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Head-First Impact With Head Protrusion Causes Noncontiguous Injuries of the Cadaveric Cervical Spine

Ivancic, Paul C. PhD

Clinical Journal of Sport Medicine: September 2012 - Volume 22 - Issue 5 - p 390–396
doi: 10.1097/JSM.0b013e3182686789
Original Research

Objective: To simulate horizontally aligned head-first impacts with initial head protrusion using a human cadaveric neck model and to determine biomechanical responses, injuries, and injury severity.

Design: Head-first impacts with initial head protrusion were simulated at 2.4 m/s using a human cadaver neck model (n = 10) mounted horizontally to a torso-equivalent mass on a sled and carrying a surrogate head. Macroscopic neck injuries were determined, and ligamentous injuries were quantified using fluoroscopy and visual inspection after the impacts. Representative time-history responses for injured specimens were determined during impact using load cell data and analyses of high-speed video.

Setting: Biomechanics research laboratory.

Participants: Cervical spines of 10 human cadavers.

Main Outcome Measures: Injury severity at the middle and lower cervical spine was statistically compared using a 2-sample t test (P < 0.05).

Results: Neck buckling consisted of hyperflexion at C6/7 and C7/T1 and hyperextension at superior spinal levels. Noncontiguous neck injuries included forward dislocation at C7/T1, spinous process fracture and compression–extension injuries at the middle cervical spine, and atlas and odontoid fractures. Ligamentous injury severity at C7/T1 was significantly greater than at the middle cervical spine.

Conclusions: Distinct injury mechanisms were observed throughout the neck, consisting of extension–compression and posterior shear at the upper and middle cervical spine and flexion–compression and anterior shear at C6/7 and C7/T1. Our experimental results highlight the importance of clinical awareness of potential noncontiguous cervical spine injuries due to head-first sports impacts.

Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut.

Corresponding Author: Paul C. Ivancic, PhD, Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 333 Cedar St, PO Box 208071, New Haven, CT 06520-8071 (

Supported by grant 5R01CE001257 from the Centers for Disease Control and Prevention, Atlanta, Georgia, and a gift to Yale University from Aspen Medical Products, Inc, Irvine, California.

The author reports no conflicts of interest.

Received May 3, 2012

Accepted July 5, 2012

© 2012 Lippincott Williams & Wilkins, Inc.