Investigation of whiplash injuries in the upper cervical spine using a detailed neck model

Effect of muscle pre-tension and pre-impact neck posture on the kinematic response of the cervical spine in simulated low-speed rear impacts

Computational human body models (HBMs) can identify potential injury pathways not easily accessible through experimental studies, such as whiplash induced injuries. However, previous computational studies investigating neck response to simulated impact conditions have neglected the effect of pre-impact neck posture and muscle pre-tension on the intervertebral kinematics and tissue-level response. The purpose of the present study was addressing this knowledge gap using a detailed neck model subjected to simulated low-acceleration rear impact conditions, towards improved intervertebral kinematics and soft tissue response for injury assessment. An improved muscle path implementation in the model enabled the modeling of muscle pre-tension using experimental muscle pre-stretch data determined from previous cadaver studies. Cadaveric neck impact tests and human volunteer tests with the corresponding cervical spine posture were simulated using a detailed neck model with the reported boundary conditions and no muscle activation. Computed intervertebral kinematics of the model with pre-tension achieved, for the first time, the S-shape behavior of the neck observed in low severity rear impacts of both cadaver and volunteer studies. The maximum first principal strain in the muscles for the model with pre-tension was 27% higher than that without pre-tension. Although, the pre-impact neck posture was updated to match the average posture reported in the experimental tests, the change in posture was generally small with only small changes in vertebral kinematics and muscle strain. This study provides a method to incorporate muscle pre-tension in HBM and quantifies the importance of pre-tension in calculating tissue-level distractions.

Quantitative cervical spine injury responses in whiplash loading with a numerical method of natural neural reflex consideration

BACKGROUND AND OBJECTIVE

Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model.

METHODS

A new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations.

RESULT

The results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries.

CONCLUSION

In summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.

Intersegmental Kinematics of the Upper Cervical Spine: Normal Range of Motion and Its Alteration After Alar Ligament Transection

STUDY DESIGN

Biomechanical study using cadaveric cervical spines.

OBJECTIVE

To evaluate joint mobility and stiffness at the craniovertebral junction.

SUMMARY OF BACKGROUND DATA

Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation.

METHODS

Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment-rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side.

RESULTS

The intersegmental (C0-C1/C1-C2) moment-rotation response was continuously quantified in full flexion (7.2 ± 6.6°/12.1 ± 5.8°), extension (11.1 ± 6.4°/3.0 ± 2.8°), lateral bending to the right (3.1 ± 2.2°/1.6 ± 1.2°) and left sides (3.3 ± 1.6°/2.1 ± 1.5°), and axial rotation to the right (1.2 ± 3.5°/32.3 ± 9.3°) and left sides (2.7 ± 2.6°/25.3 ± 8.3°). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed.

CONCLUSION

Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.Level of Evidence: N/A.

Sex, Age and Stature Affects Neck Biomechanical Responses in Frontal and Rear Impacts Assessed Using Finite Element Head and Neck Models

The increased incidence of injury demonstrated in epidemiological data for the elderly population, and females compared to males, has not been fully understood in the context of the biomechanical response to impact. A contributing factor to these differences in injury risk could be the variation in geometry between young and aged persons and between males and females. In this study, a new methodology, coupling a CAD and a repositioning software, was developed to reposture an existing Finite element neck while retaining a high level of mesh quality. A 5th percentile female aged neck model (F05_75YO) and a 50th percentile male aged neck model (M50_75YO) were developed from existing young (F05_26YO and M50_26YO) neck models (Global Human Body Models Consortium v5.1). The aged neck models included an increased cervical lordosis and an increase in the facet joint angles, as reported in the literature. The young and the aged models were simulated in frontal (2, 8, and 15 g) and rear (3, 7, and 10 g) impacts. The responses were compared using head and relative facet joint kinematics, and nominal intervertebral disc shear strain. In general, the aged models predicted higher tissue deformations, although the head kinematics were similar for all models. In the frontal impact, only the M50_75YO model predicted hard tissue failure, attributed to the combined effect of the more anteriorly located head with age, when compared to the M50_26YO, and greater neck length relative to the female models. In the rear impacts, the F05_75YO model predicted higher relative facet joint shear compared to the F05_26YO, and higher relative facet joint rotation and nominal intervertebral disc strain compared to the M50_75YO. When comparing the male models, the relative facet joint kinematics predicted by the M50_26YO and M50_75YO were similar. The contrast in response between the male and female models in the rear impacts was attributed to the higher lordosis and facet angle in females compared to males. Epidemiological data reported that females were more likely to sustain Whiplash Associated Disorders in rear impacts compared to males, and that injury risk increases with age, in agreement with the findings in the present study. This study demonstrated that, although the increased lordosis and facet angle did not affect the head kinematics, changes at the tissue level were considerable (e.g., 26% higher relative facet shear in the female neck compared to the male, for rear impact) and relatable to the epidemiology. Future work will investigate tissue damage and failure through the incorporation of aged material properties and muscle activation.

Ligament deformation patterns of the craniocervical junction during head axial rotation tracked by biplane fluoroscopes

BACKGROUND

Frequently, treatment decisions for craniocervical injuries and instability are based on imaging findings, but in vivo ligament kinematics were poorly understood. This study was to determine in vivo deformation patterns of primary ligaments in the craniocervical junction (i.e., C0-2), including the cruciform ligament, alar ligaments, and accessory ligaments, during dynamic head axial rotation.

METHODS

The skulls and cervical spines of eight asymptomatic female subjects were dynamically imaged using a biplane fluoroscopic imaging system, when they performed left and right head axial rotations. Using a 3D-to-2D registration technique, the in vivo positions and orientations of cervical segments were determined. An optimization algorithm was implemented to determine ligament wrapping paths, and the resulting ligament deformations were represented by percent elongations. Using paired t-tests, ligament deformations in the end-range position were compared to those in the neutral position.

FINDINGS

No significant differences were observed in segmental motions during left and right head rotations (p > 0.05). In general, slight deformations occurred in each component of the cruciform ligament. For the alar ligaments, the ipsilateral ligament was lengthened from -0.7 ± 13.8% to 16.6 ± 15.7% (p < 0.001*). For the accessory ligaments, the contralateral ligament was lengthened from -2.9 ± 7.5% to 10.1 ± 6.2% (p < 0.001*).

INTERPRETATION

This study reveals that there are distinct deformation patterns in craniocervical junction ligaments during dynamic axial head rotation. These ligament deformation data can enhance our understanding of the synergic function of craniocervical junction ligaments, and guide the treatment of craniocervical instability.

Importance of the cervical capsular joint cartilage geometry on head and facet joint kinematics assessed in a Finite element neck model

Finite element human neck models (NMs) aim to predict neck response and injury at the tissue level; however, contemporary models are most often assessed using global response such as head kinematics. Additionally, many NMs are developed from subject-specific imaging with limited soft tissue resolution in small structures such as the facet joints in the neck. Such details may be critical to enable NMs to predict tissue-level response. In the present study, the capsular joint cartilage (CJC) geometry in a contemporary NM was enhanced (M50-CJC) based on literature data. The M50-CJC was validated at the segment and full neck levels and assessed using relative facet joint kinematics (FJK), capsular ligament (CL) and intervertebral disc (IVD) strains, a relative vertebral rotation assessment (IV-NIC) and head kinematics in frontal and rear impact. The validation ratings at the segment level increased from 0.60 to 0.64, with improvements for modes of deformation associated with the facet joints, while no difference was noted at the head kinematic level. The improved CJC led to increased FJK rotation (188%) and IVD strain (152.2%,) attributed to the reduced facet joint gap. Further enhancements of the capsular joint representation or a link between the FJK and CL injury risk are recommended. Enhancements at the tissue level demonstrated a large effect on the IVD strain, but were not apparent in global metrics such as head kinematics. This study demonstrated that a biofidelic and detailed geometrical representation of the CJC contributes significantly to the predicted joint response, which is critical to investigate neck injury risk at the tissue level.

Biomechanics of the upper cervical spine ligaments in axial rotation and flexion-extension: Considerations into the clinical framework

Context:

The motion of the upper cervical spine (UCS) has a great interest for analyzing the biomechanical features of this joint complex, especially in case of instability. Although investigators have analyzed numerous kinematics and musculoskeletal characteristics, there are still little data available regarding several suboccipital ligaments such as occipito-atlantal, atlantoaxial, and cruciform ligaments.

Objective:

The aim of this study is to quantify the length and moment arm magnitudes of suboccipital ligaments and to integrate data into specific 3D-model, including musculoskeletal and motion representation.

Materials and Methods:

Based on a recent method, suboccipital ligaments were identified using UCS anatomical modeling. Biomechanical characteristics of these anatomical structures were assessed for sagittal and transversal displacements regarding length and moment arm alterations.

Results:

Outcomes data indicated length alterations >25% for occipito-atlantal, atlanto-axial and apical ligaments. The length alteration of unique ligaments was negligible. Length variation was dependent on the motion direction considered. Regarding moment arm, larger magnitudes were observed for posterior ligaments, and consistent alteration was depicted for these structures.

Conclusion:

These outcomes supply relevant biomechanical characteristics of the UCS ligaments in flexion-extension and axial rotation by quantifying length and moment arm magnitude. Moreover, 3D anatomical modeling and motion representation can help in the process of understanding of musculoskeletal behaviors of the craniovertebral junction.

Study of the Emergency Braking Test with an Autonomous Bus and the sEMG Neck Response by Means of a Low-Cost System

Nowadays, due to the advances and the increasing implementation of the autonomous braking systems in vehicles, the non-collision accident is expected to become more common than a crash when a sudden stop happens. The most common injury in this kind of accident is whiplash or cervical injury since the neck has high sensitivity to sharp deceleration. To date, biomechanical research has usually been developed inside laboratories and does not entirely represent real conditions (e.g., restraint systems or surroundings of the experiment). With the aim of knowing the possible neck effects and consequences of an automatic emergency braking inside an autonomous bus, a surface electromyography (sEMG) system built by low-cost elements and developed by us, in tandem with other devices, such as accelerometers or cameras, were used. Moreover, thanks to the collaboration of 18 participants, it was possible to study the non-collision effects in two different scenarios (braking test in which the passenger is seated and looking ahead while talking with somebody in front of him (BT1) and, a second braking test where the passenger used a smartphone (BT2) and nobody is seated in front of him talking to him). The aim was to assess the sEMG neck response in the most common situations when somebody uses some kind of transport in order to conclude which environments are riskier regarding a possible cervical injury.

A Novel Modelling Methodology Which Predicts the Structural Behaviour of Vertebral Bodies under Axial Impact Loading: A Finite Element and DIC Study

Cervical spine injuries (CSIs) arising from collisions are uncommon in contact sports, such as rugby union, but their consequences can be devastating. Several FE modelling approaches are available in the literature, but a fully calibrated and validated FE modelling framework for cervical spines under compressive dynamic-impact loading is still lacking and material properties are not adequately calibrated for such events. This study aimed to develop and validate a methodology for specimen-specific FE modelling of vertebral bodies under impact loading. Thirty-five (n = 35) individual vertebral bodies (VBs) were dissected from porcine spine segments, potted in bone cement and μCT scanned. A speckle pattern was applied to the anterior faces of the bones to allow digital image correlation (DIC), which monitored the surface displacements. Twenty-seven (n = 27) VBs were quasi-statically compressively tested to a load up to 10 kN from the cranial side. Specimen-specific FE models were developed for fourteen (n = 14) of the samples in this group. The material properties were optimised based on the experimental load-displacement data using a specimen-specific factor (kGSstatic) to calibrate a density to Young’s modulus relationship. The average calibration factor arising from this group was calculated (K¯GSstatic) and applied to a control group of thirteen (n = 13) samples. The resulting VB stiffnesses was compared to experimental findings. The final eight (n = 8) VBs were subjected to an impact load applied via a falling mass of 7.4kg at a velocity of 3.1ms⁻¹. Surface displacements and strains were acquired from the anterior VB surface via DIC, and the impact load was monitored with two load cells. Specimen-specific FE models were created for this dynamic group and material properties were assigned again based on the density–Young’s modulus relationship previously validated for static experiments, supplemented with an additional factor (KGSdynamic). The optimised conversion factor for quasi-static loading, K¯GSstatic, had an average of 0.033. Using this factor, the validation models presented an average numerical stiffness value 3.72% greater than the experimental one. From the dynamic loading experiments, the value for KGSdynamic was found to be 0.14, 4.2 times greater than K¯GSstatic. The average numerical stiffness was 2.3% greater than in the experiments. Almost all models presented similar stiffness variations and regions of maximum displacement to those observed via DIC. The developed FE modelling methodology allowed the creation of models which predicted both static and dynamic behaviour of VBs. Deformation patterns on the VB surfaces were acquired from the FE models and compared to DIC data, achieving high agreement. This methodology is now validated to be fully applied to create whole cervical spine models to simulate axial impact scenarios replicating rugby collision events.

Analysis of the mechanical response of damaged human cervical spine ligaments

BACKGROUND

Cervical spine ligaments that protect the spinal cord and stabilize the spine are frequently injured in motor vehicle collisions and other traumatic situations. These injuries are usually incomplete, and often difficult to notice. The focus of the presented study is placed on analysis of the effect of subfailure load on the mechanical response of the three main cervical spine ligaments: the anterior and the posterior longitudinal ligament and the ligamentum flavum.

METHODS

A total of 115 samples of human cadaveric ligaments removed within 24-48 h after death have been tested. Uniaxial tension tests along the fiber direction were performed in physiological conditions on a custom designed test equipment. The ligaments were loaded into an expected damage zone at two different subfailure values (based on previously reported reference group of 46 samples), and then reloaded to failure.

FINDINGS

The main effect of a high subfailure load has proven to be the toe elongation change. The toe elongation increase is affected by the subfailure load value. While anterior and posterior longitudinal ligament showed similar changes, the smallest subfailure effect was found in ligamentum flavum.

INTERPRETATIONS

The normal physiological region of the cervical spine ligaments mechanical response is modified by a high subfailure load. The observed ligament injury significantly compromises ligament ability to give tensile support within physiological spinal motion.

Establishment and Finite Element Analysis of a Three-dimensional Dynamic Model of Upper Cervical Spine Instability

Objectives

To establish a dynamic three‐dimensional (3D) model of upper cervical spine instability and to analyze its biomechanical characteristics.

Methods

A 3D geometrical model was established after CT scanning of the upper cervical spine specimen. The ligament of the specimen was fatigued to establish the upper cervical spine‐instability model. A 100‐N preloaded stress was applied to the upper surface of the occipital bone, and then a 1.5‐Nm moment was applied in the occipital‐sagittal direction to simulate upper cervical spine flexion and extension. Subsequently, the 3D dynamic model was established based on trajectory data that were measured using a motion‐capture system. The stress on the main ligament and the relative motion angle of the joint were analyzed.

Results

The shape of the model grid was regular and the total number of its units was 627 000. After finite‐element analysis was conducted, results of the ligament stress and relative movement angle were obtained. After the upper cervical spine instability, the pressure of the alar ligament during the upper cervical spine extension was increased from 2.85 to 8.12 MPa. The pressure of the flavum ligament was increased during the upper‐cervical spine flexion, from 0.90 to 1.21 MPa. The pressure of the odontoid ligament was reduced during the upper cervical spine flexion and extension, from 10.46 to 6.67 MPa and 25.66 to 16.35 MPa, respectively. The pressure of the anterior longitudinal ligament and cruciate ligament was increased to a certain degree during upper cervical spine flexion and extension. The pressure of the anterior longitudinal ligament was increased during flexion and extension, from 7.70 to 10.10 MPa and 10.45 to 13.75 MPa, respectively. The pressure of the cruciate ligament was increased during flexion and extension, from 2.29 to 4.34 MPa and 2.32 to 4.40 MPa, respectively. In addition, after upper cervical spine instability, the articular‐surface relative‐movement angle of the atlanto‐occipital joint and atlanto‐axial joint had also changed. During upper cervical spine flexion, the angle of the atlanto‐occipital joint was increased from 3.49° to 5.51°, and the angle of the atlanto‐axial joint was increased from 8.84° to 13.70°. During upper cervical spine extension, the angle of the atlanto‐occipital joint was increased from 11.16° to 12.96°, and the angle of the atlanto‐axial joint was increased from 14.20° to 17.20°. Therefore, the movement angle of the atlanto‐axial joint was most obvious after induction of instability.

Conclusion

The 3D dynamic finite‐element model of the upper cervical spine can be used to analyze and summarize the relationship between the change of ligament stress and the degree of instability in cervical instability. Frequent or prolonged flexion activities are more likely to lead to instability of the upper cervical spine.

Validation of a simplified human body model in relaxed and braced conditions in low-speed frontal sled tests

Objective: The goal of this study was to implement active musculature into the Global Human Body Models Consortium (GHBMC) average male simplified occupant model (M50-OS v2) and validate its performance in low-speed frontal crash scenarios.Methods: Volunteer and postmortem human subjects (PMHS) data from low-speed frontal sled tests by Beeman et al., including 2.5 and 5.0 g acceleration pulses, were used to simulate events in LS-DYNA. All muscles were modeled as 1D beam elements and assigned a Hill-type muscle material. From the output of proportional-integral-derivative (PID) controllers, the activation level for each muscle was calculated using a sigmoid function, representing the firing rate of motor neurons. The PID controller attempts to preserve the initial posture of the model. Percentage muscle contribution for all skeletal muscles was precalculated using the M50-OS with active muscles (M50-OS + Active). The M50-OS + Active employs varying levels of neural delays to represent volunteer relaxed and braced conditions, taken from literature. Braced condition experiments were simulated using elevated joint angle set values for the PID controller. The M50-OS + Active model was used to simulate 2 muscle conditions (relaxed and braced) at 2 pulse severities (2.5 and 5.0 g). A control set of simulations was conducted to compare the effect of adding active muscle. Ten whole-body simulations were conducted.Results: The results from volunteer simulations showed a strong dependence of reaction loads and kinematics on muscle activation. Compared to baseline, M50-OS, at 5.0 g acceleration, 33.3% and 7.6% decreases were observed in the overall head kinematics of the M50-OS + Active for the braced and relaxed conditions, respectively. Regarding the anterior direction, similar reductions in overall kinematics were observed for both volunteer test conditions. In comparison to control simulations in which no active muscle was implemented, objective evaluation scores increased markedly at both speeds for the braced condition. Little to no gain was found in the relaxed condition.Conclusions: The results justify the need for use of an active human body model for predicting low-speed frontal kinematics, particularly in the braced condition. Head kinematics were reduced when using active modeling for all simulations (braced and relaxed).

Rear-Impact Neck Whiplash: Role of Head Inertial Properties and Spine Morphological Variations on Segmental Rotations

Whiplash injuries continue to be a concern in low-speed rear impact. This study was designed to investigate the role of variations in spine morphology and head inertia properties on cervical spine segmental rotation in rear-impact whiplash loading. Vertebral morphology is rarely considered as an input parameter in spine finite element (FE) models. A methodology toward considering morphological variations as input parameters and identifying the influential variations is presented in this paper. A cervical spine FE model, with its morphology parametrized using mesh morphing, was used to study the influence of disk height, anteroposterior vertebral depth, and segmental size, as well as variations in head mass, moment of inertia, and center of mass locations. The influence of these variations on the characteristic S-curve formation in whiplash response was evaluated using the peak C2–C3 flexion marking the maximum S-curve formation and time taken for the formation of maximum S-curve. The peak C2–C3 flexion in the S-curve formation was most influenced by disk height and vertebral depth, followed by anteroposterior head center of mass location. The time to maximum S-curve was most influenced by the anteroposterior location of head center of mass. The influence of gender-dependent variations, such as the vertebral depth, suggests that they contribute to the greater segmental rotations observed in females resulting in different S-curve formation from men. These results suggest that both spine morphology and head inertia properties should be considered to describe rear-impact responses.

Passive cervical spine ligaments provide stability during head impacts

It has been suggested that neck muscle strength and anticipatory cocontraction can decrease head motions during head impacts. Here, we quantify the relative angular impulse contributions of neck soft tissue to head stabilization using an OpenSim musculoskeletal model with Hill-type muscles and rate-dependent ligaments. We simulated sagittal extension and lateral flexion mild experimental head impacts performed on 10 subjects with relaxed or cocontracted muscles, and median American football head impacts. We estimated angular impulses from active muscle, passive muscle and ligaments during head impact acceleration and deceleration phases. During the acceleration phase, active musculature produced resistive angular impulses that were 30% of the impact angular impulse in experimental impacts with cocontracted muscles. This was reduced below 20% in football impacts. During the deceleration phase, active musculature stabilized the head with 50% of the impact angular impulse in experimental impacts with cocontracted muscles. However, passive ligaments provided greater stabilizing angular impulses in football impacts. The redistribution of stabilizing angular impulses results from ligament and muscle dependence on lengthening rate, where ligaments stiffen substantially compared to active muscle at high lengthening rates. Thus, ligaments provide relatively greater deceleration impulses in these impacts, which limit the effectiveness of muscle strengthening or anticipated activations.

A two-step procedure for coupling development and usage of a pair of human neck models

Both finite element models and multi-body models of human head-neck complex had been widely used in neck injuries analysis, as the former could be used to generate detailed stress strain information and the later could generate dynamic responses with high efficiency. Sometimes, detailed stress and strain information were hoped to be obtained more efficiently, but current methods were not effective enough when they were used to analyze responses of human head neck complex to long duration undulate accelerations. In this paper, a two-step procedure for 'parallel' development and 'sequential' usage of a pair of human head neck models was discussed. The pair of models contained a finite element model and a multi-body model, which were developed based on the coupling 'parallel' procedure using the same bio-realistic geometry. After being validated using available data, the pair of human neck models were applied to analyze biomechanical responses of pilot's neck during arrested landing operation according to the 'sequential' procedure, because typical sustained undulate accelerations usually appeared during such processes. The results, including both kinematic and detailed biomechanical responses of human head-neck complex, were obtained with preferable efficiency. This research provided an effective way for biomechanical analysis of human head neck responses to sustained undulate accelerations.

The inclusion of hyoid muscles improve moment generating capacity and dynamic simulations in musculoskeletal models of the head and neck

OpenSim musculoskeletal models of the head and neck can provide information about muscle activity and the response of the head and neck to a variety of situations. Previous models report weak flexion strength, which is partially due to lacking moment generating capacity in the upper cervical spine. Previous models have also lacked realistic hyoid muscles, which have the capability to improve flexion strength and control in the upper cervical spine. Suprahyoid and infrahyoid muscles were incorporated in an OpenSim musculoskeletal model of the head and neck. This model was based on previous OpenSim models, and now includes hyoid muscles and passive elements. The moment generating capacity of the model was tested by simulating physical experiments in the OpenSim environment. The flexor and extensor muscle strengths were scaled to match static experimental results. Models with and without hyoid muscles were used to simulate experimentally captured motions, and the need for reserve actuators was evaluated. The addition of hyoid muscles greatly increased flexion strength, and the model is the first of its kind to have realistic strength values in all directions. Less reserve actuator moment was required to simulate real motions with the addition of hyoid muscles. Several additional ways of improving flexion strength were investigated. Hyoid muscles add control and strength to OpenSim musculoskeletal models of the head and neck and improve simulations of head and neck movements.

Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine

The objective of the present study is to investigate the influence of neck muscle activation on whiplash neck injury of the occupants of a passenger vehicle under different severities of frontal and rear-end impact collisions. The finite element (FE) model has been used as a versatile tool to simulate and understand the whiplash injury mechanism for occupant injury prevention. However, whiplash injuries and injury mechanisms have rarely been investigated in connection with neck active muscle forces, which restricts the complete reappearance and understanding of the injury mechanism. In this manuscript, a mixed FE human model in a sitting posture with an active head-neck was developed. The response of the cervical spine under frontal and rear-end collision conditions was then studied using the FE model with and without neck muscle activation. The effect of the neck muscle activation on the whiplash injury was studied based on the results of the FE simulations. The results indicated that the neck active force influenced the head-neck dynamic response and whiplash injury during a collision, especially in a low-speed collision.

Non-penetrating traumatic injuries of the aortic arch

Background In severely injured trauma patients, non-penetrating aortic arch injuries (NAAI) have a remarkable incidence and mortality. Both diagnostics and therapy of NAAI recently underwent significant changes. Purpose To assess mortality, morbidity, and the risk factors associated with NAAI in severely injured patients (Injury Severity Score [ISS] ≥16) under the light of recent technical and procedural advances in trauma care. Material and Methods A total of 230 consecutive trauma patients with ISS ≥16 admitted to our level-I trauma center during a 24-month period, were prospectively included and underwent standardized whole-body computed tomography (CT) in a 2 × 128-detector-row scanner. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded for patients with NAAI. Localization of NAAI was described referring to Mitchell and Ishimaru; severity was graded according to the proposal of Heneghan et al. Results Thirteen of 230 patients had a NAAI, yielding an incidence of 5.6%. Mean age and ISS was not elevated in NAAI (44.4 ± 14.8 years, ISS = 38 ± 12.4). Mortality was 23.1%. One patient had severe neurologic sequelae from a stroke; all surviving patients had to undergo (transient) anticoagulant therapy. Trauma mechanism was of high kinetic energy in all cases. Concomitant injuries were predominantly thoracic (rib fractures = 76.9%, thoracic spine fracture = 38.5%). Conclusion Whenever an individual possibly encountered a deceleration-acceleration trauma mechanism, a high level of suspicion for NAAI should be maintained. It remains to be determined whether recent advances in mortality are due to changes in trauma care or due to improved vehicle and road safety.

An investigation of dimensional scaling using cervical spine motion segment finite element models

The paucity of experimental data for validating computational models of different statures underscores the need for appropriate scaling methods so that models can be verified and validated using experimental data. Scaling was investigated using 50th percentile male (M50) and 5th percentile female (F05) cervical spine motion segment (C4-C5) finite element models subject to tension, flexion, and extension loading. Two approaches were undertaken: geometric scaling of the models to investigate size effects (volumetric scaling) and scaling of the force-displacement or moment-angle model results (data scaling). Three sets of scale factors were considered: global (body mass), regional (neck dimensions), and local (segment tissue dimensions). Volumetric scaling of the segment models from M50 to F05, and vice versa, produced correlations that were good or excellent in both tension and flexion (0.825-0.991); however, less agreement was found in extension (0.550-0.569). The reduced correlation in extension was attributed to variations in shape between the models leading to nonlinear effects such as different time to contact for the facet joints and posterior processes. Data scaling of the responses between the M50 and F05 models produced similar trends to volumetric scaling, with marginally greater correlations. Overall, the local tissue level and neck region level scale factors produced better correlations than the traditional global scaling. The scaling methods work well for a given subject, but are limited in applicability between subjects with different morphology, where nonlinear effects may dominate the response.

Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events

Emergency events can influence a child’s kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs–MADYMO 6 and 10 year-old models–were evaluated and compared with child volunteers’ data during emergency events–braking and steering–with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control.

A Female Ligamentous Cervical Spine Finite Element Model Validated for Physiological Loads

Mathematical cervical spine models allow for studying of impact loading that can cause whiplash associated disorders (WAD). However, existing models only cover the male anthropometry, despite the female population being at a higher risk of sustaining WAD in automotive rear-end impacts. The aim of this study is to develop and validate a ligamentous cervical spine intended for biomechanical research on the effect of automotive impacts. A female model has the potential to aid the design of better protection systems as well as improve understanding of injury mechanisms causing WAD. A finite element (FE) mesh was created from surface data of the cervical vertebrae of a 26-year old female (stature 167 cm, weight 59 kg). Soft tissues were generated from the skeletal geometry and anatomical literature descriptions. Ligaments were modeled with nonlinear elastic orthotropic membrane elements, intervertebral disks as composites of nonlinear elastic bulk elements, and orthotropic anulus fibrosus fiber layers, while cortical and trabecular bones were modeled as isotropic plastic-elastic. The model has geometrical features representative of the female cervical spine-the largest average difference compared with published anthropometric female data was the vertebral body depth being 3.4% shorter for the model. The majority the cervical segments compare well with respect to biomechanical data at physiological loads, with the best match for flexion-extension loads and less biofidelity for axial rotation. An average female FE ligamentous cervical spine model was developed and validated with respect to physiological loading. In flexion-extension simulations with the developed female model and an existing average male cervical spine model, a greater range of motion (ROM) was found in the female model.

SIMULATION OF MUSCLE ACTIVATION WITH COUPLED NONLINEAR FE MODELS

Muscle activation plays an important role in head–neck dynamic response in vehicle accidents, especially in low speed impacts. The aim of the present study was to analyze the mechanical characteristics and dynamic stability of the muscle using coupled non-linear finite element model, which could be further applied for biomechanical study of head–neck system in car crash accidents. A rabbit tibialis anterior (TA) geometry model was developed. Two finite element models of TA were developed with coupled constitutive models. One coupled model was developed combining quasi-linear viscoelastic (QLV) elements and Hill type elements, and the other was developed combining hyperelastic rubber elements and Hill type elements, representing the passive behavior and active behavior, respectively. The models were validated via eccentric contractions tests under different strain rates published by Myers et al. Isometric Contraction and axial compression were also simulated via both models to evaluate the computational stability. The results showed that the coupled constitutive muscle models had a good biofidelity for the simulation of muscle activation. Both muscle models can fulfill the requirement of neck muscle system modeling for biomechanical study.

A comparative study on dynamic stiffness in typical finite element model and multi-body model of C6-C7 cervical spine segment

In contrast to numerous researches on static or quasi-static stiffness of cervical spine segments, very few investigations on their dynamic stiffness were published. Currently, scale factors and estimated coefficients were usually used in multi-body models for including viscoelastic properties and damping effects, meanwhile viscoelastic properties of some tissues were unavailable for establishing finite element models. Because dynamic stiffness of cervical spine segments in these models were difficult to validate because of lacking in experimental data, we tried to gain some insights on current modeling methods through studying dynamic stiffness differences between these models. A finite element model and a multi-body model of C6-C7 segment were developed through using available material data and typical modeling technologies. These two models were validated with quasi-static response data of the C6-C7 cervical spine segment. Dynamic stiffness differences were investigated through controlling motions of C6 vertebrae at different rates and then comparing their reaction forces or moments. Validation results showed that both the finite element model and the multi-body model could generate reasonable responses under quasi-static loads, but the finite element segment model exhibited more nonlinear characters. Dynamic response investigations indicated that dynamic stiffness of this finite element model might be underestimated because of the absence of dynamic stiffen effect and damping effects of annulus fibrous, while representation of these effects also need to be improved in current multi-body model. Copyright © 2015 John Wiley & Sons, Ltd.

Can physical joint simulators be used to anticipate clinical wear problems of new joint replacement implants prior to market release?

One of the most important mandates of physical joint simulators is to provide test results that allow the implant manufacturer to anticipate and perhaps avoid clinical wear problems with their new products. This is best done before market release. This study gives four steps to follow in conducting such wear simulator testing. Two major examples involving hip wear simulators are discussed in which attempts had been made to predict clinical wear performance prior to market release. The second one, involving the DePuy ASR implant systems, is chosen for more extensive treatment by making it an illustrative example to explore whether wear simulator testing can anticipate clinical wear problems. It is concluded that hip wear simulator testing did provide data in the academic literature that indicated some risk of clinical wear problems prior to market release of the ASR implant systems. This supports the idea that physical joint simulators have an important role in the pre-market testing of new joint replacement implants.

Transient pressure changes in the vertebral canal during whiplash motion--A hydrodynamic modeling approach

In vehicle collisions, the occupant's torso is accelerated in a given direction while the unsupported head tends to lag behind. This mechanism results in whiplash motion to the neck. In whiplash experiments conducted for animals, pressure transients have been recorded in the spinal canal. It was hypothesized that the transients caused dorsal root ganglion dysfunction. Neck motion introduces volume changes inside the vertebral canal. The changes require an adaptation which is likely achieved by redistribution of blood volume in the internal vertebral venous plexus (IVVP). Pressure transients then arise from the rapid redistribution. The present study aimed to explore the hypothesis theoretically and analytically. Further, the objectives were to quantify the effect of the neck motion on the pressure generation and to identify the physical factors involved. We developed a hydrodynamic system of tubes that represent the IVVP and its lateral intervertebral vein connections. An analytical model was developed for an anatomical geometrical relation that the venous blood volume changes with respect to the vertebral angular displacement. This model was adopted in the hydrodynamic tube system so that the system can predict the pressure transients on the basis of the neck vertebral motion data from a whiplash experiment. The predicted pressure transients were in good agreement with the earlier experimental data. A parametric study was conducted and showed that the system can be used to assess the influences of anatomical geometrical properties and vehicle collision severity on the pressure generation.

Head and neck response of a finite element anthropomorphic test device and human body model during a simulated rotary-wing aircraft impact

A finite element (FE) simulation environment has been developed to investigate aviator head and neck response during a simulated rotary-wing aircraft impact using both an FE anthropomorphic test device (ATD) and an FE human body model. The head and neck response of the ATD simulation was successfully validated against an experimental sled test. The majority of the head and neck transducer time histories received a CORrelation and analysis (CORA) rating of 0.7 or higher, indicating good overall correlation. The human body model simulation produced a more biofidelic head and neck response than the ATD experimental test and simulation, including change in neck curvature. While only the upper and lower neck loading can be measured in the ATD, the shear force, axial force, and bending moment were reported for each level of the cervical spine in the human body model using a novel technique involving cross sections. This loading distribution provides further insight into the biomechanical response of the neck during a rotary-wing aircraft impact.

High Rotation Rate Behavior of Cervical Spine Segments in Flexion and Extension

Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2–C3 to C7–T1 were dissected from eight donors and were tested to 10 deg of rotation at 1 and 500 deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p < 0.05) of increased stiffness at the higher rotation rate above 4 deg of rotation in flexion and at 8 deg and 10 deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data.

Experimental characterization of post rigor mortis human muscle subjected to small tensile strains and application of a simple hyper-viscoelastic model

In models developed for impact biomechanics, muscles are usually represented with one-dimensional elements having active and passive properties. The passive properties of muscles are most often obtained from experiments performed on animal muscles, because limited data on human muscle are available. The aim of this study is thus to characterize the passive response of a human muscle in tension. Tensile tests at different strain rates (0.0045, 0.045, and 0.45 s−1) were performed on 10 extensor carpi ulnaris muscles. A model composed of a nonlinear element defined with an exponential law in parallel with one or two Maxwell elements and considering basic geometrical features was proposed. The experimental results were used to identify the parameters of the model. The results for the first- and second-order model were similar. For the first-order model, the mean parameters of the exponential law are as follows: Young’s modulus E (6.8 MPa) and curvature parameter α (31.6). The Maxwell element mean values are as follows: viscosity parameter η (1.2 MPa s) and relaxation time τ (0.25 s). Our results provide new data on a human muscle tested in vitro and a simple model with basic geometrical features that represent its behavior in tension under three different strain rates. This approach could be used to assess the behavior of other human muscles.

Effects of cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile collision

BACKGROUND CONTEXT

Whereas arthrodesis is the most common surgical intervention for the treatment of symptomatic cervical degenerative disc disease, arthroplasty has become increasingly more popular over the past decade. Although literature exists comparing the effects of anterior cervical discectomy and fusion and cervical total disc replacement (CTDR) on neck kinematics and loading, the vast majority of these studies apply only quasi-static, noninjurious loading conditions to a segment of the cervical spine.

PURPOSE

The objective of this study was to investigate the effects of arthrodesis and arthroplasty on biomechanical neck response during a simulated frontal automobile collision with air bag deployment.

STUDY DESIGN

This study used a full-body, 50th percentile seated male finite element (FE) model to evaluate neck response during a dynamic impact event. The cervical spine was modified to simulate either an arthrodesis or arthroplasty procedure at C5-C6.

METHODS

Five simulations of a belted driver, subjected to a 13.3 m/s ΔV frontal impact with air bag deployment, were run in LS-DYNA with the Global Human Body Models Consortium full-body FE model. The first simulation used the original model, with no modifications to the neck, whereas the remaining four were modified to represent either interbody arthrodesis or arthroplasty of C5-C6. Cross-sectional forces and moments at the C5 and C6 cervical levels of the neck, along with interbody and facet forces between C5 and C6, were reported.

RESULTS

Adjacent-level, cross-sectional neck loading was maintained in all simulations without exceeding any established injury thresholds. Interbody compression was greatest for the CTDRs, and interbody tension occurred only in the fused and nonmodified spines. Some interbody separation occurred between the superior and inferior components of the CTDRs during flexion-induced tension of the cervical spine, increasing the facet loads.

CONCLUSIONS

This study evaluated the effects of C5-C6 cervical arthrodesis and arthroplasty on neck response during a simulated frontal automobile impact. Although cervical arthrodesis and arthroplasty at C5-C6 did not appear to significantly alter the adjacent-level, cross-sectional neck responses during a simulated frontal automobile impact, key differences were noted in the interbody and facet loading.

Quantification of pediatric and adult cervical vertebra-anatomical characteristics by age and gender for automotive application

OBJECTIVE

The cervical anatomy has been shown to affect injury patterns in vehicle crashes. Characterizing the spine anatomy and changes associated with growth and gender is important when assessing occupant protection. In this study, selected cervical characteristics were quantified.

METHODS

Computed tomography (CT) scans of 750 patients were selected from the University of Michigan trauma database; 314 were children and 436 were adults. Four variables were obtained: the maximum spinal canal radius, vertebral body depth, facet angles, and retroversion angles.

RESULTS

The cervical spine measurements varied with age and gender. The body depth increased nonlinearly with age. The average vertebral body depth at C4 was 9.2 ± 0.38 mm in the 0-3 age group, 15.7 ± 0.29 mm in the 18-29 age group, and 17.2 ± 0.46 mm in the 60+ age group. Pediatric and adult males had larger vertebral body depth than females overall, irrespective of vertebral level (P <.001). Compared to females, the vertebral body depth was 8-9 percent greater in male children and 13-16 percent greater in adult males. The average radius varied with gender, with male children generally having a larger radius than females irrespective of vertebral level (P <.001). Overall, spinal canal radius was smallest in the 0-3 and 60+ age groups and largest in the 18-29 age group. The C4 radius was 5.91 ± 0.17, 6.28 ± 0.14, and 6.73 ± 0.17 mm respectively. The radius was larger in the 4-7 age group than in the 0-3 age group, irrespective of vertebral level (P <.0001). There were nonsignificant radius changes between the 4-7 and 8-11 age groups and the 8-11 and age 12-17 groups, suggesting that the size of the spinal cord reaches near maturation by the age of 7. Facet angles decreased with age in children and increased with age in adults. The average facet angles were largest in the 0-3 age group (P <.1, C2-C6). Adult facet angles were greater in the 60+ age group than in the 18-29 age group (P <.0001, C2-C6). Males had larger facet angles than females overall (P <.01 at C2, C5-C7). The retroversion angles were largest at C6 and C7. They increased with age in children and decreased in the adult population; they were larger (5-22%) in the 18-29 age group than in the 60+ age group (P <.0001, C2-C6).

CONCLUSIONS

The results obtained in this study help explain variations in cervical anatomical changes associated with age and gender. The information is useful when assessing differences in injury patterns between different segments of the population. Anatomical measurements of the cervical spine should be considered for the development of models used to assess injury mechanisms for various occupant age groups.

Finite element modeling of potential cervical spine pain sources in neutral position low speed rear impact

The rate of soft tissue sprain/strain injuries to the cervical spine and associated cost continue to be significant; however, the physiological nature of this injury makes experimental tests challenging while aspects such as occupant position and musculature may contribute to significant variability in the current epidemiological data. Several theories have been proposed to identify the source of pain associated with whiplash. The goal of this study was to investigate three proposed sources of pain generation using a detailed numerical model in rear impact scenarios: distraction of the capsular ligaments; transverse nerve root compression through decrease of the intervertebral foramen space; and potential for damage to the disc based on the extent of rotation and annulus fibre strain. There was significant variability associated with experimental measures, where the range of motion data overlapped ultimate failure data. Average data values were used to evaluate the model, which was justified by the use of average mechanical properties within the model and previous studies demonstrating predicted response and failure of the tissues was comparable to average response values. The model predicted changes in dimension of the intervertebral foramen were independent of loading conditions, and were within measured physiological ranges for the impact severities considered. Disc response, measured using relative rotation between intervertebral bodies, was below values associated with catastrophic failure or avulsion but exceeded the average range of motion values. Annulus fibre strains exceeded a proposed threshold value at three levels for 10g impacts. Capsular ligament strain increased with increasing impact severity and the model predicted the potential for injury at impact severities from 4g to 15.4g, when the range of proposed distraction corresponding to sub-catastrophic failure was exceeded, in agreement with the typically reported values of 9-15g. This study used an enhanced neck finite element model with active musculature to investigate three potential sources of neck pain resulting from rear impact scenarios and identified capsular ligament strain and deformation of the disc as potential sources of neck pain in rear impact scenarios.