An Examination of Isolated and Interaction-Based Biomechanical Metrics for Potential Lower Neck Injury Criteria

Lower neck injuries inferior to C4 level, such as fractures and dislocations, occur in motor vehicle crashes, sports, and military events. The recently developed interaction criterion, termed Nij, has been used in automotive safety standards and is applicable to the upper neck. Such criterion does not exist for the lower neck. This study was designed to conduct an analysis of data of lower neck injury metrics toward the development of a mechanistically appropriate injury criterion. Axial loads were applied to the crown of the head of post mortem human subject (PMHS) head-neck complexes at different loading rates. The generalized force histories at the inferior end of the head-neck complex were recorded using a load cell and were transformed to the cervical-thoracic joint. Peak force and peak moment (flexion or extension) were quantified for each test from corresponding time histories. Initially, a survival analysis approach was used to derive injury probability curves based on peak force and peak moment alone. Both force and moment were considered as primary variables and age a covariate in the survival analysis. Age was found to be a significant (p<0.05) covariate for the compressive force and flexion moment but insignificant for extension moment (p>0.05). A lower neck Nij formulation was done to derive a combined interactive metric. To derive cadaver-based metrics, critical intercepts were obtained from the 90% injury probability point on peak force and peak moment curves. The PMHS-based critical intercepts derived from this study for compressive force, flexion, and extension moment were 4471 N, 218 Nm, and 120 Nm respectively. The lower cervical spine injury criterion, Lower Nij (LNij), was evaluated in two different formulations: peak LNij and mechanistic peak LNij. Peak LNij was obtained from the LNij time history regardless of when it occurred. Mechanistic peak LNij was obtained from the LNij time history only during the time when the resulting injury mechanism occurred. Injury mechanism categorization included compression-flexion, compression-extension, and those best represented by a more pure compression-related classification. Mechanistic peak LNij was identified based on the peak timing of the injury mechanism. Peak LNij and mechanistic peak LNij were found to be significant (p<0.05) predictors of injury with age as a covariate. The 50% injury probability was 1.38 and 1.13 for peak LNij and mechanistic peak LNij, respectively. These results provide preliminary data based on PMHS tests for establishing lower neck injury criteria that may be used in automotive applications, sports and military research to advance safety systems.