This content is not included in
your SAE MOBILUS subscription, or you are not logged in.
Epidemiology and Injury Biomechanics of Motor Vehicle Related Trauma to the Human Spine
Annotation ability available
Sector:
Language:
English
Abstract
Engineering efforts directed at better occupant safety require a thorough understanding of available epidemiologic data. Epidemiologic studies using clinical as well as accident information facilitates the prioritization of biomechanics research so that controlled laboratory experimentation and/or analytical models can be advanced. This information has also value in dictating levels and types of injury that are critical to the development of anthropomorphic test devices used in crash environments.
In this paper, motor vehicle accident related (excluding pedestrians, bicyclists, and motorcyclists) epidemiologic data were obtained from clinical and computerized accident (National Accident Sampling System-NASS) files. Clinical data were gathered from patients admitted to the Medical College of Wisconsin Affiliated Hospitals, and fatalities occurring in Milwaukee County, State of Wisconsin. NASS database with specific focus on spinal injuries of motor vehicle occupants was also used.
The purpose of the clinical study was to determine the most commonly injured anatomic levels of the cervical spine, to classify these injuries based on an impairment scale, to determine the mechanism of injury at each spinal level, to evaluate the differences, if any, between the patient (survivors) and fatality data with respect to the location and mechanism of injury, and to compare this data obtained from a localized population with literature results and national samples. The purpose of the NASS study was to estimate the annual occurrence of cervical and thoracolumbar spinal injuries, to elicit the gross anatomical distribution of these injuries (eg., cord vs. skeletal); to tabulate the distribution of these injuries by crash type (i.e., frontal, side, rear, and rollover); to estimate the risk of these injuries as a function of crash type, and restraint use, and finally, to briefly explore the association of craniofacial trauma with spinal injury. Results indicated that while injuries to the cervical column are complex and may occur at any spinal level, they concentrate statistically in two primary zones, at the craniocervical junction for fatal victims, and in the lower cervical spine for survivors. The majority of paralyzing injuries (survivors), both complete and incomplete quadriplegia, were produced by flexion-compression loading, with disruption of the posterior elements and compressive fractures of the vertebral bodies. However, rotation appeared to be an important component in non-paralyzing cervical fractures. A strong association was found to exist between craniofacial and cervical spine trauma. While only cervical spine injuries were evaluated from the clinical database, analysis of NASS files included both cervical and thoracolumbar spine. Results indicated that the thoracolumbar injuries at AIS 3+ level were primarily bone related (96%). In contrast, neck trauma at this severity was 20% cord and 65% bone related emphasizing the relative importance of protecting the spinal cord in this region. For the cervical spine, within the limitations in the ensemble size, introduction of restraints appeared to significantly reduce the incidence of injury at the AIS 3+ level, while increasing at the AIS 1 level. However, little change was observed at the AIS 3+ level for the thoracolumbar spine.
Recommended Content
Technical Paper | Atlanto-Occipital Fracture Dislocation in Lap-Belt Restrained Children |
Technical Paper | Responses of the Human Cervical Spine to Torsion |
Technical Paper | Inertially-Induced Cervical Spine Injuries in the Pediatric Population |
Authors
- Narayan Yoganandan
- Mark Haffner
- Dennis J. Maiman
- Hunter Nichols
- Frank A. Pintar
- Jeffrey Jentzen
- Steven S. Weinshel - Dept. of Neurosurgery, Medical College of Wisconsin and Veterns Administration Medical Center
- Sanford J. Larson - Dept. of Neurosurgery, Medical College of Wisconsin and Veterns Administration Medical Center
- Anthony Sances
Citation
Yoganandan, N., Haffner, M., Maiman, D., Nichols, H. et al., "Epidemiology and Injury Biomechanics of Motor Vehicle Related Trauma to the Human Spine," SAE Technical Paper 892438, 1989, https://doi.org/10.4271/892438.Also In
References
- Alker GJ Oh YS Leslie EV High cervical spine and craniocervical junction injuries in fatal traffic accidents: A radiological study Orthopedic Clinics of North America 9 4 1978
- Alker GJ Oh YS Lesile EV Lehtotay J Panaro VA Eschnev Post-mortem radiology of head and neck injuries in fatal traffic accidents Radiology 114 611 617 1975
- Anderson DW McLaurin RL The national head and spinal cord injury survey J Neurosurg 53 S1 S2 1980
- Aufdermaur M Spinal injuries in juveniles J Bone Joint Surg 56B 3 513 519 1974
- Bohlman HH Acute fractures and dislocations of the cervical spine J Bone Joint Surg 61-A 8 119 1142 1979
- Brieg A Biomechanics of the Central Nervous System Yearbook Publ Chicago, IL 1960 183
- Bucholz RW Burkhead WZ Graham W Petty C Occult cervical spine injuries in fatal traffic accidents J Trauma 19 10 768 771 1979
- Burke DC Burley HT Ungar GH Data on spinal injuries--Part 1. Collection and analysis of 352 consecutive admissions Aust NZ J Surg 55 3 12 1985
- Careme L Post mortem review of trauma mortalities - correlative pathology and injury criteria 73 78 SAE 1988
- Daffner RH Delb AL Lupetin AR Rothfus W Patterns of high-speed impact injuries in motor vehicle accidents J Trauma 28 4 498 501 1988
- Davis D Bohlman H Walker E Fisher R Robinson R The pathological findings in fatal craniospinal injuries Neurosurgery 34 603 613 1971
- Durbin FC Fracture-dislocations of the cervical spine J Bone Joint Surg 39B 23 38 1957
- Fife D Kraus J Anatomic location of spinal cord injury: relationship of the cause of injury Spine 11 1 2 5 1986
- Hadley NM Browner C Sonntag VKH Axis fractures: a comprehensive review of management and treatment in 107 cases Neurosurgery 17 281 290 1985
- Hadley MN Dickman CA Browner CM Sonntag VKH Acute traumatic atlas fractures: management and long term outcome Neurosurgery 23 1 31 35 1988
- Harrington T Barker B Multiple trauma associated with vertebral injury Surg Neurol 149 26 149 154 1986
- Hohl M Soft-tissue injuries of the neck in automobile accidents J Bone Joint Surg 56A 1675 1682 1974
- Jentzen J Milwaukee County Medical Examiner's 1987 Statistical and Activity Reports J. Jentzen, Medical Examiner Milwaukee, Wisconsin 1987
- Kalsbeek WD McLaurin RL Harris, BS III Miller JD The national head and spinal cord injury survey: major findings J Neurosurg 53 S19 S31 1980
- Kraus JF Epidemiological features of head and spinal-cord injury; in Schoenberg, Neurological epidemiology: principals and clinical applications Adv Neurol 19 261 279 1978
- Kraus JF Franti CE Riggins RS Richards D Borhani NO Incidence of traumatic spinal cord lesions J Chron Dis 28 471 492 1975
- Kraus JF Epidemiological aspects of acute spinal cord injury: A review of incidence, prevalence, causes, and outcome Central Nervous System Trauma Status Report - 1985 Becker D.P. Povlishock J.T. National Insitute Neurol and Communicative Disorders and Stroke, National Insitutes of Health Washington, D.C. 1985 313 322
- Maiman DJ Cusick JF Traumatic atlantoaxial dislocation Surg Neurol 18 388 392 1982
- Ommaya AK Backaitis S Fan W Partyka S Langwieder K Automotive neck injuries Ninth International Technical Conference on Experimental Safety Vehicles U.S. Department of Transportation, National Highway Traffic Safety Administration 1982 274 278
- Pal JM Mulder DS Brown RA Fleiszer DM Assessing multiple trauma: Is the cervical spine enough? J Trauma 28 8 1988
- Portnoy HD McElhaney J Melvin JW Croissant PD Mechanism of cervical spine injury in auto accidents Proc 15th Conf Am Assoc for Automotive Medicine Colorado Springs, CO Oct 1971 58 83
- Roye WP Dunn EL Moody JA Cervical spinal cord injury - A public catastrophe J Trauma 28 8 1260 1265 1988
- Sances A, Jr Myklebust JB Weber R et al Head and spine injuries Proc NATO AGARD Med Panel Specialists' Mtg. Koln, Germany April 26-29 1982 13 1 34
- Sances A Jr Myklebust JB Maiman DJ Larson SJ Cusick JF Jodat R The biomechanics of spinal injuries CRC Crit Rev Bioeng 11 1 1 76 1984
- Sances A Jr Yoganandan N Myklebust JB Biomechanics and accident investigation Hnadbook of Biomedical Engineering Kline J. Academic Press Orlando, FL 1988 525 562
- Shrosbree RD Acute cervical spinal cord syndrome. Etiology, age incidence and relationship to the orthopaedic injury Paraplegia 14 251 258 1977
- Yoganandan N Sances A Jr Maiman DJ Myklebust JB Pech P Larson SJ Experimental spinal injuries with vertical impact Spine 11 9 855 860 1986
- Yoganandan N Myklebust JB Ray G Sances A Jr Mathematical and finite element analysis of spine injuries CRC Reviews in Biomed Eng 15 1 29 93 1987
- Yoganandan N Sances A Jr Pintar FA Biomechanical evaluation of the axial compressive responses of the human cadaveric and manikin necks J Biomech Eng
- Yoganandan N Butler J Pintar F Reinartz J Sances A Jr Larson SJ Dynamic response of human cervical spine ligaments Spine
- Young W Ransohoff J Acute Spinal Cord Injuries: Experimenta Therapy, Pathophysiological Mechanisms, and Recovery of Function The Cervical Spine 2nd Sherk HH Dunn EJ Eismont FJ Fielding JW Long DM, Ono K Penning L Raynor R J.B. Lippincott Company, Publ Philadelphia, PA 1989 464 495