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. 2021 Aug 24;16(1):527.
doi: 10.1186/s13018-021-02677-y.

The biomechanical effect of preexisting different types of disc herniation in cervical hyperextension injury

Jian-Jie Wang  1 , Meng-Lei Xu  1 , Hui-Zi Zeng  1 , Liang-Dong Zheng  1 , Shi-Jie Zhu  1 , Chen Jin  1 , Zhi-Li Zeng  1 , Li-Ming Cheng  2 , Rui Zhu  3   4
Affiliations

The biomechanical effect of preexisting different types of disc herniation in cervical hyperextension injury

Jian-Jie Wang et al. J Orthop Surg Res. .

Abstract

Objective: Preexisting severe cervical spinal cord compression is a significant risk factor in cervical hyperextension injury, and the neurological function may deteriorate after a slight force to the forehead. There are few biomechanical studies regarding the influence of pathological factors in hyperextension loading condition. The aim of this study is to analyze the effects of preexisting different types of cervical disc herniation and different degrees of compression on the spinal cord in cervical hyperextension.

Method: A 3D finite element (FE) model of cervical spinal cord was modeled. Local type with median herniation, local type with lateral herniation, diffuse type with median herniation, and diffuse type with lateral herniation were simulated in neutral and extention positions. The compressions which were equivalent to 10%, 20%, 30%, and 40% of the sagittal diameter of the spinal cord were modeled.

Results: The results of normal FE model were consistent with those of previous studies. The maximum von Mises stresses appeared in the pia mater for all 32 loading conditions. The maximum von Mises stresses in extension position were much higher than in neutral position. In most cases, the maximum von Mises stresses in diffuse type were higher than in local type.

Conclusion: Cervical spinal cord with preexisting disc herniation is more likely to be compressed in hyperextension situation than in neutral position. Diffuse type with median herniation may cause more severe compression with higher von Mises stresses concentrated at the anterior horn and the peripheral white matter, resulting in acute central cord syndrome from biomechanical point of view.

Keywords: Cervical hyperextension injury; Disc herniation; Finite element; Spinal cord.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The schematic diagram for different types of disc herniation. A Local type. B Diffuse type. C Local type with median herniation. D Local type with lateral herniation. E Diffuse type with median herniation. F Diffuse type with lateral herniation
Fig. 2
Fig. 2
The models simulating different types of disc herniation. A Local type with median herniation. B Local type with lateral herniation. C Diffuse type with median herniation. D Diffuse type with lateral herniation
Fig. 3
Fig. 3
The maximum von Mises stress in the whole model for all loading conditions. LTMH, local type with median herniation; LTLH, local type with lateral herniation; DTMH, diffuse type with median herniation; DTLH, diffuse type with lateral herniation. Unit of stress: MPa
Fig. 4
Fig. 4
The maximum von Mises stress in the white matter for all loading conditions. LTMH, local type with median herniation; LTLH, local type with lateral herniation; DTMH, diffuse type with median herniation; DTLH, diffuse type with lateral herniation. Unit of stress: MPa
Fig. 5
Fig. 5
The maximum von Mises stress in the gray matter for all loading conditions. LTMH, local type with median herniation; LTLH, local type with lateral herniation; DTMH, diffuse type with median herniation; DTLH, diffuse type with lateral herniation. Unit of stress: MPa
Fig. 6
Fig. 6
The distribution of von Mises stress in the middle transverse cross section of the gray matter and white matter in neutral position. LTMH, local type with median herniation; LTLH, local type with lateral herniation; DTMH, diffuse type with median herniation; DTLH, diffuse type with lateral herniation. Unit of stress: MPa
Fig. 7
Fig. 7
The distribution of von Mises stress in the middle transverse cross section of the gray matter and white matter in extension position. LTMH, local type with median herniation; LTLH, local type with lateral herniation; DTMH, diffuse type with median herniation; DTLH, diffuse type with lateral herniation. Unit of stress: MPa
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