Variations of stiffness and strength along the human cervical spine

The load-displacement response and strength of the mid (C2-C5) and lower (C5-T1) cervical regions were determined for combinations of sagittal loads, in vitro. In unpaired t-test comparisons, the mid cervical region was significantly stiffer in compression and extension than the lower region. In tests to failure, failure in six out of seven mid cervical specimens resulted from flexion alone, while combined compression-flexion was required to fail five of the eight lower cervical specimens. Post-test dissections revealed no regional differences in the pattern of failure. In addition to sagittal tests, the load-displacement responses of three-vertebrae cervical specimens were measured with the upper body axially rotated with respect to the lower body. The effect of this pre-torsion was to diminish the zone of low slope near zero load for axial, shear, and flexion motion. Three of the four axially rotated specimens failed in flexion without added compression. These controlled load-displacement measurements of cervical spine specimens describe for the first time the continuous flexion-compression response up to failure, and suggest that consideration of the biomechanics of three apparently distinct mobile regions of the cervical spine (C1-C2, C2-C5, C5-T1) may facilitate the interpretation of hazardous conditions and the diagnosis of injury. These data also provide basic information for the in vitro investigation of passive cervical spine protection such as helmets and head-rests, suggesting that the head should be kept in a non-rotated position to reduce risk of injury.