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Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury.
J Neurosurg Spine. 2006 May; 4(5):380-7.JN

Abstract

OBJECT

A rotated head posture at the time of vehicular rear impact has been correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward. No studies have been conducted to quantify the dynamic changes in foramen dimensions during head-turned rear-impact collisions. The objectives of this study were to quantify the changes in foraminal width, height, and area during head-turned rear-impact collisions and to determine if dynamic narrowing causes potential cervical nerve root or ganglion impingement.

METHODS

The authors subjected a whole cervical spine model with muscle force replication and a surrogate head to simulated head-turned rear impacts of 3.5, 5, 6.5, and 8 G following a noninjurious 2-G baseline acceleration. Continuous dynamic foraminal width, height, and area narrowing were recorded, and peaks were determined during each impact; these data were then statistically compared with those obtained at baseline. The authors observed significant increases (p < 0.05) in mean peak foraminal width narrowing values greater than baseline values, of up to 1.8 mm in the left C5-6 foramen at 8 G. At the right C2-3 foramen, the mean peak dynamic foraminal height was significantly narrower than baseline when subjected to rear-impacts of 5 and 6.5 G, but no significant increases in foraminal area were observed. Analysis of the results indicated that the greatest potential for cervical ganglion compression injury existed at C5-6 and C6-7. Greater potential for ganglion compression injury existed at C3-4 and C4-5 during head-turned rear impact than during head-forward rear impact.

CONCLUSIONS

Extrapolation of present results indicated potential ganglion compression in patients with a non-stenotic foramen at C5-6 and C6-7; in patients with a stenotic foramen the injury risk greatly increases and spreads to include the C3-4 through C6-7 as well as C4-5 through C6-7 nerve roots.

Authors+Show Affiliations

Tominaga Y
Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520-8071, USA.
Maak TG
No affiliation info available
Ivancic PC
No affiliation info available
Panjabi MM
No affiliation info available
Cunningham BW
No affiliation info available

MeSH

AccelerationAccidents, TrafficAgedAged, 80 and overBiomechanical PhenomenaCervical VertebraeChronic DiseaseFemaleHead MovementsHumansImage Processing, Computer-AssistedMaleMathematical ComputingModels, AnatomicNerve Compression SyndromesOrientationRadiculopathyRadiographic Image EnhancementSpinal Nerve RootsSpinal StenosisSuperior Cervical GanglionWhiplash Injuries

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16703905

Citation

Tominaga, Yasuhiro, et al. "Head-turned Rear Impact Causing Dynamic Cervical Intervertebral Foramen Narrowing: Implications for Ganglion and Nerve Root Injury." Journal of Neurosurgery. Spine, vol. 4, no. 5, 2006, pp. 380-7.
Tominaga Y, Maak TG, Ivancic PC, et al. Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury. J Neurosurg Spine. 2006;4(5):380-7.
Tominaga, Y., Maak, T. G., Ivancic, P. C., Panjabi, M. M., & Cunningham, B. W. (2006). Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury. Journal of Neurosurgery. Spine, 4(5), 380-7.
Tominaga Y, et al. Head-turned Rear Impact Causing Dynamic Cervical Intervertebral Foramen Narrowing: Implications for Ganglion and Nerve Root Injury. J Neurosurg Spine. 2006;4(5):380-7. PubMed PMID: 16703905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Head-turned rear impact causing dynamic cervical intervertebral foramen narrowing: implications for ganglion and nerve root injury. AU - Tominaga,Yasuhiro, AU - Maak,Travis G, AU - Ivancic,Paul C, AU - Panjabi,Manohar M, AU - Cunningham,Bryan W, PY - 2006/5/18/pubmed PY - 2006/5/31/medline PY - 2006/5/18/entrez SP - 380 EP - 7 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 4 IS - 5 N2 - OBJECT: A rotated head posture at the time of vehicular rear impact has been correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward. No studies have been conducted to quantify the dynamic changes in foramen dimensions during head-turned rear-impact collisions. The objectives of this study were to quantify the changes in foraminal width, height, and area during head-turned rear-impact collisions and to determine if dynamic narrowing causes potential cervical nerve root or ganglion impingement. METHODS: The authors subjected a whole cervical spine model with muscle force replication and a surrogate head to simulated head-turned rear impacts of 3.5, 5, 6.5, and 8 G following a noninjurious 2-G baseline acceleration. Continuous dynamic foraminal width, height, and area narrowing were recorded, and peaks were determined during each impact; these data were then statistically compared with those obtained at baseline. The authors observed significant increases (p < 0.05) in mean peak foraminal width narrowing values greater than baseline values, of up to 1.8 mm in the left C5-6 foramen at 8 G. At the right C2-3 foramen, the mean peak dynamic foraminal height was significantly narrower than baseline when subjected to rear-impacts of 5 and 6.5 G, but no significant increases in foraminal area were observed. Analysis of the results indicated that the greatest potential for cervical ganglion compression injury existed at C5-6 and C6-7. Greater potential for ganglion compression injury existed at C3-4 and C4-5 during head-turned rear impact than during head-forward rear impact. CONCLUSIONS: Extrapolation of present results indicated potential ganglion compression in patients with a non-stenotic foramen at C5-6 and C6-7; in patients with a stenotic foramen the injury risk greatly increases and spreads to include the C3-4 through C6-7 as well as C4-5 through C6-7 nerve roots. SN - 1547-5654 UR - https://www.unboundmedicine.com/medline/citation/16703905/Head_turned_rear_impact_causing_dynamic_cervical_intervertebral_foramen_narrowing:_implications_for_ganglion_and_nerve_root_injury_ DB - PRIME DP - Unbound Medicine ER -