Failure properties of cervical spinal ligaments under fast strain rate deformations

Mechanical response of human thoracic spine ligaments under quasi-static loading: An experimental study

PURPOSE

This study aimed to investigate the geometrical and mechanical properties of human thoracic spine ligaments subjected to uniaxial quasi-static tensile test.

METHODS

Four human thoracic spines, obtained through a body donation program, were utilized for the study. The anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), capsular ligament (CL), ligamenta flava (LF), and the interspinous ligament and supraspinous ligament complex (ISL + SSL), were investigated. The samples underwent specimen preparation, including dissection, cleaning, and reinforcement, before being immersed in epoxy resin. Uniaxial tensile tests were performed using a custom-designed mechanical testing machine equipped with an environmental chamber (T = 36.6 °C; humidity 95%). Then, the obtained tensile curves were averaged preserving the characteristic regions of typical ligaments response.

RESULTS

Geometrical and mechanical properties, such as initial length and width, failure load, and failure elongation, were measured. Analysis of variance (ANOVA) revealed significant differences among the ligaments for all investigated parameters. Pairwise comparisons using Tukey's post-hoc test indicated differences in initial length and width. ALL and PLL exhibited higher failure forces compared to CL and LF. ALL and ISL + SSL demonstrated biggest failure elongation. Comparisons with other studies showed variations in initial length, failure force, and failure elongation across different ligaments. The subsystem (Th1 - Th6 and Th7 - Th12) analysis revealed increases in initial length, width, failure force, and elongation for certain ligaments.

CONCLUSIONS

Variations of both the geometric and mechanical properties of the ligaments were noticed, highlighting their unique characteristics and response to tensile force. Presented results extend very limited experimental data base of thoracic spine ligaments existing in the literature. The obtained geometrical and mechanical properties can help in the development of more precise human body models (HBMs).

Mechanisms and timing of injury to the thoracic, lumbar and sacral spine in simulated underbody blast PMHS impact tests

During an underbody blast (UBB) event, mounted occupants are exposed to high rate loading of the spine via the pelvis. The objective of this study was to simulate UBB loading conditions and examine mechanisms of injury in the thoracic, lumbar and sacral spine. Fourteen instrumented, whole-body, postmortem human subject (PMHS) experiments were performed using the WSU-decelerative horizontal sled system. The specimens were positioned supine on a decelerative sled, which then impacted an energy absorbing system mounted to a concrete barrier. Variables included the peak velocity and time-to-peak velocity for seat and floor, and the presence or absence of personal protective equipment (PPE) and seat padding. Post-test CT scans and autopsies were performed to identify the presence and severity of injuries. Acceleration and angular rate data collected at vertebra T1, T5, T8, T12, and S1 were used to assess injury timing and mechanisms. Additionally, joint time-frequency analysis (JTFA) of the spinal Z acceleration of the sacrum and vertebrae was developed with the aim of verifying spinal fracture timing. Injuries observed in the spine were attributed to axial compression applied through the pelvis, together with flexion moment due to the offset in the center of gravity of the torso, and are consistent with UBB-induced combat injuries reported in the literature. The injury timing estimation techniques discussed in this study provide a time interval when the fractures are predicted to have occurred. Furthermore, this approach serves as an alternative to the estimation methods using acoustic sensors, force and acceleration traces, and strain gauges.

A one-dimensional collagen-based biomechanical model of passive soft tissue with viscoelasticity and failure

INTRODUCTION

Strains and sprains of soft tissues, including tendons and ligaments, are frequently occurring injuries. Musculoskeletal models show great promise in prediction and prevention of these injuries. However, these models rarely account for the viscoelastic properties of ligaments and tendons, much less their failure properties. The purpose of this project was to develop, simplify, and analyze a collagen-distribution model to address these limitations.

MODEL DEVELOPMENT

A distribution-moment approximation was applied to an existing partial differential equation model to reduce its computational complexity. The resulting model was equipped with a Voigt model in series, which endowed it with viscoelastic properties in addition to failure properties.

RESULTS

The model was able to reproduce the characteristic toe, linear, and failure regions ubiquitous throughout in-vitro tests on tissue specimens. In addition, it was able to reproduce a tri-phasic creep test consisting of an initial deformation, a steady-state, and failure. Stress-relaxation and hysteresis were also reproducible by the model.

DISCUSSION AND CONCLUSION

The ability to reproduce so many characteristics of biological tissues suggests more bio-fidelity was achieved by the reduced model was other currently available models. Future work to further improve its bio-fidelity is proposed for specific tendons and ligaments.

Analysis of the mechanical response of damaged human cervical spine ligaments

BACKGROUND

Cervical spine ligaments that protect the spinal cord and stabilize the spine are frequently injured in motor vehicle collisions and other traumatic situations. These injuries are usually incomplete, and often difficult to notice. The focus of the presented study is placed on analysis of the effect of subfailure load on the mechanical response of the three main cervical spine ligaments: the anterior and the posterior longitudinal ligament and the ligamentum flavum.

METHODS

A total of 115 samples of human cadaveric ligaments removed within 24-48 h after death have been tested. Uniaxial tension tests along the fiber direction were performed in physiological conditions on a custom designed test equipment. The ligaments were loaded into an expected damage zone at two different subfailure values (based on previously reported reference group of 46 samples), and then reloaded to failure.

FINDINGS

The main effect of a high subfailure load has proven to be the toe elongation change. The toe elongation increase is affected by the subfailure load value. While anterior and posterior longitudinal ligament showed similar changes, the smallest subfailure effect was found in ligamentum flavum.

INTERPRETATIONS

The normal physiological region of the cervical spine ligaments mechanical response is modified by a high subfailure load. The observed ligament injury significantly compromises ligament ability to give tensile support within physiological spinal motion.

Analysis of rider and child pillion passenger kinematics along with injury mechanisms during motorcycle crash

Objective: Traffic fatalities among motorcycle users are intolerably high in Thailand. They account for 73% of the total number of road fatalities. Children are also among these victims. To improve countermeasures and design of protection equipment, understanding the biomechanics of motorcycle users under impact conditions is necessary. The objective of this work is to analyze the overall kinematics and injuries sustained by riders and child pillion passengers in various accident configurations. Methods: Motorcycle accident data were analyzed. Common accident scenarios and impact parameters were identified. Two numerical approaches were employed. The multibody model was validated with a motorcycle crash test and used to generate possible accident cases for various impact conditions specified to cover all common accident scenarios. Specific impact conditions were selected for detailed finite element analysis. The finite element simulations of motorcycle-to-car collisions were conducted to provide insight into kinematics and injury mechanisms. Results: Global kinematics found when the motorcycle's front wheel impacts a car (config-MC) highlighted the translation motion of both the rider and passenger toward the impact position. The rider's trunk impacted the handlebar and the head either impacted the car or missed. The hood constituted the highest head impact occurrence for this configuration. The child mostly impacted the rider's back. Different kinematics were found when car impacted the lateral side of the motorcycle (config-CM). Upper bodies of both rider and child were laterally projected toward the car front. The windshield constituted the highest proportion of head impacts. The hood and A-pillar recorded a moderate proportion. The rider in finite element simulations with config-MC experienced high rib stress, lung strain, and pressure beyond the injury limit. A high head injury criterion was observed when the head hit the car. However, the simulation with config-CM exhibited high lower extremities stress and lung pressure in both occupants. Hyperextension of the rider's neck was observed. The cumulative strain damage measure of the child's brain was higher than the threshold for diffuse axonal injury (DAI). Conclusions: This study revealed 2 kinematics patterns and injury mechanisms. Simulations with config-MC manifested a high risk of head and thorax injury to the rider but a low risk of severe injury to the child. Thorax injury to the rider due to handlebar impact was only found in simulations with config-MC. However, a high risk of skull, lower extremity, brain, and neck injuries were more pronounced for cases with config-CM. A high risk of DAI was also noticed for the child. In simulations with config-CM the child exhibited a higher risk of severe injury.

A two-step procedure for coupling development and usage of a pair of human neck models

Both finite element models and multi-body models of human head-neck complex had been widely used in neck injuries analysis, as the former could be used to generate detailed stress strain information and the later could generate dynamic responses with high efficiency. Sometimes, detailed stress and strain information were hoped to be obtained more efficiently, but current methods were not effective enough when they were used to analyze responses of human head neck complex to long duration undulate accelerations. In this paper, a two-step procedure for 'parallel' development and 'sequential' usage of a pair of human head neck models was discussed. The pair of models contained a finite element model and a multi-body model, which were developed based on the coupling 'parallel' procedure using the same bio-realistic geometry. After being validated using available data, the pair of human neck models were applied to analyze biomechanical responses of pilot's neck during arrested landing operation according to the 'sequential' procedure, because typical sustained undulate accelerations usually appeared during such processes. The results, including both kinematic and detailed biomechanical responses of human head-neck complex, were obtained with preferable efficiency. This research provided an effective way for biomechanical analysis of human head neck responses to sustained undulate accelerations.

Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study

Objectives

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine.

Methods

A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion.

Results

Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA).

Conclusion

Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain.

Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1.

Evaluation of biofidelity of THUMS pedestrian model under a whole-body impact conditions with a generic sedan buck

OBJECTIVE

The goal of this study was to evaluate the biofidelity of the Total Human Model for Safety (THUMS; Ver. 4.01) pedestrian finite element models (PFEM) in a whole-body pedestrian impact condition using a well-characterized generic pedestrian buck model.

METHODS

The biofidelity of THUMS PFEM was evaluated with respect to data from 3 full-scale postmortem human subject (PMHS) pedestrian impact tests, in which a pedestrian buck laterally struck the subjects using a pedestrian buck at 40 km/h. The pedestrian model was scaled to match the anthropometry of the target subjects and then positioned to match the pre-impact postures of the target subjects based on the 3-dimensional motion tracking data obtained during the experiments. An objective rating method was employed to quantitatively evaluate the correlation between the responses of the models and the PMHS. Injuries in the models were predicted both probabilistically and deterministically using empirical injury risk functions and strain measures, respectively, and compared with those of the target PMHS.

RESULTS

In general, the model exhibited biofidelic kinematic responses (in the Y-Z plane) regarding trajectories (International Organization for Standardization [ISO] ratings: Y = 0.90 ± 0.11, Z = 0.89 ± 0.09), linear resultant velocities (ISO ratings: 0.83 ± 0.07), accelerations (ISO ratings: Y = 0.58 ± 0.11, Z = 0.52 ± 0.12), and angular velocities (ISO ratings: X = 0.48 ± 0.13) but exhibited stiffer leg responses and delayed head responses compared to those of the PMHS. This indicates potential biofidelity issues with the PFEM for regions below the knee and in the neck. The model also demonstrated comparable reaction forces at the buck front-end regions to those from the PMHS tests. The PFEM generally predicted the injuries that the PMHS sustained but overestimated injuries in the ankle and leg regions.

CONCLUSIONS

Based on the data considered, the THUMS PFEM was considered to be biofidelic for this pedestrian impact condition and vehicle. Given the capability of the model to reproduce biomechanical responses, it shows potential as a valuable tool for developing novel pedestrian safety systems.

Identifying Spinal Injury Patterns in Underbody Blast to Develop Mechanistic Hypotheses

STUDY DESIGN

A retrospective case series of UK victims of blast injury.

OBJECTIVE

To identify the injury patterns in the spine caused by under-vehicle blast, and attempt to derive the mechanism of those injuries.

SUMMARY OF BACKGROUND DATA

The Improvised Explosive Device has been a feature of recent conflicts with frequent attacks on vehicles, leading to devastating injuries. Vehicle design has evolved to reduce the risk of injury to occupants in underbody blast, where the device detonates beneath the vehicle. The mechanism of spinal injury in such attacks is not well understood; understanding the injury mechanism is necessary to produce evidence-based mitigation strategies.

METHODS

A Joint Theatre Trauma Registry search identified UK victims of blast between 2008 and 2013. Each victim had their initial scan reviewed to classify spinal fractures.

RESULTS

Seventy-eight victims were identified, of whom 53 were survivors. There were a total of 284 fractures, including 101 thoracolumbar vertebral body fractures and 39 cervical spine fractures. Most thoracolumbar fractures were wedge compression injuries. Most cervical spine fractures were compression-extension injuries.The most common thoracic and lumbar body fractures in this group suggest a flexed posture at the time of injury. Most cervical spine fractures were in extension, which might be compatible with the head having struck another object.

CONCLUSION

Modifying the seated posture might reduce the risk of thoracolumbar injury, or allow the resulting injury patterns to be controlled. Cervical spine injuries might be mitigated by changing vehicle design to protect the head.

LEVEL OF EVIDENCE

N/A.

Blast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury

BACKGROUND

Improvised explosive devices are a common feature of recent asymmetric conflicts and there is a persistent landmine threat to military and humanitarian personnel. Assessment of injury risk to the spine in vehicles subjected to explosions was conducted using a standardized model, the Dynamic Response Index (DRI). However, the DRI was intended for evaluating aircraft ejection seats and has not been validated in blast conditions.

QUESTIONS/PURPOSES

We asked whether the injury patterns seen in blast are similar to those in aircraft ejection and therefore whether a single injury prediction model can be used for both situations.

METHODS

UK military victims of mounted blast (seated in a vehicle) were identified from the Joint Theatre Trauma Registry. Each had their initial CT scans reviewed to identify spinal fractures. A literature search identified a comparison population of ejected aircrew with spinal fractures. Seventy-eight blast victims were identified with 294 fractures. One hundred eighty-nine patients who had sustained aircraft ejection were identified with 258 fractures. The Kruskal-Wallis test was used to compare the population injury distributions and Fisher's exact test was used to assess differences at each spinal level.

RESULTS

The distribution of injuries between blast and ejection was not similar. In the cervical spine, the relative risk of injury was 11.5 times higher in blast; in the lumbar spine the relative risk was 2.9 times higher in blast. In the thoracic spine, the relative risk was identical in blast and ejection. At most individual vertebral levels including the upper thoracic spine, there was a higher risk of injury in the blast population, but the opposite was true between T7 and T12, where the risk was higher in aircraft ejection.

CONCLUSIONS

The patterns of injury in blast and aircraft are different, suggesting that the two are mechanistically dissimilar. At most vertebral levels there is a higher relative risk of fracture in the blast population, but at the apex of the thoracic spine and in the lower thoracic spine, there is a higher risk in ejection victims. The differences in relative risk at different levels, and the resulting overall different injury patterns, suggest that a single model cannot be used to predict the risk of injury in ejection and blast.

CLINICAL RELEVANCE

A new model needs to be developed to aid in the design of mine-protected vehicles for future conflicts.

High Rotation Rate Behavior of Cervical Spine Segments in Flexion and Extension

Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2–C3 to C7–T1 were dissected from eight donors and were tested to 10 deg of rotation at 1 and 500 deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p < 0.05) of increased stiffness at the higher rotation rate above 4 deg of rotation in flexion and at 8 deg and 10 deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data.

Failure modes and fracture toughness in partially torn ligaments and tendons

Ligaments and tendons are commonly torn during injury, yet the likelihood that untreated initial tears could lead to further tearing or even full rupture has proven challenging to predict. In this work, porcine Achilles tendon and human anterior longitudinal ligament samples were tested using both standard fracture toughness methods and complex loading conditions. Failure modes for each of 14 distinct testing cases were evaluated using a total of 131 soft tissue tests. Results showed that these soft tissues were able to completely resist any further crack propagation of an initial tear, regardless of fiber orientation or applied loading condition. Consequently, the major concern for patients with tendon or ligament tears is likely not reduction in ultimate tissue strength due to stress risers at the tip of the tear, but rather a question of whether or not the remaining cross-section is large enough to support the anticipated loading.

Failure Properties and Damage of Cervical Spine Ligaments, Experiments and Modeling

Cervical spine ligaments have an important role in providing spinal cord stability and restricting excessive movements. Therefore, it is of great importance to study the mechanical properties and model the response of these ligaments. The aim of this study is to characterize the aging effects on the failure properties and model the damage of three cervical spine ligaments: the anterior and the posterior longitudinal ligament and the ligamentum flavum. A total of 46 samples of human cadaveric ligaments removed within 24–48 h after death have been tested. Uniaxial tension tests along the fiber direction were performed in physiological conditions. The results showed that aging decreased the failure properties of all three ligaments (failure load, failure elongation). Furthermore, the reported nonlinear response of cervical ligaments has been modeled with a combination of the previously reported hyperelastic and damage model. The model predicted a nonlinear response and damage region. The model fittings are in agreement with the experimental data and the quality of agreement is represented with the values of the coefficient of determination close to 1.

Evaluation of the intervertebral disk angle for the assessment of anterior cervical diskoligamentous injury

BACKGROUND AND PURPOSE

The anterior diskoligamentous complex is important for cervical spinal stability. Subjective widening of the disk space after trauma has been used to gauge disruption of the anterior diskoligamentous complex on CT scanning, but no quantitative CT measurements exist to evaluate injury. The purpose of our study was to evaluate if an increased intervertebral disk angle could serve as a more sensitive, reproducible indicator of disruption of the anterior diskoligamentous complex compared with subjective assessment.

MATERIALS AND METHODS

The intervertebral disk angle was retrospectively measured on CT scanning for 122 disk levels with disruption of the anterior diskoligamentous complex by MR imaging and 1095 disk levels with an intact anterior diskoligamentous complex by MR imaging. The intervertebral disk angle was measured between the anterior superior endplate and anterior inferior endplate, with angle apex at the midposterior disk. Area under the receiver operating characteristic curves for subjective disk widening and specific angle values were obtained. Intervertebral disk angle reproducibility was also evaluated.

RESULTS

Intervertebral disk angle measurements were "substantially reproducible." No disk with an intact anterior diskoligamentous complex had an intervertebral disk angle greater than 18° or 2 standard deviations from the average intervertebral disk angle of the remaining disks. The area under the receiver operating characteristic curve for a criterion of subjective disk widening was 0.58. The area under the receiver operating characteristic curve for objective criteria, an intervertebral disk angle greater than 13 or above 1 standard deviation from normal values, was 0.85. The maximal area under the receiver operating characteristic curve was achieved if an intervertebral disk angle greater than 2 SD from the average angle of the other disks was used (0.86).

CONCLUSIONS

Subjective disk widening does not accurately detect disruption of the anterior diskoligamentous complex on CT scanning; an elevated intervertebral disk angle provides a more sensitive and objective measurement to help direct further imaging in trauma patients.

Dynamic properties of the upper thoracic spine-pectoral girdle (UTS-PG) system and corresponding kinematics in PMHS sled tests

Anthropomorphic test devices (ATDs) should accurately depict head kinematics in crash tests, and thoracic spine properties have been demonstrated to affect those kinematics. To investigate the relationships between thoracic spine system dynamics and upper thoracic kinematics in crash-level scenarios, three adult post-mortem human subjects (PMHS) were tested in both Isolated Segment Manipulation (ISM) and sled configurations. In frontal sled tests, the T6-T8 vertebrae of the PMHS were coupled through a novel fixation technique to a rigid seat to directly measure thoracic spine loading. Mid-thoracic spine and belt loads along with head, spine, and pectoral girdle (PG) displacements were measured in 12 sled tests conducted with the three PMHS (3-pt lap-shoulder belted/unbelted at velocities from 3.8 - 7.0 m/s applied directly through T6-T8). The sled pulse, ISM- derived characteristic properties of that PMHS, and externally applied forces due to head-neck inertia and shoulder belt constraint were used to predict kinematic time histories of the T1-T6 spine segment. The experimental impulse applied to the upper thorax was normalized to be consistent with a T6 force/sled acceleration sinusoidal profile, and the result was an improvement in the prediction of T3 X-axis displacements with ISM properties. Differences between experimental and model-predicted displacement-time history increases were quantified with respect to speed. These discrepancies were attributed to the lack of rotational inertia of the head-neck late in the event as well as restricted kyphosis and viscoelasticity of spine constitutive structures through costovertebral interactions and mid-spine fixation. The results indicate that system dynamic properties from sub-injurious ISM testing could be useful for characterizing forward trajectories of the upper thoracic spine in higher energy crash simulations, leading to improved biofidelity for both ATDs and finite element models.

Viscoelastic effects during loading play an integral role in soft tissue mechanics

Viscoelastic relaxation during tensioning is an intrinsic protective mechanism of biological soft tissues. However, current viscoelastic characterization methodologies for these tissues either negate this important behavior or provide correction methods that are severely restricted to a specific viscoelastic formulation and/or assume an a priori (linear) strain ramp history. In order to address these shortcomings, we present a novel finite ramp time correction method for stress relaxation experiments (to incorporate relaxation manifested during loading) that is independent of a specific viscoelastic formulation and can accommodate an arbitrary strain ramp history. We demonstrate transferability of our correction method between viscoelastic formulations by applying it to quasi-linear viscoelastic (QLV) and fully nonlinear viscoelastic constitutive equations. The errors associated with currently accepted methodologies for QLV and fully nonlinear viscoelastic formulations are elucidated. Our correction method is validated by demonstrating the ability of its fitted parameters to predict an independent cyclic experiment across multiple strain amplitudes and frequencies. The results presented herein: (i) indicate that our correction method significantly reduces the errors associated with previous methodologies; and (ii) demonstrate the necessity for the use of a fully nonlinear viscoelastic formulation, which incorporates relaxation manifested during loading, to model the viscoelastic behavior of biological soft tissues.

In-vehicle extremity injuries from improvised explosive devices: current and future foci

The conflicts in Iraq and Afghanistan have been epitomized by the insurgents' use of the improvised explosive device against vehicle-borne security forces. These weapons, capable of causing multiple severely injured casualties in a single incident, pose the most prevalent single threat to Coalition troops operating in the region. Improvements in personal protection and medical care have resulted in increasing numbers of casualties surviving with complex lower limb injuries, often leading to long-term disability. Thus, there exists an urgent requirement to investigate and mitigate against the mechanism of extremity injury caused by these devices. This will necessitate an ontological approach, linking molecular, cellular and tissue interaction to physiological dysfunction. This can only be achieved via a collaborative approach between clinicians, natural scientists and engineers, combining physical and numerical modelling tools with clinical data from the battlefield. In this article, we compile existing knowledge on the effects of explosions on skeletal injury, review and critique relevant experimental and computational research related to lower limb injury and damage and propose research foci required to drive the development of future mitigation technologies.

Human cervical spine ligaments exhibit fully nonlinear viscoelastic behavior

Spinal ligaments provide stability and contribute to spinal motion patterns. These hydrated tissues exhibit time-dependent behavior during both static and dynamic loading regimes. Therefore, accurate viscoelastic characterization of these ligaments is requisite for development of computational analogues that model and predict time-dependent spine behavior. The development of accurate viscoelastic models must be preceded by rigorous, empirical evidence of linear viscoelastic, quasi-linear viscoelastic (QLV) or fully nonlinear viscoelastic behavior. This study utilized multiple physiological loading rates (frequencies) and strain amplitudes via cyclic loading and stress relaxation experiments in order to determine the viscoelastic behavior of the human lower cervical spine anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The results indicated that the cyclic material properties of these ligaments were dependent on both strain amplitude and frequency. This strain amplitude-dependent behavior cannot be described using a linear viscoelastic formulation. Stress relaxation experiments at multiple strain magnitudes indicated that the shape of the relaxation curve was strongly dependent on strain magnitude, suggesting that a QLV formulation cannot adequately describe the comprehensive viscoelastic response of these ligaments. Therefore, a fully nonlinear viscoelastic formulation is requisite to model these lower cervical spine ligaments during activities of daily living.

Re-evaluating the neck injury index (NII) using experimental PMHS tests

OBJECTIVE

The neck injury index, NII, developed in ISO 13232 (2005) as a testing and evaluation procedure for assessing the risk of injury to the AO/C1/C2 region of the cervical spine in motorcycle riders is reevaluated using an existing postmortem human subjects (PMHS) data set and resulting in a reformulated NII criterion applicable to PMHS tests.

METHODS

A recent series of 36 PMHS head/neck component tests was used to examine the risk of neck injury in frontal impacts and to assess the predictive capability of NII for impacts of various orientations. Using force and moment load cell PMHS experimental data, injury risk was assessed using NII evaluated with the ISO 13232-5 algorithms.

RESULTS

The injury risk predictions are compared with the injury outcomes from the head/neck PMHS. The NII criterion underestimated the injury incidence of the PMHS experimental group. The average predicted risk of injuries for the experimental injury tests based on NII across the MAIS levels was 0.7 percent, though there were 11 AIS 3+ injuries observed in the actual testing (30.6%). Using the experimental injury outcomes and the experimental force and moment time histories, the normalizing coefficients from NII are reevaluated to minimize the difference between NII risk assessment and the experimental injury outcome in the least squares (L(2)) basis. This reanalysis is compared with existing human and PMHS neck injury criteria.

CONCLUSIONS

By reanalyzing the NII formulation using an existing PMHS injury data set with known forces and moments and known injury outcomes, a new NII(PMHS) is developed that uses PMHS loads to predict injury. This reformulation removes the dependency of the original NII formulation on the forces and moments from motorcyclist anthropomorphic test device (MATD) experiments and simulations yet retains the advantages of the multi-axial neck injury criterion.

Viscoelastic and failure properties of spine ligament collagen fascicles

The microstructural volume fractions, orientations, and interactions among components vary widely for different ligament types. If these variations are understood, however, it is conceivable to develop a general ligament model that is based on microstructural properties. This paper presents a part of a much larger effort needed to develop such a model. Viscoelastic and failure properties of porcine posterior longitudinal ligament (PLL) collagen fascicles were determined. A series of subfailure and failure tests were performed at fast and slow strain rates on isolated collagen fascicles from porcine lumbar spine PLLs. A finite strain quasi-linear viscoelastic model was used to fit the fascicle experimental data. There was a significant strain rate effect in fascicle failure strain (P < 0.05), but not in failure force or failure stress. The corresponding average fast-rate and slow-rate failure strains were 0.098 ± 0.062 and 0.209 ± 0.081. The average failure force for combined fast and slow rates was 2.25 ± 1.17 N. The viscoelastic and failure properties in this paper were used to develop a microstructural ligament failure model that will be published in a subsequent paper.

Thoracic and lumbar spinal impact tolerance

INTRODUCTION

Thoracolumbar injuries resulting from motor vehicle accidents, falls, and assaults have a high risk of morbidity and mortality. However, there are no biomechanically based standards that address this problem.

METHODS

This study used four cadaveric porcine specimens as a model for direct spinal impact injuries to humans to determine an appropriate injury tolerance value. The anthropometric parameters of these specimens are compared with values found in a large human cadaveric dataset. Each specimen was subjected to five impacts on the dorsal surface of the lower thorax and abdomen.

RESULTS

The injuries ranged from mild spinous process fractures to endplate fractures with anterior longitudinal ligament (ALL) transactions with a maximum AIS=3. The average peak reaction force for the thoracic failure tests was 4720+/-1340 N, and the average peak reaction force for the lumbar failure tests was 4650+/-1590 N.

DISCUSSION

When scaled to human values using anthropometric parameters determined in this study, the force at which there is a 50% risk of injury is 10,200+/-3900 N. This value favorably compares to that found in the existing literature on isolated vertebral segments.

SUMMARY

After demonstrating that the porcine model can be used as a spinal impact model for the human, the resulting injury risk value can be used in determining new standards for human injury risk or in guiding the design of safety equipment for the back.

Viscoelastic properties of the cervical spinal ligaments under fast strain-rate deformations

The mechanical response of ligaments under fast strain-rate deformations is a necessary input into computational models that are used for injury assessment. However, this information frequently is not available for the ligaments that are routinely injured in fast-rate loading scenarios. In the current study, experiments were conducted at fast strain rates for the cervical spinal ligaments: the anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. Bone-ligament-bone complexes at three spine levels were harvested for mechanical testing. Displacement-controlled sub-failure uniaxial tensile tests were performed in both load-relaxation and sinusoidal conditions. A nonlinear (separable) viscoelastic model was used to examine the experimental data. An unexpected result of the modeling was that the instantaneous elastic functions could be approximated as linear for these strain rates. A five-parameter model was sufficient to characterize the ligament viscoelastic responses and had good predictive capacity under different applied loading conditions.