title: Soft tissue injury threshold during simulated whiplash: a biomechanical investigation.
abstract: METHODS
  A newly developed biofidelic whole cervical spine (WCS) model with muscle force replication (MFR) was subjected to whiplash simulations of varying intensity, and the resulting injuries were evaluated through changes in the intervertebral flexibility.
  
  
  OBJECTIVE
  To identify the soft tissue injury threshold based on the peak T1 horizontal acceleration and the association between acceleration magnitude and injury severity resulting from simulated whiplash using the WCS + MFR model.
  
  
  BACKGROUND
  Whiplash has been simulated using mathematical models, whole cadavers, volunteers, and WCSs. The measurement of injury (difference between prewhiplash and postwhiplash flexibilities) is possible only using the WCS model.
  
  
  METHODS
  Six WCS + MFR specimens (C0-T1) were incrementally rear-impacted at nominal T1 horizontal maximum accelerations of 3.5, 5, 6.5, and 8 g, and the changes in the intervertebral flexibility parameters of neutral zone and range of motion were determined. The injury threshold acceleration was the lowest T1 horizontal peak acceleration that caused a significant increase in the intervertebral flexibility.
  
  
  RESULTS
  The first significant increase (P <0.01) of 39.8% occurred in the C5-C6 extension neutral zone following the 5 g acceleration. At higher accelerations, the injuries spread among the surrounding levels (C4-C5 to C7-T1).
  
  
  CONCLUSIONS
  A rear-end collision is most likely to injure the lower cervical spine by intervertebral hyperextension at a peak T1 horizontal acceleration of 5 g and above. These results may aid in the design of injury prevention systems and more precise diagnoses of whiplash injuries.
authors.affiliation: Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ito
authors.forename: Paul C
authors.initials: PC
authors.lastname: Ivancic
authors.forename: Manohar M
authors.initials: MM
authors.lastname: Panjabi
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Cunningham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D002574:Cervical Vertebrae / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018583:Pliability; D016059:Range of Motion, Articular; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000209:etiology / Q000503:physiopathology*; D013314:Stress, Mechanical; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology*