Finite element model of the human neck during omni-directional impacts. Part II: relation between cervical curvature and risk of injury

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to an MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve.

METHODS

Three spine clinic records were reviewed over a 2-year period, looking for patients where both an initial lateral cervical X-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards, an additional exam and radiographic analysis were obtained. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain's line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii.

RESULTS

There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear-end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p < 0.001. The NDI was available on 24/41 (58.5%) patients and increased after the MVC from 15.7% to 32.8%, p < 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in the mean radius of curvature (265.5 vs. 555.5, p < 0.001) and an approximate 8° reduction of lordosis from C2-C7; p < 0.001. The mid-cervical spine (C3-C5) showed the greatest curve reduction with an averaged localized mild kyphosis at these levels. Four participants (10%) developed segmental translations that were just below the threshold of instability, segmental translations < 3.5 mm.

CONCLUSIONS

The post-exposure MVC cervical curvature was characterized by an increase in radius of curvature, an approximate 8° reduction in C2-C7 lordosis, a mild kyphosis of the mid-cervical spine, and a slight increase in anterior translation of C2-C7 sagittal balance. The modelling result indicates that the post-MVC cervical sagittal alignment approximates a second-order buckling alignment, indicating a significant alteration in curve geometry. Future biomechanics experiments and clinical investigations are needed to confirm these findings.

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.

The Influence of Neck Muscle Activation on Head and Neck Injuries of Occupants in Frontal Impacts

The aim of the present paper was to study the influence of neck muscle activation on head and neck injuries of vehicle occupants in frontal impacts. A mixed dummy-human finite element model was developed to simulate a frontal impact. The head-neck part of a Hybrid III dummy model was replaced by a well-validated head-neck FE model with passive and active muscle characteristics. The mixed dummy-human FE model was validated by 15 G frontal volunteer tests conducted in the Naval Biodynamics Laboratory. The effects of neck muscle activation on the head dynamic responses and neck injuries of occupants in three frontal impact intensities, low speed (10 km/h), medium speed (30 km/h), and high speed (50 km/h), were studied. The results showed that the mixed dummy-human FE model has good biofidelity. The activation of neck muscles can not only lower the head resultant acceleration under different impact intensities and the head angular acceleration in medium- and high-speed impacts, thereby reducing the risks of head injury, but also protect the neck from injury in low-speed impacts.

Development and validation of a statistical shape modeling-based finite element model of the cervical spine under low-level multiple direction loading conditions

Cervical spinal injuries are a significant concern in all trauma injuries. Recent military conflicts have demonstrated the substantial risk of spinal injury for the modern warfighter. Finite element models used to investigate injury mechanisms often fail to examine the effects of variation in geometry or material properties on mechanical behavior. The goals of this study were to model geometric variation for a set of cervical spines, to extend this model to a parametric finite element model, and, as a first step, to validate the parametric model against experimental data for low-loading conditions. Individual finite element models were created using cervical spine (C3–T1) computed tomography data for five male cadavers. Statistical shape modeling (SSM) was used to generate a parametric finite element model incorporating variability of spine geometry, and soft-tissue material property variation was also included. The probabilistic loading response of the parametric model was determined under flexion-extension, axial rotation, and lateral bending and validated by comparison to experimental data. Based on qualitative and quantitative comparison of the experimental loading response and model simulations, we suggest that the model performs adequately under relatively low-level loading conditions in multiple loading directions. In conclusion, SSM methods coupled with finite element analyses within a probabilistic framework, along with the ability to statistically validate the overall model performance, provide innovative and important steps toward describing the differences in vertebral morphology, spinal curvature, and variation in material properties. We suggest that these methods, with additional investigation and validation under injurious loading conditions, will lead to understanding and mitigating the risks of injury in the spine and other musculoskeletal structures.

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.

Investigating cervical muscle response and head kinematics during right, left, frontal and rear-seated perturbations

OBJECTIVE

Whiplash research has largely focused on rear collisions because they account for the majority of whiplash injuries. The purpose of this study was to evaluate the effects of 4 perturbation directions (anterior, posterior, right, and left) on muscle activity and head kinematics to provide insight into the whiplash mechanism of injury.

METHODS

The effects of 4 perturbation directions induced by a parallel robotic platform, with peak acceleration of 8.50 m/s2, were analyzed on 10 subjects. Surface electromyography (EMG) measures were collected from the sternocleidomastoid (SCM), trapezius, and splenius capitus muscles. Kinematics of the head, thorax, and head relative to thorax were also measured.

RESULTS

We observed stereotypic responses for kinematics and SCM EMG for the various perturbation directions; the trapezius and splenius capitus muscles showed amplitudes that were less than 5 percent maximum voluntary contraction (MVC). Rear perturbations elicited the smallest onset latencies for the SCM (30 ms) and kinematic variables and greatest linear head center of mass (COM) accelerations. Frontal perturbations resulted in an average SCM onset latency of 143 ms and demonstrated the greatest magnitude of head translations and rotations relative to the thorax. Left and right perturbations demonstrated similar kinematics and SCM onset latencies (55 and 65 ms, respectively).

CONCLUSIONS

Compared to frontal, left, and right directions, rear perturbations showed smaller SCM onset latencies, greater SCM amplitudes, and larger head accelerations, relating to a greater potential for injury. We suggest that the greater contact area and stiffness of the seatback, in the posterior direction, compared to restrictions in other directions, led to increased peak head accelerations and shorter SCM onset latencies.

The mechanics of the in vivo infant and toddler trunk during respiratory physiotherapy

BACKGROUND

The purpose of this study is to quantify the in vivo mechanical response of the child trunk under loading during physiotherapy treatments.

METHODS

Twenty-six children aged 45 days to 7 years (14 girls and 12 boys) took part in this study. The forces applied by the physiotherapist were recorded using a force-plate embedded in the manipulation table supporting the child. Two synchronized cameras filmed the scene in a calibrated environment. The displacement of reflective targets glued on the physiotherapist's hands was calculated using an automatic tracking procedure and the 3D reconstruction "Direct Linear Transformation" algorithm. The progression of physical parameters was evaluated according to the age of the child. They included force, displacement, normalized displacement, loading speed, displacement and normalized displacement at the maximum force, force at the maximum displacement, viscous criterion and effective stiffness.

FINDINGS

For all patients, the mean maximum displacement and load were 22 mm (SD 9 mm) and 240 N (SD 46 N) respectively. The force-displacement curves had shown the complexity of the in vivo behavior: four phases have been distinguished with cycles in respect with the respiratory phases. The increase in force always occurred before the increase in displacement.

INTERPRETATION

This study helps to understand the in vivo behavior of the child trunk subjected to repetitive non-injurious mechanical loading. Further analysis in other populations and with different therapeutic maneuvers would refine the results.

Parametric and subject-specific finite element modelling of the lower cervical spine. Influence of geometrical parameters on the motion patterns

Morphometrical and postural features of the cervical spine are supposed to significantly influence its biomechanical behaviour. However, the effects of these geometrical parameters are quite difficult to evaluate. An original numerical method is proposed in order to automatically generate parametric and subject-specific meshes of the lower cervical spine. Sixteen finite element models have been built from cadaver specimens using low dose biplanar X-rays. All the generated meshes fulfilled the quality criteria. A preliminary evaluation was performed on the C5-C6 functional units using a database of previous experimental tests. The principal and coupled motions were simulated. The responses of the numerical models were within the experimental standard deviation corridors in most cases. Rotation-moment relationships were then compared to assess the influence of geometry on the mechanical response. Geometry was found to play a significant role in the motion patterns.