Forensic Science, Medicine and Pathology

, Volume 14, Issue 4, pp 484–496 | Cite as

Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT

  • Vasiliki ChatzarakiEmail author
  • Carlo Tappero
  • Michael J. Thali
  • Wolf Schweitzer
Original Article


During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon’s bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon’s bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon’s bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon’s bleedings are present.


Virtopsy Postmortem computed tomography (PMCT) Complete hanging Incomplete hanging Simon’s bleedings Intervertebral disc vacuum phenomenon 



The authors thank Jakob Heimer, MD for the illustration of the upper part of Fig. 1 and express their gratitude to Emma Louise Kessler, MD for her generous donation to the Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.

Compliance with ethical standards

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee. This article does not contain any studies with animals performed by any of the authors.

Ethical approval

Ethical approval was obtained by the Cantonal Ethics Committee of Zurich, Switzerland, Nr. 2015–0686.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Vasiliki Chatzaraki
    • 1
    Email author
  • Carlo Tappero
    • 1
    • 2
  • Michael J. Thali
    • 1
  • Wolf Schweitzer
    • 1
  1. 1.Department of Forensic Medicine and Imaging, Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland
  2. 2.Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University HospitalBernSwitzerland

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