Article References & Abstracts

KINEMATICS


8. AUTHOR Pikus HJ; Phillips JM
INSTITUTIONSection of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
TITLE Characteristics of patients successfully treated for cervicogenic headache bysurgical decompression of the second cervical root.
SOURCE Headache 1995 Nov-Dec;35(10):621-9 ISSN 0017-8748
ABSTRACTWe have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decompressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT-guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.

 

 9. AUTHOR Castro WH; Schilgen M; Meyer S; Weber M; Peuker C; Wortler K
INSTITUTIONAcademy of Manual Medicine, Westfalische Wilhelms-Universitat Munster, Germany.
TITLE Do "whiplash injuries" occur in low-speed rear impacts?
SOURCE Eur Spine J 1997;6(6):366-75 ISSN 0940-6719
ABSTRACTA study was conducted to find out whether in a rear impact motor vehicle accident, velocity changes in the impact vehicle of between 10 and 15 km/h can cause so called "whiplash injuries";. An assessment of the actual injury mechanism of such whiplash injuries and comparison of vehicle rear end collisions with amusement park bumper car collisions was also carried out. The study was based on experimental biochemical, kinematic, and clinical analysis with volunteers. In Europe between DM 10 and 20 billion each year is paid out by insurance companies alone for whiplash injuries, although various studies show that the biodynamic stresses arising in the case of slight to moderate vehicle damage may not be high enough to cause such injuries. Most of these experimental studies with cadavers, dummies, and some with volunteers were performed with velocity changes below 10 km/h. About 65% of the insurance claims, however, take place in cases with velocity changes of up to 15 km/h. Fourteen made volunteers (aged 28-47 years; average 33.2 years) and five female volunteers (aged 26-37 years; average 32.8 years) participated in 17 vehicle rear end collisions and 3 bumper car collisions. All cars were fitted with normal European bumper systems. Before, 1 day after and 4-5 weeks after each vehicle crash test and in two of the three bumper car crash tests a clinical examination, a computerized motion analysis, and an MRI examination with Gd DTPA of the cervical spine of the test persons were performed. During each crash test, in which the test persons were completely screened off visually and acoustically, the muscle tension of various neck muscles was recorded by surface electromyography (EMG). The kinematic responses of the test persons and the forces occurring were measured by accelerometers. The kinematic analyses were performed with movement markers and a screening frequency of 700 Hz. To record the acceleration effects of the target vehicle and the bullet vehicle, vehicle accident data recorders were installed in both. The contact phase of the vehicle structures and the kinematics of the test persons were also recorded using high speed cameras. The results showed that the range of velocity change (vehicle collisions) was 8.7 - 14.2 km/h (average 11.4 km/h) and the range of mean acceleration of the target vehicle was 2.1-3.6 g (average 2.7 g). The range of velocity change (bumper car collisions) was 8.3 - 10.6 km/h (average 9.9 km/h) and the range of mean acceleration of the target bumper car was 1.8 - 2.6 g (average 2.2 g). No injury signs were found at the physical examinations, computerized motion analyses, or at the MRI examinations. Only one of the male volunteers suffered a reduction of rotation of the cervical spine to the left of 10 degrees for 10 weeks. The kinematic analysis very clearly showed that the whiplash mechanism consists of translation/extension (high energy) of the cervical spine with consecutive flexion (low energy) of the cervical spine: hyperextension of the cervical spine during the vehicle crashes was not observed. All the tests showed that the EMG signal of the neck muscles starts before the head movement takes place. The stresses recorded in the vehicle collisions were in the same range as those recorded in the bumper car crashes. From the extent of the damage to the vehicles after a collision it is possible to determine the level of the velocity change. The study concluded that, the "limit of harmlessness" for stresses arising from rear end impacts with regard to the velocity changes lies between 10 and 15 km/h. For everyday practice, photographs of the damage to cars involved in a rear end impact are essential to determine this velocity change. The stress occurring in vehicle rear end collisions can be compared to the stress in bumper car collisions.

10. AUTHOR Robbins-M-C.
TITLE Lack of relationship between vehicle damage and occupant injury.
SOURCE SAE 970494.

11. AUTHOR Jones-F-P, Kennedy-J-L.
TITLE An electromyographic technique for recording the startle pattern.
SOURCE Journal of Psychology 1951;32:63-68.

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