**1. Introduction**

114 Injury and Skeletal Biomechanics

801304, 1980, pp. 347–360.

Accid Anal Prev. 1995;27:749-756.

[44] http://www.materialise.com/mimics

mathematical models. *J. Neurotrauma* 12:N4, 1995.

(www-nrd.nhtsa.dot.gov/pdf/esv/esv21/09-0127.pdf)

[37] Baumgartner D., Willinger R., Human head tolerance limits to specific injury mechanisms inferred from real world accident numerical reconstruction, Revue

[38] Ward, C. C., M. Chan, and A. M. Nahum. Intracranial pressure—A brain injury criterion. In: Proceedings of the 24th Stapp Car Crash Conference, SAE Paper No.

[39] Bazarian JJ, Fisher SG, Flesher W, Lillis R, Knox KL, Pearson TA., Lateral automobile

[41] McLellan BA, Rizoli SB, Brenneman FD, et al. Injury pattern and severity in lateral

[42] Nahum, A. M., R. Smith, and C. C. Ward. Intracranial pressure dynamics during head impact. In: Proceedings of the 21st Stapp Car Crash Conference, 1977, pp. 339–366. [43] Willinger, R., L. Taleb, and C. M. Kopp. Modal and temporal analysis of head

[45] ABAQUS Dynamic Explicit Version 6.9 Hibbitt, Karlsson& Sorenson,Inc., Pawtucket, RI

[48] Jason Kerrigan1, Carlos Arregui2, Jeff Crandall1,Pedestrian head impact dynamicscomparison of dummy and PHMS IN SMALL SEDAN AND LARGE SUV IMPACTS

motor vehicle collisions: a Canadian experience. J Trauma. 1996;41:708-713

Européenne des Eléments Finis, vol. 14, n° 4-5, pp. 421-444, 2005.

impacts and the risk of TBI, Ann Emerg Med. 2004 Aug;44(2):142-52. [40] Morris A, Hassan A, Mackay M, et al. Head injuries in lateral impact collisions.

[46] http://www.eurailsafe.net/subsites/operas/HTML/appendix/Table13.htm [47] http://www.eurailsafe.net/subsites/operas/HTML/Section3/Page3.3.1.4.htm As of mid 2001, out of the 34000 spinal injuries that took place in the previous year, over half (55%) were cervical spine injuries [18]. Additionally, out of all the cervical spinal injuries incurred by patients in the United States every year, 15% of those injuries are fatal [7]. Motor vehicle crashes are the leading cause of death for persons under 45 years of age, and the number one cause of head and spinal cord injury [1]. This study compiles and analyzes data that may be used to assess risk of cervical injury.

The cervical spine is a very complex anatomical structure. Any neck injury can have debilitating, and sometimes life threatening consequences. Although spinal cord injuries vary significantly from the injuries of the vertebral column, they result from structural deformities and were therefore studied prior to this analysis [21]. For both spinal cord injuries and vertebral body fractures, motor vehicle accidents are the most common causes of neck injuries in both Canada and the United States (Figure 1). Out of the 1.4 million annual American spinal cord injuries, approximately 280,000 of those are motor vehicle induced. One out of every five drivers are involved in a traffic accident each year [1]. Figure 1 illustrates the most common mechanisms for cervical spine injuries. Another interesting aspect is the increase in violence, which in turn could impact the number of violence related spinal injuries and incidents (shooting, stabbing, etc.) [21].

Sports and leisure activities account for a significant amount of neck trauma. They can be broken down by both the activities most likely to cause injury, as well as the injuries accounted for in specific sports. Understanding what particular actions and motions within each activity actually contribute to the risk of injury, has helped improve sporting equipment and decrease the number of neck injuries associated with various sports. Table 1 lists the most common leisure activities associated with neck injuries [20]. Diving and surfing involve more injuries than football (Table 1). This is most probably because football has grown in popularity since 1989, when this data was originally compiled.

© 2012 Goswami et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cervical Spinal Injuries and Risk Assessment 117

**2. Research background: Analysis of cervical spinal tolerances and** 

levels of the cervical spine as well as the type of loading that causes that injury.

**Figure 2.** Frequency of Fractures per Level, Based on Type of Impact Loading

indicated by the AIS score.

risk.

This data is also represented by use of the Abbreviated Injury Scale (AIS). Especially in the case of automobile and motorcycle accidents, the victim is usually injured because of some form of head contact with another object. Many factors contribute to the severity of the injury: position of the head and neck, the impact site, the nature of the impacted surface and the direction of the cervical spine loading. Determining the relationship between all of these variables is very complex and until recently has been based on frequency of occurrence data. Table 2 is a summary of the AIS scale characteristics. Figure 3 illustrates the amount of injuries that occurred in over 100 automobile accidents, in which a passenger attained a neck injury of some degree [25]. The degree of the injury is

With respect to frequency, the 5th and 6th vertebrae of the cervical spine see the most injury, and have the most critical injuries (AIS 5). This is the most significant score one can achieve and still survive, meaning that the ability to minimalize the chance of injury through improved vehicles and vehicle interior is crucial to assessing and preventing

With motor vehicle accidents being the leading mechanism behind both spinal cord and vertebral fracture injuries, significant research has focused on improving the design and safety of automobiles [14]. Vertebral fractures can occur at any level to any degree, and can be caused by various types of loading. Figure 2 illustrates the frequency of injury to various

**injuries** 

**Figure 1.** Frequency of Activities Causing Cervical Injuries, in Percentage [7]

From Table 1, it can be seen that many common everyday activities offer the potential for serious injury. In diving, fractures and dislocations are the most commonly seen. Not only are the diver's form and function important, but depth of water, angle of entry and head velocity also prove crucial to injury severity. Degrees of participation within the various sports also play a role in the frequency of injury. Today, more athletes participate in football, making the likelihood of injury higher than it was in 1989.


**Table 1.** Sports Activities Causing Cervical Spinal Injuries
