Geometric and mechanical properties of human cervical spine ligaments

This study characterized the geometry and mechanical properties of the cervical ligaments from C2-T1 levels. The lengths and cross-sectional areas of the anterior longitudinal ligament, posterior longitudinal ligament, joint capsules, ligamentum flavum, and interspinous ligament were determined from eight human cadavers using cryomicrotomy images. The geometry was defined based on spinal anatomy and its potential use in complex mathematical models. The biomechanical force-deflection, stiffness, energy, stress, and strain data were obtained from 25 cadavers using in situ axial tensile tests. Data were grouped into middle (C2-C5) and lower (C5-T1) cervical levels. Both the geometric length and area of cross section, and the biomechanical properties including the stiffness, stress, strain, energy, and Young's modulus, were presented for each of the five ligaments. In both groups, joint capsules and ligamentum flavum exhibited the highest cross-sectional area (p < 0.005), while the longitudinal ligaments had the highest length measurements. Although not reaching statistical significance, for all ligaments, cross-sectional areas were higher in the C5-T1 than in the C2-C5 group; and lengths were higher in the C2-C5 than in the C5-T1 group with the exception of the flavum (Table 1 in the main text). Force-deflection characteristics (plots) are provided for all ligaments in both groups. Failure strains were higher for the ligaments of the posterior (interspinous ligament, joint capsules, and ligamentum flavum) than the anterior complex (anterior and posterior longitudinal ligaments) in both groups. In contrast, the failure stress and Young's modulus were higher for the anterior and posterior longitudinal ligaments compared to the ligaments of the posterior complex in the two groups. However, similar tendencies in the structural responses (stiffness, energy) were not found in both groups. Researchers attempting to incorporate these data into stress-analysis models can choose the specific parameter(s) based on the complexity of the model used to study the biomechanical behavior of the human cervical spine.     

Effect of loading rate on the compressive mechanics of the immature baboon cervical spine

Thirty-four cervical spine segments were harvested from 12 juvenile male baboons and compressed to failure at displacement rates of 5, 50, 500, or 5000 mm/s. Compressive stiffness, failure load, and failure displacement were measured for comparison across loading rate groups. Stiffness showed a significant concomitant increase with loading rate, increasing by 62% between rates of 5 and 5000 mm/s. Failure load also demonstrated an increasing relationship with loading rate, while displacement at failure showed no rate dependence. These data may help in the development of improved pediatric automotive safety standards and more biofidelic physical and computational models.     

Flexion and extension structural properties and strengths for male cervical spine segments

New vehicle safety standards are designed to limit the amount of neck tension and extension seen by out-of-position motor vehicle occupants during airbag deployments. The criteria used to assess airbag injury risk are currently based on volunteer data and animal studies due to a lack of bending tolerance data for the adult cervical spine. This study provides quantitative data on the flexion-extension bending properties and strength on the male cervical spine, and tests the hypothesis that the male is stronger than the female in pure bending. An additional objective is to determine if there are significant differences in stiffness and strength between the male upper and lower cervical spine. Pure-moment flexibility and failure testing was conducted on 41 male spinal segments (O-C2, C4-C5, C6-C7) in a pure-moment test frame and the results were compared with a previous study of females. Failures were conducted at approximately 90 N-m/s. In extension, the male upper cervical spine (O-C2) fails at a moment of 49.5 (s.d. 17.6)N-m and at an angle of 42.4 degrees (s.d. 8.0 degrees). In flexion, the mean moment at failure is 39.0 (s.d. 6.3 degrees) N-m and an angle of 58.7 degrees (s.d. 5.1 degrees). The difference in strength between flexion and extension is not statistically significant. The difference in the angles is statistically significant. The upper cervical spine was significantly stronger than the lower cervical spine in both flexion and extension. The male upper cervical spine was significantly stiffer than the female and significantly stronger than the female in flexion. Odontoid fractures were the most common injury produced in extension, suggesting a tensile mechanism due to tensile loads in the odontoid ligamentous complex.     

Comparative strengths and structural properties of the upper and lower cervical spine in flexion and extension

The purpose of this study is to test the hypothesis that the upper cervical spine is weaker than the lower cervical spine in pure flexion and extension bending, which may explain the propensity for upper cervical spine injuries in airbag deployments. An additional objective is to evaluate the relative strength and flexibility of the upper and lower cervical spine in an effort to better understand injury mechanisms, and to provide quantitative data on bending responses and failure modes. Pure moment flexibility and failure testing was conducted on 52 female spinal segments in a pure-moment test frame. The average moment at failure for the O-C2 segments was 23.7+/-3.4Nm for flexion and 43.3+/-9.3Nm for extension. The ligamentous upper cervical spine was significantly stronger in extension than in flexion (p=0.001). The upper cervical spine was significantly stronger than the lower cervical spine in extension. The relatively high strength of the upper cervical spine in tension and in extension is paradoxical given the large number of upper cervical spine injuries in out-of-position airbag deployments. This discrepancy is most likely due to load sharing by the active musculature.     

Tennis elbow and the cervical spine.

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.     

Evolution of recombination in eutherian mammals: insights into mechanisms that affect recombination rates and crossover interference

Recombination allows faithful chromosomal segregation during meiosis and contributes to the production of new heritable allelic variants that are essential for the maintenance of genetic diversity. Therefore, an appreciation of how this variation is created and maintained is of critical importance to our understanding of biodiversity and evolutionary change. Here, we analysed the recombination features from species representing the major eutherian taxonomic groups Afrotheria, Rodentia, Primates and Carnivora to better understand the dynamics of mammalian recombination. Our results suggest a phylogenetic component in recombination rates (RRs), which appears to be directional, strongly punctuated and subject to selection. Species that diversified earlier in the evolutionary tree have lower RRs than those from more derived phylogenetic branches. Furthermore, chromosome-specific recombination maps in distantly related taxa show that crossover interference is especially weak in the species with highest RRs detected thus far, the tiger. This is the first example of a mammalian species exhibiting such low levels of crossover interference, highlighting the uniqueness of this species and its relevance for the study of the mechanisms controlling crossover formation, distribution and resolution.     

The effect of lateral eccentricity on failure loads,kinematics, and canal occlusions of the cervical spine in axial loading

Current neck injury criteria do not include limits for lateral bending combined with axial compression and this has been observed as a clinically relevant mechanism, particularly for rollover motor vehicle crashes. The primary objectives of this study were to evaluate the effects of lateral eccentricity (the perpendicular distance from the axial force to the centre of the spine) on peak loads, kinematics, and spinal canal occlusions of subaxial cervical spine specimens tested in dynamic axial compression (0.5 m/s). Twelve 3-vertebra human cadaver cervical spine specimens were tested in two groups: low and high eccentricity with initial eccentricities of 1 and 150% of the lateral diameter of the vertebral body. Six-axis loads inferior to the specimen, kinematics of the superior-most vertebra, and spinal canal occlusions were measured. High speed video was collected and acoustic emission (AE) sensors were used to define the time of injury. The effects of eccentricity on peak loads, kinematics, and canal occlusions were evaluated using unpaired Student t-tests. The high eccentricity group had lower peak axial forces (1544±629 vs. 4296±1693 N), inferior displacements (0.2±1.0 vs. 6.6±2.0 mm), and canal occlusions (27±5 vs. 53±15%) and higher peak ipsilateral bending moments (53±17 vs. 3±18 Nm), ipsilateral bending rotations (22±3 vs. 1±2°), and ipsilateral displacements (4.5±1.4 vs. −1.0±1.3 mm, p<0.05 for all comparisons). These results provide new insights to develop prevention, recognition, and treatment strategies for compressive cervical spine injuries with lateral eccentricities.     

Position sense in the lumbar spine with torso flexion and loading

Proprioception plays an important role in appropriate sensation of spine position, movement, and stability. Previous research has demonstrated that position sense error in the lumbar spine is increased in flexed postures. This study investigated the change in position sense as a function of altered trunk flexion and moment loading independently. Reposition sense of lumbar angle in 17 subjects was assessed. Subjects were trained to assume specified lumbar angles using visual feedback. The ability of the subjects to reproduce this curvature without feedback was then assessed. This procedure was repeated for different torso flexion and moment loading conditions. These measurements demonstrated that position sense error increased significantly with the trunk flexion (40%, p < .05) but did not increase with moment load (p = .13). This increased error with flexion suggests a loss in the ability to appropriately sense and therefore control lumbar posture in flexed tasks. This loss in proprioceptive sense could lead to more variable lifting coordination and a loss in dynamic stability that could increase low back injury risk. This research suggests that it is advisable to avoid work in flexed postures.     

Linking latest knowledge of injury mechanisms and spine function to the prevention of low back disorders.

While several sophisticated scientific approaches have been employed to understand low back function and injury mechanisms, very few have been broadly used to develop and justify injury prevention strategies. This paper looks beyond the linked segment model, and the lessons learned from this biomechanical approach, to consider the application of more sophisticated approaches. These include modelling approaches with greater anatomical and biological fidelity, fusing the lessons learned from the areas of tissue mechanics and concepts of spine stability, together with some studies that have examined several characteristics including psychosocial, physiological and personal variables. The objective is to better link recently discovered mechanisms of injury and spine tissue health with injury risk reducing approaches.     

Prior storage conditions and loading rate affect the in vitro fracture response of spinal segments under impact loading

Traumatic injuries of the spine are mostly the consequence of rapid overload e.g. impact loading. In vitro investigations on this topic usually encompass biomechanical testing using frozen/thawed specimens and employ quasi-static loading conditions. It is generally accepted that a freezing/thawing cycle does not alter mechanical properties for slow loading rates. However, this has never been investigated for high impact velocities. In order to assess the effects of freezing/thawing and the influence of different impact velocities, we loaded 27 fresh and 15 frozen/thawed cadaveric rabbit spinal segments (intervertebral disc with one third of the adjacent vertebrae) with different impact energies and velocities using a custom-made, dropped-weight loading device. Endplate fractures were assessed by micro-CT scans. Specimen dimensions (disk, bone, and total height) and vertebrae bone density (BV/TV) were compared pre- and post-trauma. Energy absorption by spinal segments was quantified by measuring the initial ball rebound. We found that freezing/thawing increased endplate fracture frequency and decreased the energy absorption of the segments. Higher impact velocities increased the energy absorption, while higher impact energy increased both energy absorption and fracture frequency. Two conclusions are drawn: first, under impact loading, freezing alters permanently the biomechanical response, and second, for different impact velocities, different fracture initiation mechanisms apply. Therefore, quasi-static loading of frozen/thawed spinal segments is not a valid model for traumatic endplate injuries. However, caution should be exercised in extrapolating these findings to human vertebrae until tests on larger vertebrae are performed.     

Increase in facet joint loading after nucleotomy in the human lumbar spine

Low-back pain has been related to degenerative changes after nucleotomy. Although several etiologies for pain after nucleotomy have been proposed, there is evidence of pain arising in the facet joints in general, which may be related to changes in load transfer. This study addresses the effect of nucleotomy on facet joint loading.     

Variations of stiffness and strength along the human cervical spine

The load-displacement response and strength of the mid (C2-C5) and lower (C5-T1) cervical regions were determined for combinations of sagittal loads, in vitro. In unpaired t-test comparisons, the mid cervical region was significantly stiffer in compression and extension than the lower region. In tests to failure, failure in six out of seven mid cervical specimens resulted from flexion alone, while combined compression-flexion was required to fail five of the eight lower cervical specimens. Post-test dissections revealed no regional differences in the pattern of failure. In addition to sagittal tests, the load-displacement responses of three-vertebrae cervical specimens were measured with the upper body axially rotated with respect to the lower body. The effect of this pre-torsion was to diminish the zone of low slope near zero load for axial, shear, and flexion motion. Three of the four axially rotated specimens failed in flexion without added compression. These controlled load-displacement measurements of cervical spine specimens describe for the first time the continuous flexion-compression response up to failure, and suggest that consideration of the biomechanics of three apparently distinct mobile regions of the cervical spine (C1-C2, C2-C5, C5-T1) may facilitate the interpretation of hazardous conditions and the diagnosis of injury. These data also provide basic information for the in vitro investigation of passive cervical spine protection such as helmets and head-rests, suggesting that the head should be kept in a non-rotated position to reduce risk of injury.     

Comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation

Background

No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study''s goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia.

Methods/Findings

The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set.

Conclusions

When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in projecting awakening from coma and the role of delirium in these cases.