Joseph F. Cusick

Tensile strength of spinal ligaments

Spinal ligaments from 41 fresh human male cadavers were tested. The ligaments were tested In situ by sectioning all elements except the one under study. The force deflection curves demonstrated a sigmoidal shape, and the point at which an increase in deflection was obtained with decreasing force was taken as failure. The force and deformation at failure are shown for each ligament as a function of spinal level.

The Computed Tomographic Appearance of the Normal Pituitary Gland and Pituitary Microadenomas

With the use of axial and coronal computed tomography (CT), the authors compared the density, contrast enhancement, and dimensions of normal pituitary glands and pituitary microadenomas. The normal gland appears homogeneous, nearly isodense with brain tissue, and it enhances uniformly. Its upper surface is concave downward or flat and its height 2-7 mm. The cavernous sinuses, the third, fourth, and sixth cranial nerves, the infundibulum, and the adjacent carotid arteries are well demonstrated by CT. Abnormal height and upward convexity of the gland are reliable signs of prolactinoma; abnormal density and enhancement are suggestive signs. CT findings in prolactin- and ACTH-secreting tumors may differ. CT is more sensitive and more specific than polytomography in the diagnosis of pituitary adenoma.

Whiplash Syndrome : Kinematic Factors Influencing Pain Patterns

Study Design. The overall, local, and segmental kinematic responses of intact human cadaver head–neck complexes undergoing an inertia-type rear-end impact were quantified. High-speed, high-resolution digital video data of individual facet joint motions during the event were statistically evaluated. Objectives. To deduce the potential for various vertebral column components to be exposed to adverse strains that could result in their participation as pain generators, and to evaluate the abnormal motions that occur during this traumatic event. Summary of Background Data. The vertebral column is known to incur a nonphysiologic curvature during the application of an inertial-type rear-end impact. No previous studies, however, have quantified the local component motions (facet joint compression and sliding) that occur as a result of rear-impact loading. Methods. Intact human cadaver head–neck complexes underwent inertia-type rear-end impact with predominant moments in the sagittal plane. High-resolution digital video was used to track the motions of individual facet joints during the event. Localized angular motion changes at each vertebral segment were analyzed to quantify the abnormal curvature changes. Facet joint motions were analyzed statistically to obtain differences between anterior and posterior strains. Results. The spine initially assumed an S-curve, with the upper spinal levels in flexion and the lower spinal levels in extension. The upper C-spine flexion occurred early in the event (approximately 60 ms) during the time the head maintained its static inertia. The lower cervical spine facet joints demonstrated statistically greater compressive motions in the dorsal aspect than in the ventral aspect, whereas the sliding anteroposterior motions were the same. Conclusions. The nonphysiologic kinematic responses during a whiplash impact may induce stresses in certain upper cervical neural structures or lower facet joints, resulting in possible compromise sufficient to elicit either neuropathic or nociceptive pain. These dynamic alterations of the upper level (occiput to C2) could impart potentially adverse forces to related neural structures, with subsequent development of a neuropathic pain process. The pinching of the lower facet joints may lead to potential for local tissue injury and nociceptive pain.

Whiplash injury determination with conventional spine imaging and cryomicrotomy

Study Design. Soft tissue–related injuries to the cervical spine structures were produced by use of intact entire human cadavers undergoing rear-end impacts. Radiography, computed tomography, and cryomicrotomy techniques were used to evaluate the injury. Objectives. To replicate soft tissue injuries resulting from single input of whiplash acceleration to whole human cadavers simulating vehicular rear impacts, and to assess the ability of different modes of imaging to visualize soft tissue cervical lesions. Summary of Background Data. Whiplash-associated disorders such as headache and neck pain are implicated with soft tissue abnormalities to structures of the cervical spine. To the authors’ best knowledge, no previous studies have been conducted to determine whether single cycle whiplash acceleration input to intact entire human cadavers can result in these soft tissue alterations. There is also a scarcity of data on the efficacy of radiography and computed tomography in assessing these injuries. Methods. Four intact entire human cadavers underwent single whiplash acceleration (3.3 g or 4.5 g) loading by use of a whole-body sled. Pretest and posttest radiographs, computed tomography images, and sequential anatomic sections using a cryomicrotome were obtained to determine the extent of trauma to the cervical spine structures. Results. Routine radiography identified the least number of lesions (one lesion in two specimens). Although computed tomography was more effective (three lesions in two specimens), trauma was not readily apparent to all soft tissues of the cervical spine. Cryomicrotome sections identified structural alterations in all four specimens to lower cervical spine components that included stretch and tear of the ligamentum flavum, anulus disruption, anterior longitudinal ligament rupture, and zygopophysial joint compromise with tear of the capsular ligaments. Conclusions. These results clearly indicate that a single application of whiplash acceleration pulse can induce soft tissue–related and ligament-related alterations to cervical spine structures. The pathologic changes identified in this study support previous observations from human volunteers observations with regard to the location of whiplash injury and may assist in the explanation of pain arising from this injury. Although computed tomography is a better imaging modality than radiography, subtle but clinically relevant injuries may be left undiagnosed with this technique. The cryomicrotome technique offers a unique procedure to understand and compare soft tissue–related injuries to the cervical anatomy caused by whiplash loading. Recognition of these injuries may advance the general knowledge of the whiplash disorder.

Biomechanical analyses of whiplash injuries using an experimental model

Neck pain and headaches are the two most common symptoms of whiplash. The working hypothesis is that pain originates from excessive motions in the upper and lower cervical segments. The research design used an intact human cadaver head-neck complex as an experimental model. The intact head-neck preparation was fixed at the thoracic end with the head unconstrained. Retroreflective targets were placed on the mastoid process, anterior regions of the vertebral bodies, and lateral masses at every spinal level. Whiplash loading was delivered using a mini-sled pendulum device. A six-axis load cell and an accelerometer were attached to the inferior fixation of the specimen. High-speed video cameras were used to obtain the kinematics. During the initial stages of loading, a transient decoupling of the head occurs with respect to the neck exhibiting a lag of the cranium. The upper cervical spine-head undergoes local flexion concomitant with a lag of the head while the lower column is in local extension. This establishes a reverse curvature to the head-neck complex. With continuing application of whiplash loading, the inertia of the head catches up with the neck. Later, the entire head-neck complex is under an extension mode with a single extension curvature. The lower cervical facet joint kinematics demonstrates varying local compression and sliding. While the anterior- and posterior-most regions of the facet joint slide, the posterior-most region of the joint compresses more than the anterior-most region. These varying kinematics at the two ends of the facet joint result in a pinching mechanism. Excessive flexion of the posterior upper cervical regions can be correlated to headaches. The pinching mechanism of the facet joints can be correlated to neck pain. The kinematics of the soft tissue-related structures explain the mechanism of these common whiplash associated disorders.

Functional biomechanics of the thoracolumbar vertebral cortex.

Studies were conducted on human cadaver thoracolumbar vertebrae, at the T12-L5 level, of five males and six females. Isolated vertebral bodies, free of posterior elements, were first scanned using dual photon absorptiometry and then underwent axial compressive loading. All of the vertebral bodies failed as a result of compressive fractures of the bone. Results indicated that the mechanical load-deflection response was non-linear and biphasic. The mean cross-sectional areas of the vertebral bodies progressively increased from L1, to L5. The maximum load carrying capacity was not dependent upon spinal level. The bone mineral content (BMC) obtained using dual photon absorptiometry in the lateral projected plane increased from L, to L5. Male vertebral bodies consistently had higher BMC than female specimens. The cortical shell contributed 12·44% (mean) of the total cross-sectional area in the male, 17·56% in the female; 8·85% of the BMC in the male and 1654% in the female. In contrast, it accounted for 43·8% (mean) of the total load in the male compared to 35·2% in the female specimens. Mean failure loads of decorticated vertebrae were significantly lower (p<0.001) when compared with that of the adjacent intact vertebral bodies. In one osteoporotic spine, the cortical shell accounted for 74% of the total strength. The anatomical placement of the thin shell which enables it to act as an encasing element to resist the collapse of the trabeculae under compression, and the difference in rigidity of the two structural components, and their differing sensitivity to metabolic influences, seem to explain this relatively high magnitude of load absorption in spite of its limited contribution to vertebral geometry.

DYNAMIC CHARACTERISTICS OF THE HUMAN CERVICAL SPINE

This paper presents the experimental dynamic tolerance and the force-deformation response corridor of the human cervical spine under compression loading. Twenty human cadaver head-neck complexes were tested using a crown impact to the head at speeds from 2.5 m/s to 8 m/s. The cervical spine was evaluated for pre-alignment by using the concept of the stiffest axis. Mid cervical column (C3 to C5) vertebral body wedge, burst, and vertical fractures were produced in compression. Posterior ligament tears in the lower column occurred under flexion. Anterior longitudinal ligament tears and spinous process fractures occurred under extension. Mean values were: force at failure, 3326 N; deformation at failure, 18 mm; and stiffness, 555 N/mm. The deformation at failure parameter was associated with the least variance and should describe the most accurate tolerance measure for the population as a whole. (A) For the covering abstract of the conference see IRRD 882980.

Human head-neck biomechanics under axial tension.

A significant majority of cervical spine biomechanics studies has applied the external loading in the form of compressive force vectors. In contrast, there is a paucity of data on the tensile loading of the neck structure. These data are important as the human neck not only resists compression but also has to withstand distraction due to factors such as the anatomical characteristics and loading asymmetry. Furthermore, evidence exists implicating tensile stresses to be a mechanism of cervical spinal cord injury. Recent advancements in vehicular restraint systems such as air bags may induce tension to the neck in adverse circumstances. Consequently, this study was designed to develop experimental methodologies to determine the biomechanics of the human cervical spinal structures under distractive forces. A part-to-whole approach was used in the study. Four experimental models from 15 unembalmed human cadavers were used to demonstrate the feasibility of the methodology. Structures included isolated cervical spinal cords, intervertebral disc units, skull to T3 preparations, and intact unembalmed human cadavers. Axial tensile forces were applied, and the failure load and distraction were recorded. Stiffness and energy absorbing characteristics were computed. Maximum forces for the spinal cord specimens were the lowest (278 N +/- 90). The forces increased for the intervertebral disc (569 N +/- 54). skull to T3 (1555 N +/- 459), and intact human cadaver (3373 N +/- 464) preparations, indicating the load-carrying capacities when additional components are included to the experimental model. The experimental methodologies outlined in the present study provide a basis for further investigation into the mechanism of injury and the clinical applicability of biomechanical parameters.

Biomechanics of cervical spine facetectomy and fixation techniques.

Facetectomy, either unilateral or bilateral, significantly altered the capacity of cervical spine functional units to withstand increasing compression-flexion loads applied in a constant mode to different specimen configurations. Unilateral facetectomy resulted in an average 31.6 ± 9.7 percent decrease in strength whereas bilateral disruption caused an average 53.1 ± 11 percent decrease in strength. Motion analysis in a two-dimensional plane after facetectomy indicated an anterior displacement of the instantaneous axis of rotation (IAR) with a resultant increased load on the vertebral bodies and disc. This anterior shift of the IAR in the horizontal plane was significantly but not completely resolved by wire fixation of the facet joints. These fixation techniques, constisting of either facet to facet or facet to spinous process wiring, demonstrated a similar capability to restore strength to the functional units as well as reducing excessive motion in the vertical and anterior axes induced by the facetectomies.

Biomechanics of the cervical spine 4: major injuries

This review presents considerations regarding major cervical spine injury, including some concepts that are presently undergoing evaluation and clarification. Correlation of certain biomechanical parameters and clinical factors associated with the causation and occurrence of traumatic cervical spine injuries assists in clarifying the pathogenesis and treatment of this diverse group of injuries. Instability of the cervical column based on clinical and mechanistic perspectives as well as the role of ligaments in determining instability is discussed. Patient variables such as pre-existing conditions (degenerative disease) and age that can influence the susceptibility or resistance to injury are reviewed. Radiological considerations of major injuries including dynamic films, CT and MRI are presented in the diagnosis and treatment of cervical trauma. Specific injury patterns of the cervical vertebral column are described including attention to the relative mechanisms of trauma. From a biomechanical perspective, quantification of injury tolerance is discussed in terms of external and human-related variables using laboratory-driven experimental models. This includes force vectors (type, magnitude, direction) responsible for injury causation, as well as potential influences of loading rate, gender, age, and type of injury.