Multiplanar cervical spine injury due to head-turned rear impact

Abstract

Study design: Head-turned whole cervical spine model was stabilized with muscle force replication and subjected to simulated rear impacts of increasing severity. Multiplanar flexibility testing evaluated any resulting injury.

Objectives: To identify and quantify cervical spine soft tissue injury and injury threshold acceleration for head-turned rear impact, and to compare these data with previously published head-forward rear and frontal impact results.

Summary of background data: Epidemiologically and clinically, head-turned rear impact is associated with increased injury severity and symptom duration, as compared to forward facing. To our knowledge, no biomechanical data exist to explain this finding.

Methods: Six human cervical spine specimens (C0-T1) with head-turned and muscle force replication were rear impacted at 3.5, 5, 6.5, and 8 g, and flexibility tests were performed before and after each impact. Soft tissue injury was defined as a significant increase (P < 0.05) in intervertebral flexibility above baseline. Injury threshold was the lowest T1 horizontal peak acceleration that caused the injury.

Results: The injury threshold acceleration was 5 g with injury occurring in extension or axial rotation at C3-C4 through C7-T1, excluding C6-C7. Following 8 g, 3-plane injury occurred in extension and axial rotation at C5-C6, while 2-plane injury occurred at C7-T1.

Conclusions: Head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6, as compared to head-forward rear and frontal impacts, and resulted in multiplanar injuries at C5-C6 and C7-T1.