Biomechanical tolerance of whole lumbar spines in straightened posture subjected to axial acceleration

Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12-L5) were dynamically loaded using a custom-built drop tower. Twenty-three specimens were tested at sub-failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p < 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty-percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9-5.2 kN), and 16 (13-19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2-L5 spinal levels. In general, force-based tolerance was consistent with previous shorter-segment lumbar spine testing (3-5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:1747-1756, 2018.

Lumbar spine endplate fractures: Biomechanical evaluation and clinical considerations through experimental induction of injury

Lumbar endplate fractures were investigated in different experimental scenarios, however the biomechanical effect of segmental alignment was not outlined. The objectives of this study were to quantify effects of spinal orientation on lumbar spine injuries during single-cycle compressive loads and understand lumbar spine endplate injury tolerance. Twenty lumbar motion segments were compressed to failure. Two methods were used in the preparation of the lumbar motion segments. Group 1 (n = 7) preparation maintained pre-test sagittal lordosis, whereas Group 2 (n = 13) specimens had a free-rotational end condition for the cranial vertebra, allowing sagittal rotation of the cranial vertebra to create parallel endplates. Five Group 1 specimens experienced posterior vertebral body fracture prior to endplate fracture, whereas two sustained endplate fracture only. Group 2 specimens sustained isolated endplate fractures. Group 2 fractures occurred at approximately 41% of the axial force required for Group 1 fracture (p < 0.05). Imaging and specimen dissection indicate endplate injury consistently took place within the confines of the endplate boundaries, away from the vertebral periphery. These findings indicate that spinal alignment during compressive loading influences the resulting injury pattern. This investigation identified the specific mechanical conditions under which an endplate breach will take place. Development of endplate injuries has significant clinical implication as previous research identified internal disc disruption (IDD) and degenerative disc disease (DDD) as long-term consequences of the axial load-shift that occurs following a breach of the endplate. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1084-1091, 2016.

Characterization of Lumbar Spine Annular Disruption in PMHS Using MRI, Cryomicrotomy and Histology Techniques

Internal intervertebral disc disruption is involved in the onset of a wide range of spinal dysfunction, ultimately affecting not only the disc itself but the surrounding osseous and neural structures as well. The ability of disc to withstand and effectively distribute axial load is dependent upon whether peripherally located annular fibers provide the support necessary to contain and corral the pressure sensitive nucleus. Any alteration in the structures immediate to the nucleus jeopardize this ability. While annular tears and fissures have been thoroughly investigated, one form of internal disc disruption is less well-understood. A network of elastin cross-bridges provides resistance to delamination of the collagenous sheets that comprise the annulus. The current investigation utilized a Nitrogen gas-induced pressure mechanism to disrupt elastin cross links that exist between annular lamellae. Twenty five cadaveric lumbar spine motion segments (mean age: 52±12 yr.) were subjected to the annular disruption protocol. Damage to the annulus was assessed using MRI, cryomicrotome and histological staining procedures. MRI images were compared to cryomicrotome images to determine the ability of standard clinical MRI scans to determine annular damage. In many cases MRI was moderately revealing in terms of damage. Future studies will quantify biomechanical consequences of these low level annular disruptions relative to segmental stability.

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

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

Comparison of AIS 1990 update 98 versus AIS 2005 for describing PMHS injuries in lateral and oblique sled tests

This study analyzed skeletal and organ injuries in pure lateral and oblique impacts from 20 intact post mortem human surrogate (PMHS) sled tests at 6.7 m/s. Injuries to the shoulder, thorax, abdomen, pelvis and spine were scored using AIS 1990-1998 update and 2005. The Injury Severity Scores (ISS) were extracted for both loadings from both versions. Mean age, stature, total body mass and body mass index for pure lateral and oblique tests: 58 and 55 years, 1.7 and 1.8 m, 69 and 66 kg, and 24 and 21 kg/m(2). Skeletal injuries (ribs, sternum) occurred in both impacts. However, oblique impacts resulted in more injuries. Pure lateral and oblique impacts ISS: 0 to 16 and 0 to 24, representing a greater potential for injury-related consequences in real-world situations in oblique impacts. Internal organs were more involved in oblique impacts. ISS decreased in AIS 2005, reflecting changes to scoring and drawing attention to potential effects for pre-hospital care/medical aspects. Mean AIS scores for the two load vectors and two AIS coding schemes are included. From automotive crashworthiness perspectives, decreases in injury severities might alter injury risk functions with a shift to lower metrics for the same risk level than current risk estimations. This finding influences dummy-based injury criteria and occupant safety as risk functions are used for countermeasure effectiveness and cost-benefit analyses by regulatory bodies. Increase in organ injuries in oblique loading indicate the importance of this vector as current dummies and injury criteria used in regulations are based on pure lateral impact data.