Cervical spine injuries, mechanisms, stability and AIS scores from vertical loading applied to military environments. Eur Spine J 2016 Jul;25(7):2193-201
Date
04/05/2016Pubmed ID
27043728DOI
10.1007/s00586-016-4536-yScopus ID
2-s2.0-84962164849 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
PURPOSE: The purpose of this study was to determine injuries to osteo-ligamentous structures of cervical column, mechanisms, forces, severities and AIS scores from vertical accelerative loading.
METHODS: Seven human cadaver head-neck complexes (56.9 ± 9.5 years) were aligned based on seated the posture of military soldiers. Army combat helmets were used. Specimens were attached to a vertical accelerator to apply caudo-cephalad g-forces. They were accelerated with increasing insults. Intermittent palpation and radiography were done. A roof structure mimicking military vehicle interior was introduced after a series of tests and experiments were conducted following similar protocols. Upon injury detection, CT and dissection were done. Temporal force responses were extracted, peak forces and times of occurrence were obtained, injury severities were graded, and spine stability was determined.
RESULTS: Injuries occurred in tests only when the roof structure was included. Responses were tri-phasic: initial thrust, secondary tensile, tertiary roof contact phases. Peak forces: 1364-4382 N, initial thrust, 165-169 N, secondary tensile, 868-3368 N tertiary helmet-head roof contact phases. Times of attainments: 5.3-9.6, 31.7-42.6, 55.0-70.8 ms. Injuries included fractures and joint disruptions. Multiple injuries occurred in all but one specimen. A majority of injury severities were AIS = 2. Spines were considered unstable in a majority of cases.
CONCLUSIONS: Spine response was tri-phasic. Injuries occurred in roof contact tests with the helmeted head-neck specimen. Multiplicity and unstable nature of AIS = 2 level injuries, albeit at lower severities, might predispose the spine to long-term accelerated degenerative changes. Clinical protocols should include a careful evaluation of sub-catastrophic injuries in military patients.
Author List
Yoganandan N, Pintar FA, Humm JR, Maiman DJ, Voo L, Merkle AAuthors
Frank A. Pintar PhD Chair, Professor in the Biomedical Engineering department at Medical College of WisconsinNarayan Yoganandan PhD Professor in the Neurosurgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Abbreviated Injury ScaleAdult
Aged
Cadaver
Cervical Vertebrae
Head
Head Protective Devices
Humans
Male
Middle Aged
Military Personnel
Multiple Trauma
Neck
Neck Injuries
Posture
Radiography
Spinal Cord Injuries
Spinal Fractures
Spine
Tomography, X-Ray Computed
Weight-Bearing
