Hybrid cadaveric/surrogate model of thoracolumbar spine injury due to simulated fall from height

Abstract

A fall from high height can cause thoracolumbar spine fracture with retropulsion of endplate fragments into the canal leading to neurological deficit. Our objectives were to develop a hybrid cadaveric/surrogate model for producing thoracolumbar spine injury during simulated fall from height, evaluate the feasibility and performance of the model, and compare injuries with those observed clinically. Our model consisted of a 3-vertebra human lumbar specimen (L3–L4–L5) stabilized with muscle force replication and mounted within an impact dummy. The model was subjected to a fall from height of 2.2m with impact velocity of 6.6m/s. Kinetic and kinematic time-history responses were determined using spinal and pelvis load cell data and analyses of high-speed video. Injuries to the L4 vertebra were evaluated by fluoroscopy, radiography, and detailed anatomical dissection. Peak compression forces during the fall from height occurred at 7ms and reached 44.7kN at the ground, 9.1kN at the pelvis, and 4.5kN at the spine. Pelvis acceleration peaks reached 209.9g at 8ms for vertical and 62.8g at 12ms for rearward. Tensile load peaks were then observed (spine: 657.0N at 47ms; pelvis: 569.4N at 61ms). T1/pelvis peak flexion of 68.3° occurred at 38ms as the upper torso translated forward while the pelvis translated rearward. Complete axial burst fracture of the L4 vertebra was observed including endplate comminution, retropulsion of bony fragments into the canal, loss of vertebral body height, and increased interpedicular distance due to fractures anterior to the pedicles and a vertical split fracture of the left lamina. Our dynamic injury model closely replicated the biomechanics of real-life fall from height and produced realistic, clinically relevant burst fracture of the lumbar spine. Our model may be used for further study of thoracolumbar spine injury mechanisms and injury prevention strategies.