title: Cervical spine injuries, mechanisms, stability and AIS scores from vertical loading applied to military environments.
abstract: The purpose of this study was to determine injuries to osteo-ligamentous structures of cervical column, mechanisms, forces, severities and AIS scores from vertical accelerative loading.
  
  
  
  Seven human cadaver head-neck complexes (56.9 ± 9.5 years) were aligned based on seated the posture of military soldiers. Army combat helmets were used. Specimens were attached to a vertical accelerator to apply caudo-cephalad g-forces. They were accelerated with increasing insults. Intermittent palpation and radiography were done. A roof structure mimicking military vehicle interior was introduced after a series of tests and experiments were conducted following similar protocols. Upon injury detection, CT and dissection were done. Temporal force responses were extracted, peak forces and times of occurrence were obtained, injury severities were graded, and spine stability was determined.
  
  
  
  Injuries occurred in tests only when the roof structure was included. Responses were tri-phasic: initial thrust, secondary tensile, tertiary roof contact phases. Peak forces: 1364-4382 N, initial thrust, 165-169 N, secondary tensile, 868-3368 N tertiary helmet-head roof contact phases. Times of attainments: 5.3-9.6, 31.7-42.6, 55.0-70.8 ms. Injuries included fractures and joint disruptions. Multiple injuries occurred in all but one specimen. A majority of injury severities were AIS = 2. Spines were considered unstable in a majority of cases.
  
  
  
  Spine response was tri-phasic. Injuries occurred in roof contact tests with the helmeted head-neck specimen. Multiplicity and unstable nature of AIS = 2 level injuries, albeit at lower severities, might predispose the spine to long-term accelerated degenerative changes. Clinical protocols should include a careful evaluation of sub-catastrophic injuries in military patients.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. yoga@mcw.edu.
authors.forename: Narayan
authors.initials: N
authors.lastname: Yoganandan
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pintar
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Humm
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Maiman
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Liming
authors.initials: L
authors.lastname: Voo
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Merkle
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D002102:Cadaver; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D006257:Head; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009104:Multiple Trauma; D009333:Neck; D019838:Neck Injuries / Q000000981:diagnostic imaging; D011187:Posture; D011859:Radiography; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging; D013131:Spine; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing
keywords: Cervical spine; Injuries; Injury mechanisms; Military helmet; Military patients; Personal protective equipment