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Impact Biomechanics of Neck Injury

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The Biomechanics of Impact Injury

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Abstract

The three major functions of the neck are to support the head, to allow it move three-dimensionally, and to conduct nerve signals to and from the brain via the spinal cord. Many muscles in the neck provide the flexibility for head motion, while a bony vertebral column protects the delicate tissues of the spinal cord. This protection, however, is not adequate for high-speed crashes, and a variety of neck injuries occur when the head is impacted directly or inertially. In order to attain a better understanding of the injury mechanisms involved, a brief review of spinal anatomy is needed. This review covers the cervical spine as well as the thoracolumbar spine to avoid repetition in subsequent chapters. It also stresses certain anatomical features that are normally glossed over in anatomical texts.

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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 7

  1. 7.1.

    The principal cause of a bilateral fracture/dislocation of the cervical spine is:

    1. [ ] (i)

      Hyperextension of the head and neck

    2. [ ] (ii)

      Axial compression of the neck

    3. [ ] (iii)

      Combined flexion and compression of the neck

    4. [ ] (iv)

      Lateral bending of the neck

    5. [ ] (v)

      None of the above

  2. 7.2.

    The principal cause of quadriplegia due to diving into a shallow pool is

    1. [ ] (i)

      Hyperextension of the head and neck

    2. [ ] (ii)

      Axial compression of the neck

    3. [ ] (iii)

      Combined flexion and compression of the neck

    4. [ ] (iv)

      Lateral bending of the neck

    5. [ ] (v)

      None of the above

  3. 7.3.

    Neck injury is a multi-faceted problem . Only one of the following is valid:

    1. [ ] (i)

      The injury mechanism can be determined based on the direction of head rotation

    2. [ ] (ii)

      Paralysis results only when the spinal cord is severed

    3. [ ] (iii)

      Injury to the spinal cord above the level of C3 is rarely fatal

    4. [ ] (iv)

      Vertebral body fracture and dislocation occur before head rotation takes place

    5. [ ] (v)

      Severity of neck injury is independent of the end conditions of the neck

  4. 7.4.

    Neck injury is a multi-faceted problem . Only one of the following is valid:

    1. [ ] (i)

      Tolerance to injury is dependent on bending moment only

    2. [ ] (ii)

      Injury tolerance is dependent on axial force only

    3. [ ] (iii)

      Injury to the spinal cord above the level of C3 is rarely fatal

    4. [ ] (iv)

      In crown impacts, vertebral body fracture can be easily reproduced in the cadaver

    5. [ ] (v)

      Severity of neck injury is dependent upon the end conditions of the neck

  5. 7.5.

    Identify the incorrect statement:

    1. [ ] (i)

      Diving into shallow pools can produce a flexion-compression injury of the neck

    2. [ ] (ii)

      Out of position occupants can sustain a severe flexion-compression injury of the neck when the airbag is deployed

    3. [ ] (iii)

      Severe injury to the cervical cord above C3 is invariably fatal

    4. [ ] (iv)

      Injury of the cord above T1 can produce partial or total quadriplegia

    5. [ ] (v)

      Impact of the head with the windshield can produce an extension-compression injury

  6. 7.6.

    Identify the incorrect statement:

    1. [ ] (i)

      Unstable neck injuries occur when the neck has to manage the inertia of the body following the head

    2. [ ] (ii)

      Unstable neck injuries tend to occur when the head is trapped in a soft or padded surface

    3. [ ] (iii)

      Under flexion and compression the neck undergoes a buckling mode in which part of it is in extension and the other part is in flexion

    4. [ ] (iv)

      The final position of the head is a good indicator of the type of bending the neck underwent

    5. [ ] (v)

      If both ends of the neck are constrained, it is more likely for the neck to sustain an unstable injury

  7. 7.7.

    Cervical disc ruptures

    1. [ ] (i)

      Can occur following a single crash or impact

    2. [ ] (ii)

      Are the same as cleavage of the disc in which the disc is split into two across a transverse plane

    3. [ ] (iii)

      Are usually associated with long term degeneration of the disc

    4. [ ] (iv)

      Can be prevented by the use of headrests

    5. [ ] (v)

      Are the only source of neck pain following a neck injury

  8. 7.8.

    Select the incorrect statement:

    1. [ ] (i)

      There have been several studies attempting to create compression-flexion type neck injuries using cadavers

    2. [ ] (ii)

      There have been many studies attempting to create catastrophic tension-extension type neck injuries using cadavers

    3. [ ] (iii)

      It is quite difficult to produce fracture dislocation and burst fractures in cadaveric necks

    4. [ ] (iv)

      It is virtually impossible to load the entire neck in pure compression

    5. [ ] (v)

      It is very difficult to cause severe injuries to an unconstrained neck

  9. 7.9.

    Select the incorrect statement

    1. [ ] (i)

      Tolerance corridor for the neck in flexion is available

    2. [ ] (ii)

      Tolerance corridor for the neck in extension is available

    3. [ ] (iii)

      Tolerance corridor for the neck in lateral bending is available

    4. [ ] (iv)

      Tolerance for the neck in compression is available

    5. [ ] (v)

      Tolerance corridor for the neck in tension for children is available

  10. 7.10.

    Select the incorrect statement

    1. [ ] (i)

      Tolerance of the neck in torsion has been studied

    2. [ ] (ii)

      Tolerance of the neck to transverse shear has been studied, but not extensively

    3. [ ] (iii)

      Tolerance of the neck to pure tensile loading has been studied

    4. [ ] (iv)

      Loads required to fracture the odontoid process have not been measured or estimated

    5. [ ] (v)

      Transverse cleavage of cervical discs is usually seen in elderly cadavers

  11. 7.11.

    Computer models of the neck simulating impact response

    1. [ ] (i)

      Were available as early as 1966

    2. [ ] (ii)

      Were not available until the early 1980s

    3. [ ] (iii)

      Were available in the early 1970s

    4. [ ] (iv)

      Were originally developed as finite element models in the 1970s

    5. [ ] (v)

      None of the above

  12. 7.12.

    Finite element models of the neck for impact response:

    1. [ ] (i)

      Were developed by researchers at the University of California, Berkeley

    2. [ ] (ii)

      Were developed by researchers at the University of California, San Diego

    3. [ ] (iii)

      Were developed by researchers at Ohio State University

    4. [ ] (iv)

      Were developed by researchers at the University of Michigan

    5. [ ] (v)

      None of the above

  13. 7.13.

    The Wayne State University neck model has many features. Select the incorrect statement:

    1. [ ] (i)

      This model simulates neck ligaments

    2. [ ] (ii)

      This model simulates individual vertebrae and discs

    3. [ ] (iii)

      This model simulates active muscle response

    4. [ ] (iv)

      This model simulates passive muscle response

    5. [ ] (v)

      This model simulates the geometry of the upper cervical vertebrae

  14. 7.14.

    The Wayne State University neck model was validated against several different test situations. Select the incorrect statement:

    1. [ ] (i)

      It has been validated against flexion-compression tests done at Duke University

    2. [ ] (ii)

      It has been validated against whiplash type tests done at Wayne State University

    3. [ ] (iii)

      It has been validated against airbag tests done at the University of Virginia

    4. [ ] (iv)

      It has been tested against airbag tests done at Wayne State University

    5. [ ] (v)

      It has not been validated against torsional tests

  15. 7.15.

    The following spinal ligaments are continuous from C1 to the sacrum

    1. [ ] (i)

      The supraspinous ligament

    2. [ ] (ii)

      The ligamentum flavum

    3. [ ] (iii)

      The posterior longitudinal ligament

    4. [ ] (iv)

      (i) and (iii)

    5. [ ] (v)

      (i) and (ii)

  16. 7.16.

    The following spinal ligaments are not continuous down the spine but span only adjacent vertebrae:

    1. [ ] (i)

      The anterior longitudinal ligament

    2. [ ] (ii)

      The interspinous ligament

    3. [ ] (iii)

      The ligamentum flavum

    4. [ ] (iv)

      (i) and (iii)

    5. [ ] (v)

      (ii) and (iii)

  17. 7.17.

    The intervertebral disc is made up of an annulus and a nucleus. Select the incorrect answer:

    1. [ ] (i)

      The nucleus contains more collagen fibers than the annulus

    2. [ ] (ii)

      The water content in the nucleus is higher than that of the annulus

    3. [ ] (iii)

      There are approximately 18 annular layers in a normal lumbar disc

    4. [ ] (iv)

      The chemical in the disc that absorbs water is proteoglycans

    5. [ ] (v)

      The collagen in the annulus is different from that of the nucleus

  18. 7.18.

    There are many differences between the facets of the cervical spine and those of the lumbar spine. Some of these differences are listed below. Select the incorrect answer

    1. [ ] (i)

      The articulating surface of the lumbar facets is flatter (closer to the transverse plane) than that of the lower cervical facets

    2. [ ] (ii)

      The lumbar facets bottom out on the lamina below but the cervical facets do not

    3. [ ] (iii)

      The lower cervical facets can resist antero-posterior shear better than the lumbar facets

    4. [ ] (iv)

      There are biomechanical data to show that lumbar facets transmit vertical (supero-inferior) loads down the spine

    5. [ ] (v)

      Lumbar vertebrae have inferior and superior facets and so do the cervical vertebrae

  19. 7.19.

    The Wayne State University neck model was validated against several different test situations. Select the correct statement:

    1. [ ] (i)

      It has been validated against flexion-compression drop tests done at the Medical College of Wisconsin

    2. [ ] (ii)

      It has been validated against crown impact tests done at Wayne State University

    3. [ ] (iii)

      It has been validated against airbag tests done at the University of Virginia

    4. [ ] (iv)

      It has been used to simulate airbag tests done at Wayne State University

    5. [ ] (v)

      It has been validated against torsional tests

  20. 7.20.

    In the airbag tests conducted by Cheng et al. (1982), fatal neck injury occurred in three of the six cadavers tested. Identify the correct statement:

    1. [ ] (i)

      The airbag was deployed at the time of impact

    2. [ ] (ii)

      The fatal neck injuries were due to the development of a large compressive force in the neck

    3. [ ] (iii)

      The fatal neck injuries were due to the development of a large tensile force in the neck

    4. [ ] (iv)

      The fatal neck injuries were due to severe impact of the chest with the airbag

    5. [ ] (v)

      None of the above

Answers to Problems by Chapter

Prob

Ans

1

(iii)

2

(iii)

3

(iv)

4

(v)

5

(ii)

6

(iv)

7

(iii)

8

(ii)

9

(v)

10

(iv)

11

(iii)

12

(v)

13

(iii)

14

(iii)

15

(v)

16

(v)

17

(i)

18

(ii)

19

(iv)

20

(iii)

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King, A.I. (2018). Impact Biomechanics of Neck Injury. In: The Biomechanics of Impact Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-49792-1_7

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