Cervical spine injury can range from minor to severe or fatal, where severe injuries can result in incomplete or complete quadriplegia. There are close to 45,000 Canadians currently affected by paralysis due to traumatic spinal cord injury (tSCI) with an estimated 1700 new cases each year. The majority of tSCI occur in automotive collisions, and current methods for injury prediction are limited to predicting the likelihood for occupant injury but lack the detail to predict the specific injury and location at the tissue level. This research focused on major injuries associated with high impact automotive collisions such as rollover type collisions. Although whiplash is an injury commonly associated with automotive collisions, it was not considered for this study based on the low risk of neurological impairment. The goal of this study was to develop a cervical spine segment finite element model capable of predicting severe injuries such as ligament tears, disc failure, and bone fracture. The segment models used in this study were developed from previous cervical spine segment models representative of a 50th percentile male. The segment models included the vertebrae, detailed representations of the disc annulus fibres and nucleus, and the associated ligaments. The original model was previously verified and validated under quasi-static loading conditions for physiological ranges of motion. To accomplish the objectives of this research, the original models were modified to include updated material properties with the ability to represent tissue damage corresponding to injuries. Additional verification of the model was required to verify that the new material properties provided a physically correct response. Progressive failure was introduced in the ligament elements to produce a more biofidelic failure response and a tied contact between the vertebral bony endplates and the disc was used to represent disc avulsion. To represent the onset of bone fracture, a critical plastic strain failure criterion was implemented, and elements exceeding this criterion were eroded. The changes made to the material models were based on experimental studies and were not calibrated to produce a specific result. After verifying the modifications were implemented successfully, the models were validated against experimental segment failure tests. Modes of loading investigated included tension, compression, flexion, extension and axial rotation. In each case, the simulated response of the segment was evaluated against the average failure load, displacement at failure, and the observed injuries reported in the experimental studies. Additionally, qualitative analysis of elevated stress locations in the model were compared to reported fracture sites. Overall, the simulations showed good agreement with the experimental failure values, and produced tissue failure that was representative of the observed tissue damage in the experimental tests. The results of this research have provided a solid basis for cervical spine segment level injury prediction. Some limitations include the current implementation of bone fracture under compressive loads, and failure within the annulus fibrosus fibres of the disc should be investigated for future models. In addition to material model modifications, further investigation into the kinetics and kinematics of the upper cervical spine segment are important to better understand the complex interactions between the bone geometry and ligaments. This would give insight into the initial positioning and expected response in subsequent models. Future research will include integrating the current segment-level failure criteria into a full cervical spine model for the purpose of predicting severe cervical spine injury in simulated crash scenarios, with future applications in sports injury prevention and protective equipment.

<p>Pediatric cervical spinal injuries are associated with high morbidity and mortality. Cervical injuries observed in the pediatric population appear to be age dependent with younger children experiencing more upper cervical level injuries compared to increased lower level cervical injury patterns to older children. The majority of pediatric cervical spinal injuries are motor vehicle crash related. Current progress in child occupant protection, including increased and proper restraint usage continues to reduce serious injury and fatalities to child occupants. However, improper restraint usage and incorrect child seating location, especially with children transitioning from rear-facing child restraints to forward-facing restraints is still a concern. Continued reductions in serious injury and fatalities to child occupants in survivable motor vehicle crashes will be based on continued education and improvements in child anthropometric test devices, child computational injury models and child restraint system design. Improvements in all of these categories are dependent on an improved understanding of the developmental biomechanics of the human cervical spine. Currently, limited data exist on human child neck biomechanics and none of the current cadaveric work has evaluated the biomechanical response over the entire age spectrum from birth to young adulthood. Numerous surrogate studies exist and have formed the basis of child injury criteria and developmental biomechanics, but have not been assessed in relation to the response of the pediatric human cervical spine. The current work investigates the biomechanics of the osteoligamentous human cervical spine from birth to young adulthood under tensile and bending loading environments. Tensile low-load and load-to-failure stiffness, load-to-failure, and flexion-extension bending stiffness increased with age. Tensile normalized displacement at failure and total bending low-load range of motion decreased with age. Viscoelastic rate effects are present in the pediatric cervical spine and are modeled with quasi-linear viscoelasticity. Peak load and loading energy increases with increased loading rate, while hysteresis energy is rate insensitive at lower loading rates, but increases at higher rates of loading. These data establish structural response behavior and injury thresholds for the osteoligamentous cervical spine by age. Additionally, they provide human data to assess the appropriateness of current surrogate models and current scaling techniques associated with these models. Finally, these data provide human response by age useful in progressing the biofidelity of computational and physical models for child occupant protection.</p> / Dissertation

<p>Injuries to the neck, or cervical region, are very importantsince there is a potential risk of damage to the spinal cord.Any neck injury can have devastating if not life threateningconsequences. High-speed transportation as well as leisure-timeadventures have increased the number of serious neck injuriesand made us increasingly aware of its consequences.Surveillance systems and epidemiological studies are importantprerequisites in defining the scope of the problem. Thedevelopment of mechanical and clinical tools is important forprimary prevention of neck injuries.</p><p>Thus, the main objectives of the present doctoral thesisare:- To illustrate the dimension of cervical injuries inSweden,- To develop a Finite Element (FE) model of the uppercervical spine, and- To study spinal stability for cervical injuries.</p><p>The incidence studies were undertaken with data from theinjury surveillance program at the Swedish National Board ofHealth and Welfare. All in-patient data from Swedish hospitals,ranging over thirteen years from 1987 to 1999, were analyzed.During this period 14,310 nonfatal and 782 fatal cervicalinjuries occurred. The lower cervical spine is the mostfrequent location for spinal trauma, although, this changeswith age so that the upper cervical spine is the most frequentlocation for the population over 65 years of age. The incidencefor cervical fractures for the Swedish population decreased forall age groups, except for those older than 65 years of age.The male population, in all age groups, has a higher incidencefor neck fractures than females. Transportation relatedcervical fractures have dropped since 1991, leaving fallaccidents as the sole largest cause of cervical trauma.</p><p>An anatomically detailed FE model of the human uppercervical spine was developed. The model was validated to ensurerealistic motions of the joints, with significant correlationfor flexion, extension, lateral bending, axial rotation, andtension. It was shown that an FE-model could simulate thecomplex anatomy and mechanism of the upper cervical spine withgood correlation to experimental data. Three studies wereconducted with the FE model. Firstly, the model of the uppercervical spine was combined with an FE model of the lowercervical spine and a head model. The complete model was used toinvestigate a new car roof structure. Secondly, the FE modelwas used for a parameter study of the ligament materialcharacteristics. The kinematics of the upper cervical spine iscontrolled by the ligamentous structures. The ligaments have tomaintain spinal stability while enabling for large rotations ofthe joints. Thirdly, the FE-model was used to study spinalinjuries and their effect on cervical spinal stability inflexion, extension, and lateral bending. To do this, the intactupper cervical spine FE model was modified to implementruptures of the various spinal ligaments. Transection of theposterior atlantooccipital membrane, the ligametum flavum andthe capsular ligament had the most impact on flexion, while theanterior longitudinal ligament and the apical ligamentinfluenced extension.</p><p>It is concluded that neck injuries in Sweden is a problemthat needs to be address with new preventive strategies. It isespecially important that results from the research on fallaccidents among the elderly are implemented in preventiveprograms. Secondly, it is concluded that an FE model of thecervical region is a powerful tool for development andevaluation of preventive systems. Such models will be importantin defining preventive strategies for the future. Lastly, it isconcluded that the FE model of the cervical spine can increasethe biomechanical understanding of the spine and contribute inanalyses of spinal stability.</p>

Aims: The primary physiotherapeutic aims of the study were to validate a manual physiotherapy evaluation technique in the assessment of cervical biomechanical dysfunction, and to test the effectiveness of a manual physiotherapy treatment technique in the correction of cervical biomechanical dysfunction. The primary educational aims were to test the effectiveness and safety of a therapeutic exercise programme for the correction of biomechanical dysfunction as well as the effectiveness of a neck rehabilitation programme for improving neck muscle strength. Design: A four group experimental design with three pre-test - post-test groups and a control group was used for the investigation. Sample: The subjects were South African schoolboy rugby players between the ages of 15 and 18 years. Groups I and 2 presented with biomechanical dysfunction of their cervical spines, Group 3 had no biomechanical dysfunction of their cervical spines and the players of Group 4, the control group, presented with or without biomechanical dysfunction of their cervical spines. Each group consisted of 25 players. Method: Group I received manual physiotherapy with x-rays before and after treatment. Groups 2 and 3 performed a therapeutic exercise programme, with before and after x-rays, and Group 4 received no intervention between their sets of x-rays. Following the second set of x-rays all the players from Groups I, 2 and 3 performed the neck rehabilitation programme after which a third set of x-rays were taken. Results: The results validated the manual physiotherapy evaluation technique. The manual therapy treatment technique used in the treatment of Group I showed highly significant improvements in cervical biomechanical function. Results for Group 2 following the therapeutic exercise programme showed moderate practically significant improvements in cervical biomechanical dysfunction. The therapeutic exercise programme for the correction of biomechanical dysfunction was found to be very safe with only small significant changes in x-ray measurements (Group 3). The results of the control group showed a negative trend of small statistical significance. A highly significant improvement in cervical circumference as moderate significant improvement in biomechanical function was found following the neck rehabilitation programme. Conclusion: It could therefore be concluded that the manual physiotherapy evaluation technique for motion segment analysis was indeed valid in determining biomechanical dysfunction of the cervical spine. The manual physiotherapy treatment technique as well as the therapeutic exercise programme for the correction of biomechanical dysfunction was found to be effective in the correction of cervical biomechanical dysfunction. It could further be concluded that the therapeutic exercise programme was safe to be performed by players without biomechanical dysfunction. The neck rehabilitation programme was effective in improving cervical circumference as well as cervical biomechanical function. / Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2005.

Aims: The primary physiotherapeutic aims of the study were to validate a manual physiotherapy evaluation technique in the assessment of cervical biomechanical dysfunction, and to test the effectiveness of a manual physiotherapy treatment technique in the correction of cervical biomechanical dysfunction. The primary educational aims were to test the effectiveness and safety of a therapeutic exercise programme for the correction of biomechanical dysfunction as well as the effectiveness of a neck rehabilitation programme for improving neck muscle strength. Design: A four group experimental design with three pre-test - post-test groups and a control group was used for the investigation. Sample: The subjects were South African schoolboy rugby players between the ages of 15 and 18 years. Groups I and 2 presented with biomechanical dysfunction of their cervical spines, Group 3 had no biomechanical dysfunction of their cervical spines and the players of Group 4, the control group, presented with or without biomechanical dysfunction of their cervical spines. Each group consisted of 25 players. Method: Group I received manual physiotherapy with x-rays before and after treatment. Groups 2 and 3 performed a therapeutic exercise programme, with before and after x-rays, and Group 4 received no intervention between their sets of x-rays. Following the second set of x-rays all the players from Groups I, 2 and 3 performed the neck rehabilitation programme after which a third set of x-rays were taken. Results: The results validated the manual physiotherapy evaluation technique. The manual therapy treatment technique used in the treatment of Group I showed highly significant improvements in cervical biomechanical function. Results for Group 2 following the therapeutic exercise programme showed moderate practically significant improvements in cervical biomechanical dysfunction. The therapeutic exercise programme for the correction of biomechanical dysfunction was found to be very safe with only small significant changes in x-ray measurements (Group 3). The results of the control group showed a negative trend of small statistical significance. A highly significant improvement in cervical circumference as moderate significant improvement in biomechanical function was found following the neck rehabilitation programme. Conclusion: It could therefore be concluded that the manual physiotherapy evaluation technique for motion segment analysis was indeed valid in determining biomechanical dysfunction of the cervical spine. The manual physiotherapy treatment technique as well as the therapeutic exercise programme for the correction of biomechanical dysfunction was found to be effective in the correction of cervical biomechanical dysfunction. It could further be concluded that the therapeutic exercise programme was safe to be performed by players without biomechanical dysfunction. The neck rehabilitation programme was effective in improving cervical circumference as well as cervical biomechanical function. / Thesis (Ph.D. (Education))--North-West University, Potchefstroom Campus, 2005.

Cervical spine injury can range from minor to severe or fatal, where severe injuries can result in incomplete or complete quadriplegia. There are close to 45,000 Canadians currently affected by paralysis due to traumatic spinal cord injury (tSCI) with an estimated 1700 new cases each year. The majority of tSCI occur in automotive collisions, and current methods for injury prediction are limited to predicting the likelihood for occupant injury but lack the detail to predict the specific injury and location at the tissue level. This research focused on major injuries associated with high impact automotive collisions such as rollover type collisions. Although whiplash is an injury commonly associated with automotive collisions, it was not considered for this study based on the low risk of neurological impairment. The goal of this study was to develop a cervical spine segment finite element model capable of predicting severe injuries such as ligament tears, disc failure, and bone fracture. The segment models used in this study were developed from previous cervical spine segment models representative of a 50th percentile male. The segment models included the vertebrae, detailed representations of the disc annulus fibres and nucleus, and the associated ligaments. The original model was previously verified and validated under quasi-static loading conditions for physiological ranges of motion. To accomplish the objectives of this research, the original models were modified to include updated material properties with the ability to represent tissue damage corresponding to injuries. Additional verification of the model was required to verify that the new material properties provided a physically correct response. Progressive failure was introduced in the ligament elements to produce a more biofidelic failure response and a tied contact between the vertebral bony endplates and the disc was used to represent disc avulsion. To represent the onset of bone fracture, a critical plastic strain failure criterion was implemented, and elements exceeding this criterion were eroded. The changes made to the material models were based on experimental studies and were not calibrated to produce a specific result. After verifying the modifications were implemented successfully, the models were validated against experimental segment failure tests. Modes of loading investigated included tension, compression, flexion, extension and axial rotation. In each case, the simulated response of the segment was evaluated against the average failure load, displacement at failure, and the observed injuries reported in the experimental studies. Additionally, qualitative analysis of elevated stress locations in the model were compared to reported fracture sites. Overall, the simulations showed good agreement with the experimental failure values, and produced tissue failure that was representative of the observed tissue damage in the experimental tests. The results of this research have provided a solid basis for cervical spine segment level injury prediction. Some limitations include the current implementation of bone fracture under compressive loads, and failure within the annulus fibrosus fibres of the disc should be investigated for future models. In addition to material model modifications, further investigation into the kinetics and kinematics of the upper cervical spine segment are important to better understand the complex interactions between the bone geometry and ligaments. This would give insight into the initial positioning and expected response in subsequent models. Future research will include integrating the current segment-level failure criteria into a full cervical spine model for the purpose of predicting severe cervical spine injury in simulated crash scenarios, with future applications in sports injury prevention and protective equipment.

Orientador: Francisco Haiter Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T03:59:30Z (GMT). No. of bitstreams: 1 Araujo_LucianeFariasde_D.pdf: 1820402 bytes, checksum: 03ccca96db91bba812e586ce3a350bc6 (MD5) Previous issue date: 2005 / Resumo: No presente trabalho propõe-se avaliar a existência de evidências clínicas e/ou radiográficas que identifiquem indivíduos com disfunção temporomandibular e da região cervical, bem como avaliar a eficácia da análise corporal computadorizada e da análise cefalométrica de Rocabado no diagnóstico destes pacientes. Para isso, foram avaliadas radiografias cefalométricas de perfil e fotografias de corpo inteiro de 100 pacientes, sendo 50 destes com sinais e sintomas de disfunção temporomandibular e 50 indivíduos assintomáticos, constituindo o grupo controle. A amostra foi selecionada a partir de ficha clínica de documentações ortodônticas em arquivo de uma clínica odontológica da cidade de Recife ¿ PE. Foi realizada avaliação fisioterapêutica das radiografias e fotografias, para fins de diagnóstico. Análise corporal e de Rocabado foram executadas para averiguação de sua aplicabilidade na detecção de desarmonias posturais da cabeça e dos segmentos corporais. As avaliações fisioterapêuticas diagnosticaram alterações posturais em ambos os grupos, sugerindo não existir associação entre elas e as disfunções temporomandibulares (p>0,05). Valores de Kappa indicaram que, na análise de Rocabado, o índice de curvatura da coluna cervical e o ângulo crânio-cervical apresentaram diagnósticos significantemente equivocados, o mesmo acontecendo com a predição da curva da coluna cervical pela análise fotográfica, não devendo, portanto, ser aplicados como instrumentos de diagnóstico. As análises corporais frontal, de perfil e de costas mostraram-se confiáveis quanto aos seus resultados, podendo ser utilizada como forma de avaliação de alterações posturais / Abstract: The aim of this paper was to evaluate the existence of clinical and/or radiographic evidences that identify patients with temporomandibular dysfunction and cervical region, as well as evaluating the effectiveness of the computerized corporal analysis and the cephalometric analysis of Rocabado in the diagnosis of these patients. In order to this, lateral cephalometric radiography and photographs of the entire body of 100 patients, being 50 of these with signals and symptoms of temporomandibular dysfunction and 50 asymptomatic individuals, constituting the control group. The sample was selected from the clinical information of orthodontic documentations in a file of a Dental clinic of the city of Recife - PE. It was carried through physiotherapeutic analysis of the x-rays and photographs for diagnosis ends. Corporal analysis and of Rocabado were executed for scertainment of its applicability in the detention of postural disharmony of the head and the corporal segments. The physiotherapeutics evaluations diagnosed postural alterations in both groups, suggesting not to exist association between them and the temporomandibular dysfunction (p>0,05). Values of Kappa indicated the same that, in the analysis of Rocabado, bending of the skull-cervical angle and the index column cervical were ignificantly presented making a diagnostic mistake, happening with the prediction of the curve of the cervical column for the photographic analysis, not having, therefore, to be applied as diagnosis instruments. The frontal corporal analyses of the profile and coasts revealed trustworthy how much to its results, being able to be used as form of evaluation the postural alterations / Doutorado / Radiologia Odontologica / Doutor em Radiologia Odontológica

Background: Axis fractures are a common injury in the elderly population. Treatment is often complicated due to osteoporosis and patient comorbidity. Knowledge of the incidence of these fractures, as well as their treatment, outcome and mortality rate, will improve knowledge and decision-making processes for this fragile group of patients. Objectives: This thesis aims (1) to review the literature on the non-surgical and surgical treatment of odontoid fractures type 2 in the elderly population, (2) to provide an updated overview of axis fracture subtypes, their incidence and their treatment in a cohort in two university cities, (3) to map the incidence of fractures and the treatment of these patients in Sweden, (4) to investigate the effect on mortality of both the surgical and non-surgical treatment of axis fractures and (5) to present the protocol for a randomized controlled trial (RCT) on the treatment of odontoid fractures type 2 in the elderly population. Methods: A systematic review was performed using the MeSH keywords “odontoid AND fracture AND elderly”. The data for the cohort study were extracted from the regional hospital information system. The radiographs were reviewed retrospectively. Data were extracted from the Swedish National Patient Registry (NPR) and the mortality registry for the national registry studies. Finally, the RCT protocol was carried out according to the SPIRIT and CONSORT statements for clinical trial reporting. Results and conclusions: So far, there has been a scarcity of existing evidence on treatment of odontoid fractures type 2 in the elderly population. In this thesis, we found in two university cities an increased incidence, and a trend towards more surgical treatment of type 2 and 3 odontoid fractures 2002-2014. Between 1997 and 2014 in Sweden, there was an increasing incidence of C2 fractures, but the treatment trend went towards more non-surgical treatment. Surgically treated patients had a greater survival rate than non-surgically treated patients. Among those over 88 years of age, surgical treatment lost its effect on survival. In the RCT we will study the function of patients with odontoid fractures type 2 and by comparing non-surgical treatment with posterior C1-C2 fusion, the cost-effectiveness of the treatment options.

The South African Professional Board for Emergency Care prehospital Clinical Practice Guideline (CPG) recommends that emergency medical services (EMS) make use of the National Emergency X Radiography Utilization Study (NEXUS) rule and Canadian C-spine Rule (CCSR) when managing traumatic spinal injury. However, the safety and effectiveness of prehospital clinical spinal clearance or spinal motion restriction (SMR) decision support tools within poorly resourced settings are unclear. We conducted a scoping review on clinical spinal clearance and selective SMR decision support tools which aimed at identifying possible barriers to their implementation, safety, and effectiveness when used by EMS personnel. Studies were included if they described the use of clinical spinal clearance or SMR decision tools in first line management of blunt trauma patients by medical practitioners in the Emergency Department (ED) or by EMS personnel working in a prehospital setting. After screening, 42 documents fulfilled the inclusion criteria. Several selective SMR decision support tools have been implemented in the prehospital setting, the most common of which were those based on the NEXUS and the CCSR tools. Only one study evaluated the safety and efficacy of the NEXUS rule when used by EMS personnel. The limited prehospital literature available investigating either the NEXUS rule or CCSR therefore makes it difficult to determine its appropriateness for adoption and implementation by EMS personnel in other prehospital settings such as that of South Africa. Furthermore, commonly found prehospital NEXUS-based decision tools presented with unique challenges related to the subjective nature of some of the individual components of the decision tool. This leaves the decision tool open to interpretation by examiners and is especially relevant in settings, such as South Africa, where there are many different levels in scope of practices. This increases the risk of the patient being either under-triaged or over-triaged. More studies are therefore needed to definitively assess for the safety, efficacy and effectiveness of clinical spine clearance within the prehospital setting. It is believed that a selective SMR decision tool which has more specific instructions for the prehospital practitioner may be able to accommodate such challenges and is an area which needs further investigation.

No description available.