Motor vehicle accidents continue to be a leading cause of cervical spine injury despite a conscientious effort to improve occupant safety. Accurately predicting occupant head and neck response in numerical crash simulations is an essential part of the process for developing better safety solutions. <br /><br /> A biofidelic model of the human cervical spine was developed with a focus on accurate representation of the cervical spine at the local tissue level. These tissues were assembled to create a single segment model that was representative of <em>in vitro</em> spine in quasi-static loading. Finally, the single segment models were assembled to create a full cervical spine model that was simulated in dynamic loading and compared to human volunteer response. <br /><br /> Models of each segment were constructed from the basic building blocks of the cervical spine: the intervertebral disc, the vertebrae, the ligaments, and the facet joints. Each model was simulated in all modes of loading and at different levels of load. The results of the study indicate that the cervical spine segments performed very well in flexion, compression, and tension. Segment response to lateral bending and axial rotation was also good, while response in extension often proved too compliant compared to the experimental data. Furthermore, the single segment models did not fully agree with the experimental shear response, again being more compliant. <br /><br/> The full cervical spine model was assembled from the single segment models incorporating neck musculature. The model was simulated dynamically using a 15 G frontal impact test. Active muscles were used to simulate the response of the human volunteers used in the study. The response of the model was in reasonable agreement with the experimental data, and compared better than current finite element cervical spine models. Higher frequency oscillation caused most of the disagreement between the model and the experimental data, which was attributed to a lack of appropriate dynamic material properties of the soft tissues of the spine. In addition, a study into the active properties of muscle indicated that muscle response has a significant influence on the response of the head. <br /><br /> A number of recommendations were proposed that would improve the biofidelity of the model. Furthermore, it was recommended that the future goal of this model would be to implement injury-predicting capabilities through the development of advance material models.

Approximately 80% of the population will experience low-back pain within their lifetime. Significant research efforts have focused on compressive loading as an injury mechanism that could lead to low-back pain and injury. However, the influence of shear loading, and its relationship to vertebral tissue tolerances as well as modulating factors for these tolerances have not been studied as extensively. The primary objective of this thesis was to produce a series of investigations that begin to determine the roles of different modulating factors such as posture, compression, bone density, bone morphology, and repetitive load magnitude on measured vertebral joint shear failure tolerances. The thesis comprises four independent studies using in vitro mechanical testing, imaging modalities, and finite element modeling. Each of the in vitro studies within this thesis used a validated porcine cervical model as a surrogate for the human lumbar spine. The first study employed in vitro mechanical testing to investigate the combined roles of flexion/extension postural deviation and compressive load on the measured ultimate shear failure tolerances. Peripheral quantitative computed tomography scans of the pars interarticularis and measurements of vertebral bone morphology were used in the second investigation along with in vitro mechanical testing to identify the morphological characteristics that can be used to predict ultimate shear failure tolerances. The influence of sub-maximal shear load magnitude on the cumulative shear load and number of loading cycles sustained prior to failure were investigated with in vitro mechanical testing in the third study. Finally, a finite element model of the porcine C3-C4 functional spinal unit was used to investigate the plausibility of hypotheses, developed from previous research and the findings of the first investigation for this thesis, surrounding alterations in measured ultimate shear failure tolerances as a function of changes in facet interaction. Results from the first investigation showed that there was no statistically significant interaction between postural deviation and compressive force on ultimate shear failure tolerance. However, ultimate shear failure tolerance was reduced (compared to neutral) by 13.2% with flexed postures, and increased (compared to neutral) by 12.8% with extended postures. Each 15% increment (up to a maximum of 60% of predicted compressive failure tolerance) in compressive force was met with an average 11.1% increase in ultimate shear failure tolerance. It was hypothesized that alterations in flexion/extension posture and/or compressive force altered the location for the force centroid of facet contact. These changes in the location of facet contact were hypothesized to produce subsequent changes in the bending moment at the pars interarticularis that altered the measured ultimate shear failure tolerance. The three leading factors for calculating of measured ultimate shear failure tolerance were the pars interarticularis length for the cranial vertebra, the average facet angle measured in the transverse plane, and cortical bone area through the pars interarticularis. A bi-variate linear regression model that used the cranial vertebra’s pars interarticularis length and average facet angle as inputs was developed to nondestructively calculate ultimate shear failure tolerances of the porcine cervical spine. Longer pars interarticularis lengths and facets oriented closer to the sagittal plane were associated with higher measured ultimate shear failure tolerances. Fractures observed in this investigation were similar to those reported for studies performed with human specimens and also similar to reported spondylolitic fractures associated with shear loading in humans. This provided additional evidence that the porcine cervical spine is a suitable surrogate in vitro model for studying human lumbar spine mechanics. Altered sub-maximal shear load magnitude create a non-linear decrease in both the number of cycles and the cumulative shear load sustained prior to failure. These findings suggested that estimates of cumulative shear load should assign greater importance to higher instantaneous shear loads. This was due to an increased injury potential at higher instantaneous shear loads. Cumulative load sustained prior to failure was used to develop a tissue-based weighting factor equation that would apply nonlinearly increased weight to higher shear load magnitudes in estimates of cumulative shear load. A finite element model of the porcine C3-C4 functional spinal unit was created, and simulations were performed using similar boundary conditions as the comparable in vitro tests, to assess the plausibility of the moment arm hypothesis offered within the first investigation of this thesis. Moment arm length between the force centroid of facet contact and the location of peak stress within the pars interarticularis was increased for flexed postures and decreased for extended postures. Alterations in moment arm length were larger for postural deviation than compressive force, suggesting a secondary mechanism to explain the observed increase in shear failure tolerance with higher compressive loads from the first investigation. One such possibility was the increase in the number of contacting nodes with higher compressive forces. Alterations in moment arm length were able to explain 50% of the variance in measured ultimate shear failure tolerances from the first study. Thus, the finite element model was successful in demonstrating the plausibility of moment arm length between the force centroid of facet contact and the pars interarticularis as a modulator of measured ultimate shear failure tolerance. This thesis has developed the basis for understanding how failure of the vertebral joint exposed to shear loading can be modulated. In particular, this thesis has developed novel equations to predict the ultimate shear failure tolerance measured during in vitro testing, and to determine appropriate weighting factors for sub-maximal shear forces in calculations of cumulative shear load. Evidence presented within this thesis also provides support for the long-standing moment arm hypothesis for modulation of shear injury potential.

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

No description available.

No description available.

<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>

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 153-165).

No description available.

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.