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Impact Injuries of the Thoracolumbar Spine

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Abstract

Impact injuries to the thoracolumbar spine are rare in automotive crashes. They take the form of vertebral body wedge fractures and, at times, burst fractures, particularly among the elderly. The cause is not vertical acceleration of the vehicle but is instead the straightening effect of the thoracic spine when the shoulder belt restraint is used. However, impact injuries due to vertical acceleration do occur in other environments, especially in the military environment. One of the first military problems is that of seat ejection – the emergency exit of a pilot from a disabled military jet aircraft. Some pilots sustain anterior wedge fractures of the thoracolumbar spine due to the 20 g acceleration of the seat. The injury was first recognized by the Luftwaffe or the German air force during World War II and was studied intensely in Britain and the USA for several decades after the war. The current problem is injury to the spine, pelvis, and lower extremities sustained by mounted soldiers whose vehicle they are riding in encounters an improvised explosive device. In this book, the seat ejection problem will be addressed, but blast-related injuries will not. Civilian injuries to the thoracolumbar spine due to falls also produce similar injuries. Falling from a height and landing on one’s buttocks generate wedge-type vertebral injuries. Fracture-dislocations can occur in more severe impacts. Such injuries are catastrophic because they can result in damage to the spinal cord and paralysis from the waist down. Ejection from a moving automobile or rollover of a vehicle can also cause these injuries.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA

    Albert I. King

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  1. Albert I. King
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Appendices

Questions for Chapter 9

  1. 9.1.

    One of the following statements relating to the anatomy of the human spine is untrue

    1. [ ] (i)

      The spine has a total of 24 vertebrae

    2. [ ] (ii)

      There is a disc between every adjacent pair of thoracic and lumbar vertebrae

    3. [ ] (iii)

      There is a disc between the first and second cervical vertebra

    4. [ ] (iv)

      The cervical and lumbar spine are lordotic and the thoracic spine is kyphotic

    5. [ ] (v)

      The first cervical vertebra does not have a body

  2. 9.2.

    One of the following statements does not apply to flexion-compression type injuries of the neck:

    1. [ ] (i)

      The injuries are due to a compression load applied to the head anterior to the head c.g.

    2. [ ] (ii)

      Flexion and compression can combine to produce wedge fracture of vertebral bodies

    3. [ ] (iii)

      Endplates can separate from the disc surface under flexion and compression loads

    4. [ ] (iv)

      Burst fractures of the vertebral bodies can occur due to flexion and compression

    5. [ ] (v)

      Anterior dislocation of facets can occur as a result of a flexion compression load

  3. 9.3.

    Burst fractures of vertebral bodies

    1. [ ] (i)

      Cause spinal cord injury because of the severe loss of the height of the vertebral body

    2. [ ] (ii)

      Are due to an axially directed compressive load on the body of the vertebra

    3. [ ] (iii)

      Do not propel fragments of the body into the spinal canal to injure the cord

    4. [ ] (iv)

      Are usually associated with rupture of the adjacent intervertebral discs

    5. [ ] (v)

      Can frequently occur during airbag deployments

  4. 9.4.

    The most common injury sustained by pilots who eject from disabled jet aircraft is:

    1. [ ] (i)

      A herniated lumbar intervertebral disc

    2. [ ] (ii)

      Fracture of the spinous process

    3. [ ] (iii)

      Burst fracture of a lumbar vertebral body

    4. [ ] (iv)

      Fracture dislocation of thoracic or lumbar vertebrae

    5. [ ] (v)

      Wedge fracture of a vertebral body of the thoracolumbar spine

  5. 9.5.

    Wedge fractures in the lumbar spine can occur in automotive crashes because of:

    1. [ ] (i)

      Vertical (z-axis) loads due to vehicle bounce

    2. [ ] (ii)

      Vertical (z-axis) loads due to springs in the seat cushion

    3. [ ] (iii)

      Vertical (z-axis) loads due to a lap belt

    4. [ ] (iv)

      Vertical (z-axis) loads due to a shoulder belt restraint

    5. [ ] (v)

      Vertical (z-axis) loads due to vehicle pitch during the crash

  6. 9.6.

    Chance fractures occur in automotive crashes :

    1. [ ] (i)

      When there is a chance encounter of a vehicle with another object

    2. [ ] (ii)

      When there is no shoulder belt and the lap belt rides over the pelvis and fractures the lumbar spine

    3. [ ] (iii)

      When the lumbar spine pivots around a lap belt holding a passenger who does not have a shoulder restraint

    4. [ ] (iv)

      When the shoulder belt is worn too tightly and there is no lap belt

    5. [ ] (v)

      (ii) and (iii)

  7. 9.7.

    During pilot ejection from a disabled jet aircraft, the most frequently injured area of the spine is:

    1. [ ] (i)

      The cervical spine

    2. [ ] (ii)

      The intervertebral discs

    3. [ ] (iii)

      The lamina

    4. [ ] (iv)

      T1-T6 vertebral bodies

    5. [ ] (v)

      T10-L2 vertebral bodies

  8. 9.8.

    During pilot ejection from a disabled jet aircraft, the most frequently injured area of the spine is:

    1. [ ] (i)

      The transverse processes

    2. [ ] (ii)

      The spinous processes

    3. [ ] (iii)

      The neural arch

    4. [ ] (iv)

      The sacrum

    5. [ ] (v)

      None of the above

  9. 9.9.

    Anterior wedge fractures of the thoracolumbar spine are caused by:

    1. [ ] (i)

      High shear loads in the antero-posterior direction

    2. [ ] (ii)

      High facet loads due to antero-posterior shear

    3. [ ] (iii)

      High compressive loads without forward flexion

    4. [ ] (iv)

      High compressive loads with forward flexion

    5. [ ] (v)

      High bending loads without significant compressive loading

  10. 9.10.

    In pilot ejection, the tolerance of the vertebral body to fracture can be increased by:

    1. [ ] (i)

      Hyperflexing the spine prior to ejection

    2. [ ] (ii)

      Hyperextending the spine prior to ejection

    3. [ ] (iii)

      Placing the spine in lateral bending prior to ejection

    4. [ ] (iv)

      Placing a cushion on the seat pan prior to ejection

    5. [ ] (v)

      (ii) and (iv)

  11. 9.11.

    During pilot ejection (20 g peak), vertical load down the spine can be efficiently transmitted by:

    1. [ ] (i)

      The lumbar facets

    2. [ ] (ii)

      The intervertebral discs

    3. [ ] (iii)

      Voluntary generation of abdominal pressure

    4. [ ] (iv)

      All of the above

    5. [ ] (v)

      (i) and (ii)

  12. 9.12.

    The average burst fracture load for a lumbar vertebra was found to be about 6 kN. This is equivalent to a vertical (+Gz) acceleration of about 13 g. This value is lower than the whole-body acceleration tolerance. Possible reasons for this are:

    1. [ ] (i)

      Duration of impact not compatible with the ejection seat pulse

    2. [ ] (ii)

      Cadaveric specimens used were not taken from a population of healthy young males

    3. [ ] (iii)

      The applied force was from a dropping weight and this is different from an inertial load

    4. [ ] (iv)

      All of the above

    5. [ ] (v)

      (i) and (ii)

  13. 9.13.

    A middle-aged male driver was involved in a frontal crash. He was belted and sustained no fractures or lacerations. However, he complained of low back pain immediately after the crash. Subsequently, he was diagnosed with a ruptured disc at the L5-S1 level. He also has a history of intermittent low back pain. The ruptured disc was not caused by the crash because:

    1. [ ] (i)

      His lumbar spine did not sustain a vertical (infero-superior) load during the crash

    2. [ ] (ii)

      Discs do not rupture as the result of a single loading event or impact unless there is massive bony fracture of the adjacent vertebral bodies

    3. [ ] (iii)

      The immediate pain is due to the degenerated condition of his spine and is not necessarily an indication of a permanent injury

    4. [ ] (iv)

      All of the above

    5. [ ] (v)

      (ii) and (iii)

  14. 9.14.

    During pilot ejection (20 g peak), vertical load down the spine can be efficiently transmitted by:

    1. [ ] (i)

      The ligamentum flavum

    2. [ ] (ii)

      The extensor muscles behind the spine

    3. [ ] (iii)

      Voluntarily generated abdominal pressure

    4. [ ] (iv)

      The neural arch

    5. [ ] (v)

      None of the above

  15. 9.15.

    The Prasad model of the spine can be used to simulate pilot ejection from a disabled aircraft

    1. [ ] (i)

      It was a finite element model

    2. [ ] (ii)

      It was a lumped parameter model

    3. [ ] (iii)

      It was a discrete parameter model

    4. [ ] (iv)

      It was a 3-D model

    5. [ ] (v)

      It was a continuum model

  16. 9.16.

    In cadaveric studies using the vertical accelerator, Prasad et al. (1974) discovered the cause for anterior wedge fractures in pilots who eject from disabled aircraft. Identify the incorrect statement

    1. [ ] (i)

      the facets were able to transmit a vertical load down the spine

    2. [ ] (ii)

      the spinal fracture load was increased dramatically if the spine was put in hyperextension

    3. [ ] (iii)

      In the erect mode, the facet load became tensile towards the end of the acceleration pulse

    4. [ ] (iv)

      The facet load was measured directly during the vertical accelerator tests

    5. [ ] (v)

      None of the above

  17. 9.17.

    During vertical acceleration of the whole body, abdominal pressure is a possible load path to transmit the inertial load of the head and torso to the pelvis

    1. [ ] (i)

      Abdominal pressure was a load path that can transmit inertial load to the pelvis

    2. [ ] (ii)

      With abdominal pressure, the facet load remained in compression

    3. [ ] (iii)

      To generate abdominal pressure in a living person, abdominal muscles need to contract causing the spinal extensors to contract

    4. [ ] (iv)

      The spinal extensors add compression to the spine and the spine load is not decreased by abdominal pressure

    5. [ ] (v)

      All of the above

  18. 9.18.

    Live dogs were subjected to vertical acceleration by Tennyson (1976). Select the correct answer

    1. [ ] (i)

      The purpose was to determine the spinal tolerance of the dog spine

    2. [ ] (ii)

      The dogs were anesthetized during testing

    3. [ ] (iii)

      The applied vertical acceleration ranged from 3 to 5 g

    4. [ ] (iv)

      The dogs sustained anterior wedge fractures of the thoracolumbar spine

    5. [ ] (v)

      None of the above

  19. 9.19.

    There is delay between the onset of acceleration and muscular response in the form of electromyographic signals (EMG) . This delay was measured in spinal muscles of dogs undergoing vertical acceleration

    1. [ ] (i)

      The delay is in the order of 100–200 ms

    2. [ ] (ii)

      The delay is in the order of 20–50 ms

    3. [ ] (iii)

      Muscle force reaches a maximum at the end of this delay

    4. [ ] (iv)

      There is another delay before muscle force reaches a maximum

    5. [ ] (v)

      (ii) and (iv)

  20. 9.20.

    Muscular response to an impact is delayed by several mechanisms. Select the incorrect answer:

    1. [ ] (i)

      There is delay due to the time needed to cause the Golgi tendons to fire

    2. [ ] (ii)

      There is delay due to transmission of the efferent signal from the cord

    3. [ ] (iii)

      There is delay due to the time needed to stretch the muscle spindles

    4. [ ] (iv)

      There is delay due to the time needed to generate muscle force after activation of the muscle

    5. [ ] (v)

      There is delay due to transmission of the afferent signal to the spinal cord

Answers to Problems by Chapter

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1

(iii)

2

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3

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(v)

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(v)

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(v)

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(v)

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(v)

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13

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14

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15

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16

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17

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18

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19

(v)

20

(i)

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King, A.I. (2018). Impact Injuries of the Thoracolumbar Spine. In: The Biomechanics of Impact Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-49792-1_9

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