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Human Lumbar Spine Responses from Vertical Loading: Ranking of Forces Via Brier Score Metrics and Injury Risk Curves

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Abstract

This study was conducted to quantify the human tolerance from inferior to superior impacts to whole lumbar spinal columns excised from 43 post mortem human subjects. The specimens were fixed at the ends, aligned in a consistent seated posture, load cells were attached to the proximal and distal ends of the fixation, and the impact was applied using a custom accelerator device. Pretest X-rays and computed tomography (CT) scans, prepositioned X-rays, and posttest X-rays, CT scans and dissection data were used to identify injuries. Right, left, and interval censoring processes were used for the survival analysis, 16 were right censored, 24 were interval censored, and three were left censored observations. Force-based injury risk curves were developed, and the optimal metric describing the underlying response to injury was identified using the Brier score metric. Material, geometry (disc and body areas), and demographic covariates were included in the analysis. The distal force was found to be optimal metric. The bone mineral density was a significant covariate for distal and proximal forces. Both material and geometrical factors affected the transmitted force in this mode of loading. These quantified data serve as the first set of human lumbar spinal column injury risk curves.

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Acknowledgments

This research study was supported in part by the Department of Veterans Affairs Medical Research, and DoD grant W81XWH-16-01-0010. This material is the result of work supported with resources and use of facilities at the Zablocki VA Medical Center, Milwaukee, Wisconsin and Medical College of Wisconsin. The first and fourth authors are part time employees of the Zablocki VA Medical Center. This work was performed as part of the Biomechanics Product Team led by the Johns Hopkins Applied Physic Laboratory (JHU/APL) and supported under contract W911QX-17-D-0006, sponsored by the U.S. Army Research Lab in support of the WIAMan Program. Contributions of the WIAMan Engineering Office, staff of the Neuroscience Research Laboratories at the Medical College of Wisconsin, and engineers at JHU/APL are acknowledged. The views expressed are those of the authors and do not necessarily represent the official position or policy of the U. S. Government, the Department of Defense (or its branches), or the Department of the Army. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1TR001436. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH. This project is funded by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Narayan Yoganandan & Jason Moore

  2. Division of Biostatistics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Nicholas DeVogel & Anjishnu Banerjee

  3. Joint Department of Biomedical Engineering, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Frank Pintar

  4. Research and Exploratory Development Department, The Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD, 20723, USA

    JiangYue Zhang

Authors
  1. Narayan Yoganandan
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  2. Nicholas DeVogel
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  4. Frank Pintar
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  5. Anjishnu Banerjee
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  6. JiangYue Zhang
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Correspondence to Narayan Yoganandan.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Appendix

Appendix

See Figure A1–A6.

Figure A1–A6
figure 9

Images from left to right: A1—coronal CT scan before the test, A2—coronal CT scan after the test showing injuries at the upper lumbar vertebrae, A3—photograph of the specimen in the coronal plane after the test showing injuries, although to a less demonstrable extent at the inferior level, A4—sagittal CT scan before the test, A5—sagittal CT scan after the test, and A6—photograph of the specimen in the sagittal plane after the test. Note that the CT images are more effective in showing the pathology in both planes.

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Yoganandan, N., DeVogel, N., Moore, J. et al. Human Lumbar Spine Responses from Vertical Loading: Ranking of Forces Via Brier Score Metrics and Injury Risk Curves. Ann Biomed Eng 48, 79–91 (2020). https://doi.org/10.1007/s10439-019-02363-5

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  • DOI: https://doi.org/10.1007/s10439-019-02363-5

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