A proposed injury threshold for mild traumatic brain injury

Traumatic brain injuries constitute a significant portion of injury resulting from automotive collisions, motorcycle crashes, and sports collisions. Brain injuries not only represent a serious trauma for those involved but also place an enormous burden on society, often exacting a heavy economical, social, and emotional price. Development of intervention strategies to prevent or minimize these injuries requires a complete understanding of injury mechanisms, response and tolerance level. In this study, an attempt is made to delineate actual injury causation and establish a meaningful injury criterion through the use of the actual field accident data. Twenty-four head-to-head field collisions that occurred in professional football games were duplicated using a validated finite element human head model. The injury predictors and injury levels were analyzed based on resulting brain tissue responses and were correlated with the site and occurrence of mild traumatic brain injury (MTBI). Predictions indicated that the shear stress around the brainstem region could be an injury predictor for concussion. Statistical analyses were performed to establish the new brain injury tolerance level.

Neck kinematics in rear-end impacts

The purpose of this study was to document the kinematics of the neck during low-speed rear-end impacts. In a series of experiments reported by Deng et al (2000), a pneumatically driven mini-sled was used to study cervical spine motion using six cadavers instrumented with metallic markers at each cervical level, a 9-accelerometer mount on the head, and a tri-axial accelerometers on the thorax. A 250-Hz x-ray system was used to record marker motion while acceleration data were digitized at 10,000 Hz. Results show that, in the global coordinate system, the head and all cervical vertebrae were primarily in extension during the entire period of x-ray data collection. In local coordinate systems, upper cervical segments were initially in relative flexion while lower segments were in extension. Facet joint capsular stretch ranged from 17 to 97%. In the vertical direction, the head and T1 accelerated upward almost instantaneously after impact initiation while there was delay for the head in the horizontal direction. This combination was the result of a force vector which was pointed in the forward and upward direction to generate an extension moment. Upward ramping of the torso was larger in tests with a 20-deg seatback angle. The study concluded that the kinematics of the neck is rather complicated and greatly influenced by the large rotations of the thoracic spine. Significant posterior shear deformation was found, as evidenced by the large facet capsular stretch. Although the neck forms a "mild" S-shaped curve during whiplash, using its shape as an injury mechanism can be misleading because the source of pain is likely to be located in the facet capsules.

Mechanical characterization of porcine abdominal organs

Typical automotive related abdominal injuries occur due to contact with the rim of the steering wheel, seatbelt and armrest, however, the rate is less than in other body regions. When solid abdominal organs, such as the liver, kidneys and spleen are involved, the injury severity tends to be higher. Although sled and pendulum impact tests have been conducted using cadavers and animals, the mechanical properties and the tissue level injury tolerance of abdominal solid organs are not well characterized. These data are needed in the development of computer models, the improvement of current anthropometric test devices and the enhancement of our understanding of abdominal injury mechanisms. In this study, a series of experimental tests on solid abdominal organs was conducted using porcine liver, kidney and spleen specimens. Additionally, the injury tolerance of the solid organs was deduced from the experimental data.

Computational study of the contribution of the vasculature on the dynamic response of the brain

Brain tissue architecture consists of a complex network of neurons and vasculature interspersed within a matrix of supporting cells. The role of the relatively stiffer blood vessels on the more compliant brain tissues during rapid loading has not been properly investigated. Two 2-D finite element models of the human head were developed. The basic model (Model I) consisted of the skull, dura matter, cerebral spinal fluid (CSF), tentorium, brain tissue and the parasagittal bridging veins. The pia mater was also included but in a simplified form which does not correspond to the convolutions of the brain. In Model II, major branches of the cerebral arteries were added to Model I. Material properties for the brain tissues and vasculature were taken from those reported in the literature. The model was first validated against intracranial pressure and brain/skull relative motion data from cadaveric tests. Two loading conditions, an anterior-posterior linear acceleration and a flexion-extension angular velocity pulse, were applied to both models. Resulting maximum principal strain, shear strain and intracranial pressure throughout the intracranial tissue were calculated and compared. Overall, the maximum principal strain/stress in the brain was lower in the model that included simulated blood vessels. The inclusion of the cerebral vessels added regional strength to the brain substance, and thereby contributed to the load bearing capacity of this composite brain model during head impact, analogous to reinforcing bars in a reinforced concrete structure. In addition to the neurovasculature, the pia membrane, which conforms to the numerous gyri and sulci not modeled in this study, may add to the structural strength of the brain. Results from this investigation suggest that the fine anatomical substructures of the brain should not be ignored in traumatic brain injury modeling. However, incorporation of blood vessels in a 3-D FE head model is not practical at this stage due to the lack of computing power.

Structural Response of Lower Leg Muscles in Compression: A Low Impact Energy Study Employing Volunteers, Cadavers and the Hybrid III

Little has been reported in the literature on the compressive properties of muscle. These data are needed for the development of finite element models that address impact of the muscles, especially in the study of pedestrian impact. Tests were conducted to characterize the compressive response of muscle. Volunteers, cadaveric specimens and a Hybrid III dummy were impacted in the posterior and lateral aspect of the lower leg using a free flying pendulum. Volunteer muscles were tested while tensed and relaxed. The effects of muscle tension were found to influence results, especially in posterior leg impacts. Cadaveric response was found to be similar to that of the relaxed volunteer. The resulting data can be used to identify a material law using an inverse method.

Fundamentals of impact biomechanics: Part 2--Biomechanics of the abdomen, pelvis, and lower extremities

This is the second of two chapters (the first chapter appeared in the Annual Review of Biomedical Engineering, 2000, 2:55-81) dealing with some 60 years of accumulated knowledge in the field of impact biomechanics. The regions covered in the first chapter were the head, neck, and thorax. In this chapter, the abdomen, pelvis, and lower extremities are discussed. The thoracolumbar spine is not covered because of length limitations and the low frequency of injury to this area from automotive accidents. Again, in the cited results, the reader needs to be keenly aware of the wide variation in human response and tolerance. This is due primarily to the large biological variations among humans and to the effects of aging. Average values that are useful in design cannot be applied to individuals.

Fundamentals of impact biomechanics: Part I--Biomechanics of the head, neck, and thorax

This is the first of two chapters dealing with some 60 years of accumulated knowledge in the field of impact biomechanics. The regions covered in this first chapter are the head, neck, and thorax. The next chapter will discuss the abdomen, pelvis, and the lower extremities. Although the principal thrust of the research has been toward the mitigation of injuries sustained by automotive crash victims, the results of this research have applications in aircraft safety, contact sports, and protection of military personnel and civilians from intentional injury, such as in the use of nonlethal weapons. The reader should be keenly aware of the wide variation in human response and tolerance data in the cited results. This is due primarily to the large biological variation among humans and to the effects of aging. Average values are useful in design but cannot be applied to individuals.

Recent advances in brain injury research: a new human head model development and validation

Many finite element models have been developed by several research groups in order to achieve a better understanding of brain injury. Due to the lack of experimental data, validation of these models has generally been limited. Consequently, applying these models to investigate brain responses has also been limited. Over the last several years, several versions of the Wayne State University brain injury model (WSUBIM) were developed. However, none of these models is capable of simulating indirect impacts with an angular acceleration higher than 8,000 rad/s(2). Additionally, the density and quality of the mesh in the regions of interest are not detailed and sensitive enough to accurately predict the stress/strain level associated with a wide range of impact severities. In this study, WSUBIM version 2001, capable of simulating direct and indirect impacts with a combined translational and rotational acceleration of the head up to 200 g and 12,000 rad/s(2) has been developed. This new finely meshed model, consisting of more than 314,500 elements and 281,800 nodes, also simulates an anatomically detailed facial bone model. An additional new feature of the model is the damageable material property representation of the facial bone and the skull, allowing it to simulate bony fractures. The model was subjected to extensive validation using published cadaveric test data. These data include the intracranial and ventricular pressure data reported by Nahum et al. (1977) and Trosseille et al. (1992), the relative displacement data between the brain and the skull reported by King et al. (1999) and Hardy et al. (2001), and the facial impact data reported by Nyquist et al. (1986) and Allsop et al. (1988). With the enhanced accuracy of model predictions offered by this new model, along with new experimental data, it is hoped that it will become a powerful tool to further our understanding of the mechanisms of injury and the tolerance of the brain to blunt impact.

Investigation of Head Injury Mechanisms Using Neutral Density Technology and High-Speed Biplanar X-ray

The principal focus of this study was the measurement of relative brain motion with respect to the skull using a high-speed, biplanar x-ray system and neutral density targets (NDTs). A suspension fixture was used for testing of inverted, perfused, human cadaver heads. Each specimen was subjected to multiple tests, either struck at rest using a 152-mm-diameter padded impactor face, or stopped against an angled surface from steady-state motion. The impacts were to the frontal and occipital regions. An array of multiple NDTs was implanted in a double-column scheme of 5 and 6 targets, with 10 mm between targets in each column and 80 mm between columns. These columns were implanted in the temporoparietal and occipitoparietal regions. The impacts produced peak resultant accelerations of 10 to 150 g, and peak angular accelerations between 1000 and 8000 rad/s(2). For all but one test, the peak angular speeds ranged from 17 to 22 rad/s. The relative 3D displacements between the skull and the NDTs were analyzed. The localized motions of the brain generally followed loop or figure eight patterns, with peak displacements on the order of +/- 5 mm. These results can be used to further finite-element modeling efforts.

Lower Limb: Advanced FE Model and New Experimental Data

The Lower Limb Model for Safety (LLMS) is a finite element model of the lower limb developed mainly for safety applications. It is based on a detailed description of the lower limb anatomy derived from CT and MRI scans collected on a subject close to a 50th percentile male. The main anatomical structures from ankle to hip (excluding the hip) were all modeled with deformable elements. The modeling of the foot and ankle region was based on a previous model Beillas et al. (1999) that has been modified. The global validation of the LLMS focused on the response of the isolated lower leg to axial loading, the response of the isolated knee to frontal and lateral impact, and the interaction of the whole model with a Hybrid III model in a sled environment, for a total of nine different set-ups. In order to better characterize the axial behavior of the lower leg, experiments conducted on cadaveric tibia and foot were reanalyzed and experimental corridors were proposed. Future work will include additional validation of the model using global data, joint kinematics data, and deformation data at the local level.

Development of a computer model to predict aortic rupture due to impact loading

Aortic injuries during blunt thoracic impacts can lead to life threatening hemorrhagic shock and potential exsanguination. Experimental approaches designed to study the mechanism of aortic rupture such as the testing of cadavers is not only expensive and time consuming, but has also been relatively unsuccessful. The objective of this study was to develop a computer model and to use it to predict modes of loading that are most likely to produce aortic ruptures. Previously, a 3D finite element model of the human thorax was developed and validated against data obtained from lateral pendulum tests. The model included a detailed description of the heart, lungs, rib cage, sternum, spine, diaphragm, major blood vessels and intercostal muscles. However, the aorta was modeled as a hollow tube using shell elements with no fluid within, and its material properties were assumed to be linear and isotropic. In this study fluid elements representing blood have been incorporated into the model in order to simulate pressure changes inside the aorta due to impact. The current model was globally validated against experimental data published in the literature for both frontal and lateral pendulum impact tests. Simulations of the validated model for thoracic impacts from a number of directions indicate that the ligamentum arteriosum, subclavian artery, parietal pleura and pressure changes within the aorta are factors that could influence aortic rupture. The model suggests that a right-sided impact to the chest is potentially more hazardous with respect to aortic rupture than any other impact direction simulated in this study. The aortic isthmus was the most likely site of aortic rupture regardless of impact direction. The reader is cautioned that this model could only be validated on a global scale. Validation of the kinematics and dynamics of the aorta at the local level could not be done due to a lack of experimental data. It is hoped that this model will be used to design experiments that can reproduce field relevant aortic ruptures in the laboratory. Only after such experiments have been run, can local validation be examined and the model judged to be acceptable or unacceptable.

Biomechanics of neurotrauma

This paper reviews the traditional areas of impact biomechanics as they relate to brain injury caused by blunt impact. These areas are injury mechanisms, human response to impact, human tolerance to impact and the use of human surrogates. With the advent of high-speed computers, it is now possible to add computer models to the list of human surrogates that used to be limited to animals and human cadavers. The advantages and shortcomings of current computer models are discussed. One of the computer models was used to predict the pressures and shear stresses developed in the brain and the extent of stretch of the bridging veins in the brains of American football players who sustained severe helmet-to-helmet head impact during the game. It was found that increases in intracranial pressure were more dependent on translational acceleration while the primary determinant for the development of shear stresses in the brain is rotational acceleration. Although the current head injury criterion is based almost entirely on translational acceleration, it is recommended that any new criterion should reflect the contribution of both translational and rotational acceleration.

Comparison of brain responses between frontal and lateral impacts by finite element modeling

This study was conducted to investigate differences in brain response due to frontal and lateral impacts based on a partially validated three-dimensional finite element model with all essential anatomical features of a human head. Identical impact and boundary conditions were used for both the frontal and lateral impact simulations. Intracranial pressure and localized shear stress distributions predicted from these impacts were analyzed. The model predicted higher positive pressures accompanied by a relatively large localized skull deformation at the impact site from a lateral impact when compared to a frontal impact. Lateral impact also induced higher localized shear stress in the core regions of the brain. Preliminary results of the simulation suggest that skull deformation and internal partitions may be responsible for the directional sensitivity of the head in terms of intracranial pressure and shear stress response. In previous experimental studies using subhuman primates, it was found that a lateral impact was more injurious than a frontal impact. In this study, shear stress in the brain predicted by the model was much higher in a lateral impact in comparison with a frontal impact of the same severity. If shear deformation is considered as an injury indicator for diffuse brain injuries, a higher shear stress due to a lateral impact indicate that the head would tend to have a decreased tolerance to shear deformation in lateral impact. More research is needed to further quantify the effect of the skull deformation and dural partitions on brain injury due to impacts from a variety of directions and at different locations.

Development of a finite element model of the human shoulder

Previous studies have hypothesized that the shoulder may be used to absorb some impact energy and reduce chest injury due to side impacts. Before this hypothesis can be tested, a good understanding of the injury mechanisms and the kinematics of the shoulder is critical for occupant protection in side impact. However, existing crash dummies and numerical models are not designed to reproduce the kinematics and kinetics of the human shoulder. The purpose of this study was to develop a finite element model of the human shoulder in order to achieve a deeper understanding of the injury mechanisms and the kinematics of the shoulder in side impact. Basic anthropometric data of the human shoulder used to develop the skeletal and muscular portions of this model were taken from commercial data packages. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. This model was then integrated into a human thorax model developed at Wayne State University (WSU) along with pre-existing models of other body parts such as the pelvis and the lower extremities. Material properties used for the model were taken from the literature. The model was first used to simulate lateral shoulder impact study by the Association Peugeot- Renault (APR) followed by simulations of several of the 17 rigid and padded cadaveric impacts conducted on a side impact sled at WSU. Contact forces measured at the levels of shoulder, thorax, abdomen and pelvis were used as response variables to validate the model. Additionally, a cadaveric test involving the deployment of a generic side airbag was also used to check the validity of the model. Model prediction of accelerations of the shoulder matched well against those measured experimentally. The role of the shoulder in side impact protection and the reduction of injury to the ribcage are discussed, based on model results.

Qualitative analysis of neck kinematics during low-speed rear-end impact

OBJECTIVE

To analyze neck kinematics and loading patterns during rear-end impacts.

DESIGN

The motion of each cervical vertebra was captured using a 250 frame/s X-ray system during a whole body rear-end impact. These data were analyzed in order to understand different phases of neck loading during rear-end impact.

BACKGROUND

The mechanism of whiplash injury remains largely unknown. An understanding of the underlying kinematics of whiplash is crucial to the identification of possible injury mechanisms before countermeasures can be designed.

METHODS

Metallic markers were inserted into the vertebral bodies and spinous processes of each of the seven cervical vertebrae. Relative displacement-time traces between each pair of adjacent cervical vertebrae were calculated from X-ray data. Qualitative analyses of the kinematics of the neck at different phase of impact were performed.

RESULTS

The neck experiences compression, tension, shear, flexion and extension at different cervical levels and/or during different stages of the whiplash event.

CONCLUSIONS

Neck kinematics during whiplash is rather complicated and greatly influenced by the rotation of the thoracic spine, which occurs as a result of the straightening of the kyphotic thoracic curvature.

RELEVANCE

Understanding the complicated kinematics of a rear-end impact may help clinicians and researchers shed some light on potential mechanisms of whiplash neck injury.

Kinematics of human cadaver cervical spine during low speed rear-end impacts

The purposes of this study were to measure the relative linear and angular displacements of each pair of adjacent cervical vertebrae and to compute changes in distance between two adjacent facet joint landmarks during low posterior-anterior (+Gx) acceleration without significant hyperextension of the head. A total of twentysix low speed rear-end impacts were conducted using six postmortem human specimens. Each cadaver was instrumented with two to three neck targets embedded in each cervical vertebra and nine accelerometers on the head. Sequential x-ray images were collected and analyzed. Two seatback orientations were studied. In the global coordinate system, the head, the cervical vertebrae, and the first or second thoracic vertebra (T1 or T2) were in extension during rear-end impacts. The head showed less extension in comparison with the cervical spine. Relative motion for each cervical motion segment went from flexion at the upper cervical levels to extension at the lower cervical levels, with a transition region at the mid-cervical levels. This rotational pattern formed an "S" shape in the cervical spine during the initial phase of low-speed rear impacts. A pair of facet joint landmarks on each cervical motion segment was used to measure the distance across the joint space. Uni-axial facet capsular strains were calculated by dividing changes in this distance over the original distance in seven tests using three specimens. In 20-degree seatback tests, the average strain was 32+/-11% for the C2/C3 facet joint (17%-43% range), and 59+/-26% for the C3/C4 facet joint (41%-97% range). The C4/C5 and C5/C6 facet joints exhibited peak tensile or compressive strains in different specimens. In 0-degree seatback tests, the average strain was 28+/-11% for the C2/C3 facet joint (21%-41% range), 30+/-9% for the C3/C4 facet joint (21%-39% range), 22+/-4% for the C4/C5 facet joint (19%-25% range), and 60+/-13% for the C5/C6 facet joint (51%-69% range). In 20-degree seatback tests, there was less initial cervical lordosis, more upward ramping of the thoracic spine, and more relative rotation of each cervical motion segment in comparison with the 0-degree seatback tests. Relative to T1, the head went from flexion to extension for 20-degree seatback tests while stayed in extension for 0-degree seatback tests.

Effects of phospholipase A2 on lumbar nerve root structure and function

STUDY DESIGN

To investigate the effects of phospholipase A2 on the neurophysiology and histology of rat lumbar spinal nerves and the corresponding behavioral changes.

OBJECTIVES

To study possible mechanisms of sciatica.

SUMMARY OF BACKGROUND DATA

The pathophysiology of sciatica is uncertain, although mechanical, chemical, and ischemic factors have been proposed.

METHODS

Phospholipase A2 was injected into the rat L4-L5 epidural space, and the rats were observed for 3 or 21 days. Behavioral studies were conducted daily during the survival period. On the 3rd or 21st day, extracellular nerve recordings were made from dorsal roots, to determine discharge properties and mechanical sensitivity. The nerve roots were then sectioned for a light-microscopic examination.

RESULTS

Motor weakness of hind limbs and altered sensation were observed. In the 3-day phospholipase A2 groups, squeezing the dorsal roots at the L4-L5 disc level (force = 0.8 g) evoked sustained ectopic discharge that lasted approximately 8 minutes. Squeezing the roots distal to the L4-L5 area did not result in sustained discharges. In sham, control, and 21-day phospholipase A2 groups, squeezing the dorsal roots elicited only a transient firing that lasted approximately 0.1 second. Loss of myelin was seen in the nerve root cross sections in the 3-day group, and remyelination was observed in the 21-day group. No abnormality was found in the control groups.

CONCLUSIONS

Based on these studies, it is hypothesized that phospholipase A2 causes demyelination that results in hypersensitive regions where ectopic discharge may be elicited by mechanical stimulation. These ectopic discharges may be a source of sciatica. We believe that, as long as these irritating factors are present, the hypersensitive nerve root nerve will continue to fire, and sciatic pain will persist.

Mechanisms of low back pain: a neurophysiologic and neuroanatomic study

Idiopathic low back pain has confounded health care practitioners for decades. The cellular and neural mechanisms that lead to facet pain, discogenic pain, and sciatica are not well understood. To help elucidate these mechanisms, anesthetized New Zealand white rabbits were used in a series of neurophysiologic and neuroanatomic studies. These studies showed the following evidence in support of facet pain: an extensive distribution of small nerve fibers and endings in the lumbar facet joint, nerves containing substance P, high threshold mechanoreceptors in the facet joint capsule, and sensitization and excitation of nerves in facet joint and surrounding muscle when the nerves were exposed to inflammatory or algesic chemicals. Evidence for pain of disc origin included an extensive distribution of small nerve fibers and free nerve endings in the superficial annulus of the disc and small fibers and free nerve endings in adjacent longitudinal ligaments. Possible mechanisms of sciatica included vigorous and long lasting excitatory discharges when dorsal root ganglia were subjected to moderate pressure, excitation of dorsal root fibers when the ganglia were exposed to autologous nucleus pulposus, and excitation and loss of nerve function in nerve roots exposed to phospholipase A2.

The relationship between loading conditions and fracture patterns of the proximal femur

In an attempt to test the hypothesis of spontaneous hip fracture, seven pairs of femurs, with ages ranging from 59 to 90, were tested under two loading conditions designed to simulate muscular contraction. Simulated iliopsoas contraction produced femoral neck fractures at an average normalized ultimate load of 5.2 +/- 0.8 times body weight. Simulated gluteus medius contraction produced sub-/inter-trochanteric fractures at an average normalized ultimate load of 4.1 +/- 0.6 times body weight. The average ultimate load for all specimens was 3040 +/- 720 N. Fracture patterns produced by both loading conditions were clinically relevant. The results from this study suggest that abnormal contraction produced by major rotator muscles could induce hip fracture.

Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology

Idiopathic low back pain has confounded health care practitioners for decades. Although there has been much advance in the understanding of the biomechanics of the lumbar spine over the past 25 years, the cellular and neural mechanisms that lead to facet pain are not well understood. An extensive series of experiments was undertaken to help elucidate these mechanisms and gain a better understanding of lumbar facet pain. Biomechanic and neuroanatomic studies were performed in human cadaveric facet joints and neurophysiologic studies were performed in New Zealand White rabbits. These studies provide the following evidence to help explain the mechanisms of lumbar facet pain: (1) The facet joint can carry a significant amount of the total compressive load on the spine when the human spine is hyperextended. (2) Extensive stretch of the human facet joint capsule occurs when the spine is in the physiologic range of extreme extension. (3) An extensive distribution of small nerve fibers and free and encapsulated nerve endings exists in the lumbar facet joint capsule, including nerves containing substance P, a putative neuromodulator of pain. (4) Low and high threshold mechanoreceptors fire when the facet joint capsule is stretched or is subject to localized compressive forces. (5) Sensitization and excitation of nerves in facet joint and surrounding muscle occur when the joint is inflamed or exposed to certain chemicals that are released during injury and inflammation. (6) Marked reduction in nerve activity occurs in facet tissue injected with hydrocortisone and lidocaine. Thus, the facet joint is a heavily innervated area that is subject to high stress and strain. The resulting tissue damage or inflammation is likely to cause release of chemicals irritating to the nerve endings in these joints, resulting in low back pain.

A morphological study of the fibrous capsule of the human lumbar facet joint

STUDY DESIGN

Macroscopic and microscopic investigations of the human lumbar facet joint capsule were undertaken.

OBJECTIVE

To describe the morphologic characteristics of the fibrous capsule of the lumbar facet joints.

SUMMARY OF BACKGROUND DATA

Previous biomechanical and neurophysiologic studies by the authors have shown that the lumbar facet joint capsule may be a source of low back pain.

METHODS

Macroscopic investigation was performed on the facet joint capsules dissected from five fresh adult cadavers. For microscopic studies, facet joint capsules obtained from cadaver dissection and spinal surgeries were stained by the hematoxylin and eosin method and the Elastica-Van Gieson method.

RESULTS

The outer layer of the fibrous capsule is a dense regular connective tissue that is composed of parallel bundles of collagenous fibers. The inner layer of the fibrous capsule consists of bundles of elastic fibers, similar to the ligamentum flavum. In the superior and middle part of the joint, the fibers run in the medial to lateral direction, crossing over the joint gap. In the inferior part of the joint, the fibers are relatively long and run in a superior-medial to inferior-lateral direction, covering the inferior articular recess. They are thicker than the layer in the superior and middle parts of the joint.

CONCLUSIONS

Anatomical and histologic features of the lumbar facet joint capsule are different between its outer layer and inner layer. This complex of morphologic factors can affect the biomechanics and neurophysiology of the lumbar facet joint.

Phospholipase A2-induced electrophysiologic and histologic changes in rabbit dorsal lumbar spine tissues

STUDY DESIGN

The present study was designed to characterize the effect of phospholipase A2 on the discharge of perispinal sensory nerves in the anesthetized New Zealand white rabbit.

OBJECTIVES

To examine the effects of phospholipase A2 on the neural response of somatosensory neurons innervating the lumbar facet joint and surrounding tissues.

SUMMARY OF BACKGROUND DATA

An irritating component of disc tissue may be phospholipase A2, which has been found at extraordinary high levels in herniated and painful discs. Phospholipase A2 has been shown to be inflammatory, but its effect on nerve response has never been shown.

METHODS

Surgically isolated facet joint capsules from rabbits were investigated by means of electrophysiologic and histologic techniques. Phospholipase A2 was injected into the characterized nerve receptive field, and responses were evaluated over time with varying doses.

RESULTS

The injection of phospholipase A2 into the nerve receptive fields produced neurotoxicity with a 1500-U dose, sensitization of the nerves and recruitment of "silent units" with a 750-U dose, and no electrophysiologic effect with a 400-U dose. The tissues injected with phospholipase A2 and control solutions were examined histologically using a hematoxylin and eosin staining technique. In all three doses, the inflammatory changes were observed as soon as 2 hours after the injections. In control subjects, no changes were observed.

CONCLUSIONS

After phospholipase A2 injection, the discharge rate of the units showed dose and time dependent patterns. Regardless of the different doses, histologic changes were observed as soon as 2 hours after the phospholipase A2 injections.

Recent advances in biomechanics of brain injury research: a review

Biomechanics of cerebral trauma attempts to delineate the dynamic response of the cranial vault contents to a direct or indirect impact to the head. Consequently, brain injury mechanisms and associated tolerance to impact can be deduced by establishing a relationship between neurological deficit and mechanical dosage. The resulting information is invaluable to brain injury prevention and diagnosis. This paper presents an overview of our recent research on head injury focusing on establishing brain injury biomechanics by developing a comprehensive and validated mathematical model. To achieve our goal, we developed a comprehensive three-dimensional finite element human head model, finite element porcine head models, and sensors to monitor head kinematics and brain strains by neutral density accelerometers. The information obtained from this research thus far provided a predictive and somewhat validated mathematical model of the head, which clearly shows a correspondence between brain mechanical response and experimentally observed injuries.

Research in biomechanics of occupant protection

This paper discusses the biomechanical bases for occupant protection against frontal and side impact. Newton's Laws of Motion are used to illustrate the effect of a crash on restrained and unrestrained occupants, and the concept of ride down is discussed. Occupant protection through the use of energy absorbing materials is described, and the mechanism of injury of some of the more common injuries is explained. The role of the three-point belt and the airbag in frontal protection is discussed along with the potential injuries that can result from the use of these restraint systems. Side impact protection is more difficult to attain but some protection can be derived from the use of padding or a side impact airbag. It is concluded that the front seat occupants are adequately protected against frontal impact if belts are worn in an airbag equipped vehicle. Side impact protection may not be uniform in all vehicles.