title: Traumatic instability of the lumbar spine. A dynamic in vitro study of flexion-distraction injury.
abstract: METHODS
  This in vitro study determined the effect on the lumbar spine of a dynamic flexion-distraction loading simulating a lap seatbelt injury. The proportion by which the forces and the moments contributed to the injury of the lumbar spinal segment in such a situation was analyzed. The remaining stability of the injured lumbar motion segment was determined together with the threshold for lumbar spine instability in such an injury.
  
  
  OBJECTIVE
  Based on the experimental results in this study, radiographic guidelines for instability criteria in lumbar and thoracolumbar dislocations in the sagittal plane without concomitant compression fracture of the middle column were proposed.
  
  
  BACKGROUND
  A number of check-lists and guidelines were suggested for the diagnosis of spinal instability after trauma, but no conclusive system was established. Those systems were mostly based on experiments performed on spinal segments after sequential ablation of ligaments and facet joints followed by static, unidirectional physiologic loading. We believed that there was a need for more profound knowledge of spinal injury and for instability criteria of lumbar spinal injuries based on more realistic experimental data simulating the clinical situation. In our injury model, we decided to study the biomechanic outcome of a flexion-distraction injury similar to seatbelt type injury seen in frontal motor vehicle collisions.
  
  
  METHODS
  Twenty lumbar functional spinal units were first loaded statically with a physiologic flexion-shear load to determine angulations and displacements under noninjurous conditions. Dynamic flexion-shear loading to injury with two different load pulses was then applied. Static physiologic load was then again applied to determine any permanent residual deformation.
  
  
  RESULTS
  The viscoelastic effect of loading rate on translatory and angular displacements and the values for translatory and angulation displacements at first sign of injury (yield) and at failure were determined.
  
  
  CONCLUSIONS
  Radiographic guidelines for instability criteria in lumbar and thoracolumbar fracture-dislocations without concomitant posterior vertebral body compression are proposed: 1. Instability exists if there is a kyphosis of the lumbar motion segment > or = 12 degrees (impending instability) or > or = 19 degrees (total instability) on lateral radiographs. 2. Relative increase in interspinous process distance > or = 20 mm (impending instability), > or = 33 mm (total instability) on anteroposterior radiographs.
authors.affiliation: Department of Orthopaedics, Göteborg University, Sahlgrenska University Hospital, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Neumann
authors.forename: A
authors.initials: A
authors.lastname: Nordwall
authors.forename: A L
authors.initials: AL
authors.lastname: Osvalder
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology; D013124:Spinal Injuries / Q000175:diagnosis / Q000503:physiopathology*