Moderate and Severe Hypobaric Hypoxia Conditions.

BACKGROUND: Hypoxia continues to present risks in military aviation. Hypoxia symptoms include sensory and cognitive effects; of these, it is important to identify which components of operator performance are most vulnerable to hypoxia-induced decline in order to determine which sensory modality is most effective for alerting an impaired aviator of an imminent hypoxic episode. METHODS: A study was performed in a hypobaric chamber to characterize deterioration of cognitive performance under moderate (MH) and severe (SH) hypoxia conditions, culminating in subjects' inability to perform tasks. Subjects operated a synthetic workstation, performing multiple simultaneous tasks during hypobaric exposures equivalent to 5486 m (18,000 ft) MH and 7620 m (25,000 ft) SH ascents. Performance was compared across baseline, altitude exposure, and recovery periods within MH vs. SH altitude profiles. Ascents lasted until at least one of a list of termination criteria was met, at which point the chamber was returned to ground level pressure and the subject resumed workstation performance during recovery. RESULTS: SH conditions generated greater deficits than MH conditions, and these more severe effects hastened the termination of exposures (5 vs. 18 min mean duration, respectively). Workstation performance collapsed rapidly on SH exposure, with Mathematics and Auditory Monitoring tasks proving vulnerable to breakdown. In MH exposures, these tasks exhibited impaired accuracy (declining 11% and 9%, respectively) and speed, with declines in Auditory Monitoring lingering into recovery. DISCUSSION: The relative robustness of memory and visual monitoring vs. the vulnerability of mathematical and auditory processing suggest that care should be taken designing purely auditory cockpit hypoxia warning alerts.Beer JMA, Shender BS, Chauvin D, Dart TS, Fischer J. Cognitive deterioration in moderate and severe hypobaric hypoxia conditions. Aerosp Med Hum Perform. 2017; 88(7):617-626.

Real-Time Hypoxia Prediction Using Decision Fusion.

Humans who operate in high altitudes for prolonged durations often suffer from hypoxia. The commencement of physiological and cognitive changes due to the onset of hypoxia may not be immediately apparent to the exposed individual. These changes can go unrecognized for minutes and even hours and may lead to serious performance degradation or complete incapacitation. A dynamic system capable of monitoring and detecting decreased physiologic states due to the onset of hypoxia has the potential to prevent adverse outcomes. In this study, we develop a real-time hypoxia monitoring system based on a parallel M -ary decision fusion architecture. Blood oxygen saturation levels and altitude readings are the inputs and estimates of the level of hypoxia are the outputs. We develop new temporal evolution models for blood oxygen saturation and functional impairment with respect to varying altitude. The proposed models enable accurate tracking of various hypoxia levels based on the duration of stay of the subject at an altitude. Using a Bayesian decision-making formulation, the system generates global estimates of the degree of hypoxia. The detection system is tested against synthetic and real datasets to demonstrate applicability and accuracy.

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.

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.

A method for inducing and determining biomechanics associated with endplate fractures in the lumbar spine.

Lumbar spine endplate fracture is not easily detectible using medical imaging, but can lead to pain symptoms. Understanding endplate fracture mechanics can lead to more informed clinical diagnosis and more appropriate safety enhancements for civilian and military vehicles. Lumbar motion segments obtained from PMHS were prepared using two methods. Group 1 (n=6) was potted preserving the natural segmental lordosis while Group 2 (n=4) removed the curvature. Specimens were compressed at 0.5 mm/sec until fracture, observed via real-time fluoroscopy video as radio-opaque dye transferred from the intervertebral disc nucleus into the vertebral body. Fracture was confirmed using CT and dissection. Force, bony acoustics and disc pressure were correlates of fracture. Fractures in Group 1 (5 of 6 specimens) were concentrated in the posterior cortex of the inferior vertebral body whereas Group 2 experienced endplate fractures. The mean sagittal plane angle between endplates for specimens with cortical fracture was 5.1±1.2 degrees, compared to 1.0±0.5 degrees for endplate fracture. The average peak force for cortical fracture was 10.0±1.9 kN and 4.5±0.8 kN for endplate fracture. Pre-positioning during compressive loading has a significant role in determining whether a motion segment sustains a cortical or endplate fracture. Likewise, an appropriately oriented segment can sustain endplate fracture at approximately 45% of the load for cortex fracture.

Mechanical yield of the lumbar annulus: a possible contributor to instability: Laboratory investigation.

OBJECT: Segmental instability in the lumbar spine can result from a number of mechanisms including intervertebral disc degeneration and facet joint degradation. Under traumatic circumstances, elevated loading may lead to mechanical yield of the annular fibers, which can decrease load-carrying capacity and contribute to instability. The purpose of this study was to quantify the biomechanics of intervertebral annular yield during tensile loading with respect to spinal level and anatomical region within the intervertebral disc. METHODS: This laboratory-based study incorporated isolated lumbar spine annular specimens from younger and normal or mildly degenerated intervertebral discs. Specimens were quasi-statically distracted to failure in an environmentally controlled chamber. Stress and strain associated with yield and ultimate failure were quantified, as was stiffness in the elastic and postyield regions. Analysis of variance was used to determine statistically significant differences based on lumbar spine level, radial position, and anatomical region of the disc. RESULTS: Annular specimens demonstrated a nonlinear response consisting of the following: toe region, linear elastic region, yield point, postyield region, and ultimate failure point. Regional dependency was identified between deep and superficial fibers. Mechanical yield was evident prior to ultimate failure in 98% of the specimens and occurred at approximately 80% and 74% of the stress and strain, respectively, to ultimate failure. Fiber modulus decreased by 34% following yield. CONCLUSIONS: Data in this study demonstrated that yielding of intervertebral disc fibers occurs relatively early in the mechanical response of the tissues and that stiffness is considerably decreased following yield. Therefore, yielding of annular fibers may result in decreased segmental stability, contributing to accelerated degeneration of bony components and possible idiopathic pain.

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.

Upright magnetic resonance imaging measurement of prevertebral soft tissue in the cervical spine of normal volunteers.

BACKGROUND CONTEXT: Anteroposterior width of prevertebral soft tissues (PVSTs) in the cervical spine has long been considered a valuable radiographic measurement for evaluation of occult cervical spine pathology. These measurements, generally obtained from lateral radiographs of the cervical spine, have been used clinically as references for the evaluation of patients with traumatic, neoplastic, or other cervical spine disorders. Magnetic resonance imaging (MRI) offers a subtle delineation of the soft-tissue structures anterior to the vertebral column, with the potential for more accurate and sensitive determination of PVST width. Upright magnetic resonance images permit comparison with and validation of previously reported upright lateral radiographic measurements of PVST width. To our knowledge, evaluation of cervical spine PVST width using upright MRI has not been previously published in the English literature. PURPOSE: The purposes of this study were to validate lateral radiographic measurements of PVST width using upright weight-bearing MRI in healthy subjects and quantify effects of spinal level and gender. STUDY DESIGN: Clinical study in asymptomatic volunteers. METHODS: Eleven male and eight female volunteers consented and were enrolled in the study. All volunteers were asymptomatic and had no history of cervical spine injury or degenerative disease. Prevertebral soft-tissue width was measured at each cervical level from C2 to C7 using upright weight-bearing MRI. Statistically significant differences in PVST width based on spinal level and gender were determined using two-factor analysis of variance. RESULTS: Width magnitudes were significantly dependent on gender (p<.0001) and spinal level (p<.0001). All C3 and C6 measurements were below the traditionally accepted values of 7 and 20 mm, respectively, that would be considered "abnormal." Prevertebral soft-tissue width was greater in men at upper and lower extents of the cervical spine. Prevertebral soft-tissue widths reported in the present study were similar in magnitude and level-by-level trends to measurements of asymptomatic volunteers obtained using lateral radiography. CONCLUSION: The present study validated the use of lateral radiography to measure PVST width, presented level-by-level and gender-specific normative data, and provided a weighted statistical analysis of differences between normal volunteers and injured patients.