Biomechanics of Pediatric Cervical Spine: Compression,Flexion and Extension Responses

The objective of the present study was to develop three separate age-specific one, three, and six year old pediatric human cervical spine (C4-CS-C6) three-dimensional nonlinear finite element models and to quantify the biomechanical responses. The adult model was modified to create one, three, and six year old pediatric spines by incorporating the local geometrical and material characteristics of the developmental anatomy. The adult human cervical spine model was constructed from close-up computed tomography sections and sequential anatomic cryomicrotome sections, and validated with experimental data. The biomechanical responses were compared with the adult human cervical spine behavior under different loading modes using three approaches. Approach 1: using pure overall structural scaling (reduce size) of the adult model. Approach 2: using three separate age-specific pediatric models incorporating local component geometrical and material property changes. Approach 3: applying the overall structural scaling to the above three pediatric models. All pediatric structures were consistently more flexible than the adult spine under all loading modes. However, responses obtained using the pure overall structural scaling (Approach 1) increased the flexibilities slightly. In contrast, the inclusion of local component geometrical and material property changes to create the three individual pediatric cervical spine models (Approach 2) produced significantly higher changes in the flexibilities under all loading modes. When overall structural scaling effects were added to the three pediatric models (Approach 3), the increase was not considerably higher. White the one year old pediatric model was the most flexible followed by the three and six year old models in flexion and extension, the three year old pediatric model was the most flexible under compression followed by the six and one year old models. The differing biomechanical responses among different pediatric groups were ascribed to the individual developmental anatomical features. The present findings of significant increase in biomechanical response due to local geometry and material property changes emphasize the need to consider the developmental anatomical features in the pediatric structures to better predict their biomechanical behavior.