Development and validation of a 10-year-old child ligamentous cervical spine finite element model

Age-related variations in opening pressure in lumbar puncture: Implications for its interpretation in children

INTRODUCTION

Opening pressure in lumbar puncture (LP) is an important parameter in the diagnosis of various neurological diseases. In children pressures may vary according to age. This study aimed to analyze the variation of opening pressure in LP according to age in children.

METHODS

All LPs performed between February 2017 and March 2023 were analyzed. Patients with modifying factors for opening pressure were excluded. Descriptive analysis was conducted, along with a comparison of means and medians, local regression, and quantile regression. To identify the most relevant cutoff points, graphical analyses were employed.

RESULTS

The median opening pressure was 21.0 cm H2O, with a 10th percentile (P10) of 10 and a 90th percentile (P90) of 32. An increase in opening pressure with age was found. Graphical analysis revealed a significant cutoff point at 96 months. The median opening pressure from 1 to 96 months of age was 19.2 cm H2O, with a P10 of 8 and a P90 of 28.9. For children older than 96 months, the median was 22 cm H2O, with a P10 of 11.8 and a P90 of 35.

CONCLUSION

Opening pressures in children vary with age, with no differences related to sex. Graphical analysis indicates that 96 months of age is an important cutoff point. Above this age, standard values could be used, up to 96 months of age, however, it is necessary to conduct studies for reference values. Opening pressure alone is not sufficient for the diagnosis of intracranial hypertension in children.

Patient-specific finite element modeling of scoliotic curve progression using region-specific stress-modulated vertebral growth

PURPOSE

This study describes the creation of patient-specific (PS) osteo-ligamentous finite element (FE) models of the spine, ribcage, and pelvis, simulation of up to three years of region-specific, stress-modulated growth, and validation of simulated curve progression with patient clinical angle measurements.

RESEARCH QUESTION

Does the inclusion of region-specific, stress-modulated vertebral growth, in addition to scaling based on age, weight, skeletal maturity, and spine flexibility allow for clinically accurate scoliotic curve progression prediction in patient-specific FE models of the spine, ribcage, and pelvis?

METHODS

Frontal, lateral, and lateral bending X-Rays of five AIS patients were obtained for approximately three-year timespans. PS-FE models were generated by morphing a normative template FE model with landmark points obtained from patient X-rays at the initial X-ray timepoint. Vertebral growth behavior and response to stress, as well as model material properties were made patient-specific based on several prognostic factors. Spine curvature angles from the PS-FE models were compared to the corresponding X-ray measurements.

RESULTS

Average FE model errors were 6.3 ± 4.6°, 12.2 ± 6.6°, 8.9 ± 7.7°, and 5.3 ± 3.4° for thoracic Cobb, lumbar Cobb, kyphosis, and lordosis angles, respectively. Average error in prediction of vertebral wedging at the apex and adjacent levels was 3.2 ± 2.2°. Vertebral column stress ranged from 0.11 MPa in tension to 0.79 MPa in compression.

CONCLUSION

Integration of region-specific stress-modulated growth, as well as adjustment of growth and material properties based on patient-specific data yielded clinically useful prediction accuracy while maintaining physiological stress magnitudes. This framework can be further developed for PS surgical simulation.

Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children

Background

Spinal injury in children usually occurs in the cervical spine region. Anterior fixation of the lower cervical spine has been applied in treating pediatric cervical spine injury and disease due to its stable and firm mechanical properties. This study performed finite element analysis and comparison of four different anterior cervical internal fixation systems for children to explore more standard methods of anterior cervical internal fixation in children and seek more effective and safe treatment for children's cervical spine diseases.

Methods

A finite element model of 6-year-old children with lower cervical spine C4/5 discectomy was established, and the self-designed lower cervical spine anterior locking internal fixation system ACBLP and the children's anterior cervical internal fixation system ACOP, ACVLP, and ACSLP plate screws were fixed and loaded on the model. 27.42 N·m torque load was applied to each internal fixation model under six working conditions of anteflexion, backward flexion, left flexion, right flexion, left rotation, and right rotation, to simulate the movement of the cervical spine. The activity and stress distribution cloud diagram of each finite element model was obtained to explore the optimal method of anterior cervical fixation in children.

Results

In the four internal fixation models of ACOP, ACVLP, ACSLP, and ACBLP, the mobility of the C4/5 segment showed a decreasing relationship, and the mobility of adjacent segments increased significantly. In the Mises stress cloud diagram of the cervical spine of the four models, the vertebral body and accessories of the ACBLP model born the least stress, followed by ACSLP. The steel plate and screws in the ACVLP internal fixation model were the most stressed. The stress of the internal fixation system (plate/screw) in all models increased in the order of ACBLP, ACSLP, ACVLP, and ACOP.

Conclusions

ACBLP internal fixation system had obvious advantages in anterior internal fixation of the lower cervical spine in children, C4/5 had the smallest degree of movement, relative displacement was minimal, and the stress on the centrum and pedicle was the least, while the stress on the plate screw was relatively the smallest.

Development of a Finite Element Model of the Pediatric Thoracic and Lumbar Spine, Ribcage, and Pelvis with Orthotropic Region-Specific Vertebral Growth

Finite element (FE) modeling of the spine has increasingly been applied in orthopedic precision-medicine approaches. Previously published FE models of the pediatric spine growth have made simplifications in geometry of anatomical structures, material properties, and representation of vertebral growth. To address those limitations, a comprehensive FE model of a pediatric (10-year-old) osteo-ligamentous thoracic and lumbar spine (T1-L5 with intervertebral discs (IVDs) and ligaments), ribcage, and pelvis with age- and level-specific ligament properties and orthotropic region-specific vertebral growth was developed and validated. Range of motion (ROM) measures, namely lateral bending, flexion-extension, and axial rotation, of the current 10 YO FE model were generally within reported ranges of scaled in vitro adult ROM data. Changes in T1-L5 spine height, as well as kyphosis (T2-T12) and lordosis (L1-L5) angles in the current FE model for two years of growth (from ages 10 to 12 years) were within ranges reported from corresponding pediatric clinical data. The use of such comprehensive pediatric FE models can provide clinically relevant insights into normative and pathological biomechanical responses of the spine, and also contribute to the development and optimization of clinical interventions for spine deformities.

FEBio finite element model of a pediatric cervical spine

OBJECTIVE

The underlying biomechanical differences between the pediatric and adult cervical spine are incompletely understood. Computational spine modeling can address that knowledge gap. Using a computational method known as finite element modeling, the authors describe the creation and evaluation of a complete pediatric cervical spine model.

METHODS

Using a thin-slice CT scan of the cervical spine from a 5-year-old boy, a 3D model was created for finite element analysis. The material properties and boundary and loading conditions were created and model analysis performed using open-source software. Because the precise material properties of the pediatric cervical spine are not known, a published parametric approach of scaling adult properties by 50%, 25%, and 10% was used. Each scaled finite element model (FEM) underwent two types of simulations for pediatric cadaver testing (axial tension and cardinal ranges of motion [ROMs]) to assess axial stiffness, ROM, and facet joint force (FJF). The authors evaluated the axial stiffness and flexion-extension ROM predicted by the model using previously published experimental measurements obtained from pediatric cadaveric tissues.

RESULTS

In the axial tension simulation, the model with 50% adult ligamentous and annulus material properties predicted an axial stiffness of 49 N/mm, which corresponded with previously published data from similarly aged cadavers (46.1 ± 9.6 N/mm). In the flexion-extension simulation, the same 50% model predicted an ROM that was within the range of the similarly aged cohort of cadavers. The subaxial FJFs predicted by the model in extension, lateral bending, and axial rotation were in the range of 1-4 N and, as expected, tended to increase as the ligament and disc material properties decreased.

CONCLUSIONS

A pediatric cervical spine FEM was created that accurately predicts axial tension and flexion-extension ROM when ligamentous and annulus material properties are reduced to 50% of published adult properties. This model shows promise for use in surgical simulation procedures and as a normal comparison for disease-specific FEMs.

Numerical investigation on the stability of human upper cervical spine (C1-C3)

BACKGROUND

The finite element method (FEM) is an efficient and powerful tool for studying human spine biomechanics.

OBJECTIVE

In this study, a detailed asymmetric three-dimensional (3D) finite element (FE) model of the upper cervical spine was developed from the computed tomography (CT) scan data to analyze the effect of ligaments and facet joints on the stability of the upper cervical spine.

METHODS

A 3D FE model was validated against data obtained from previously published works, which were performed in vitro and FE analysis of vertebrae under three types of loads, i.e. flexion/extension, axial rotation, and lateral bending.

RESULTS

The results show that the range of motion of segment C1-C2 is more flexible than that of segment C2-C3. Moreover, the results from the FE model were used to compute stresses on the ligaments and facet joints of the upper cervical spine during physiological moments.

CONCLUSION

The anterior longitudinal ligaments (ALL) and interspinous ligaments (ISL) are found to be the most active ligaments, and the maximum stress distribution is appear on the vertebra C3 superior facet surface under both extension and flexion moments.

Experimental Analysis of Fabricated Synthetic Midthoracic Paediatric Spine as Compared to the Porcine Spine Based on Range of Motion (ROM)

The present study is aimed at investigating the mechanical behaviour of fabricated synthetic midthoracic paediatric spine based on range of motion (ROM) as compared to porcine spine as the biological specimen. The main interest was to ensure that the fabricated synthetic model could mimic the biological specimen behaviour. The synthetic paediatric spine was designed as a 200% scaled-up model to fit into the Bionix Servohydraulic spine simulator. Biomechanical tests were conducted to measure the ROM and nonlinearity of sigmoidal curves at six degrees of freedom (DOF) with moments at ±4 Nm before the specimens failed. Results were compared with the porcine spine (biological specimen). The differences found between the lateral bending and axial rotation of synthetic paediatric spine as compared to the porcine spine were 18% and 3%, respectively, but was still within the range. Flexion extension of the synthetic spine is a bit stiff in comparison of porcine spine with 45% different. The ROM curves of the synthetic paediatric spine exhibited nonlinearities for all motions as the measurements of neutral zone (NZ) and elastic zone (EZ) stiffness were below “1.” Therefore, it showed that the proposed synthetic paediatric spine behaved similarly to the biological specimen, particularly on ROM.

Distraction forces on the spine in early-onset scoliosis: A systematic review and meta-analysis of clinical and biomechanical literature

Distraction-based growing rods are frequently used to treat Early-Onset Scoliosis. These use intermittent spinal distractions to maintain correction and allow for growth. It is unknown how much spinal distraction can be applied safely. We performed a systematic review and meta-analysis of clinical and biomechanical literature to identify such safety limits for the pediatric spine. This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three systematic searches were performed including in-vivo, ex-vivo and in-silico literature. Study quality was assessed in all studies and data including patient- or specimen characteristics, distraction magnitude and spinal failure location and ultimate force at failure were collected. Twelve studies were included, 6 in-vivo, 4 ex-vivo and 2 in-silico studies. Mean in-vivo distraction forces ranged between 242 and 621 N with maxima of 422-981 N, without structural failures when using pedicle screw constructs. In the ex-vivo studies (only cervical spines), segment C0-C2 was strongest, with decreasing strength in more distal segments. Meta-regression analysis demonstrated that ultimate force at birth is 300-350 N, which increases approximately 100 N each year until adulthood. Ex-vivo and in-silico studies showed that yielding occurs at 70-90% of ultimate force, failure starts at the junction between endplate and intervertebral disc, after which the posterior- and anterior long ligament rupture. While data on safety of distraction forces is limited, this systematic review and meta-analysis may aid in the development of guidelines on spinal distraction and may benefit the development and optimization of contemporary and future distraction-based technologies.

Estimation of a statistical geometric model for the cervical vertebrae of children aged 10-18 years

Child neck injuries in motor vehicle crashes (MVCs) result in high morbidity and mortality rates. Estimating a statistical cervical vertebrae geometric model and quantifying the variations of the size and shape with age are very important for investigating the dynamic response and injury risk to a child's cervical spine, as well as for providing a geometric basis for developing child anthropomorphic test devices (ATDs) and finite element models (FEMs) of different ages. In this study, spatial geometric points were automatically extracted from the cervical vertebrae computed tomography (CT) scans of 30 children aged 10 to 18 years old (YO), and a statistical geometric model was estimated for the cervical vertebrae as a function of age and neck circumference/neck length according to the method of principal component analysis and regression (PCA&R). Based on this statistical model, geometric point sets representing cervical vertebrae geometries at different ages and percentiles were generated and formed to envelope surfaces. Meanwhile, the size changes of the cervical vertebrae with child growth from 10 to 18 YO were quantified. In general, the anteroposterior length (APL), transverse process width (TPW), vertebral body height (VBH), and vertebral body depth (VBD) of the cervical vertebrae increase with age; the VBH and VBD increase faster than the APL and TPW. Compared with other vertebrae, the APL of C7 is larger, and the rate of increase of C1 with age is evidently slower. The TPWs of C1 and C7 are greater than those of C2 to C6. C7 has higher average values for the VBH and VBD than C3 to C6.

The effect of cervical intervertebral disc degeneration on the motion path of instantaneous center of rotation at degenerated and adjacent segments: A finite element analysis

BACKGROUND

The motion path of instantaneous center of rotation (ICR) is a crucial kinematic parameter to dynamically characterize cervical spine intervertebral patterns of motion; however, few studies have evaluated the effect of cervical disc degeneration (CDD) on ICR motion path. The purpose of this study was to investigate the effect of CDD on the ICR motion path of degenerated and adjacent segments.

METHOD

A validated nonlinear three-dimensional finite element (FE) model of a healthy adult cervical spine was used. Progressive degeneration was simulated with six FE models by modifying intervertebral disc height and material properties, anterior osteophyte size, and degree of endplate sclerosis at the C5-C6 level. All models were subjected to a pure moment of 1 Nm and a compressive follower load of 73.6 N to simulate physical motion. ICR motion paths were compared among different models.

RESULTS

The normal FE model results were consistent with those of previous studies. In degenerative models, average ICR motion paths shifted significantly anterior at the degenerated segment (β = 0.27 mm; 95% CI: 0.22, 0.32) and posterior at the proximal adjacent segment (β = -0.09 mm; 95% CI: -0.15, -0.02) than those of the normal model.

CONCLUSION

CDD significantly affected ICR motion paths at the degenerated and proximal adjacent segments. The changes at adjacent segments may be a result of compensatory mechanisms to maintain the balance of the cervical spine. Surgical treatment planning should take into account the restoration of ICR motion path to normal. These findings could provide a basis for prosthesis design and clinical practice.

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

BACKGROUND

The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM.

METHODS

An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed.

RESULTS

Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress.

CONCLUSION

Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

Toward Patient Specific Models of Pediatric IVDs: A Parametric Study of IVD Mechanical Properties

Patient specific finite element (FE) modeling of the pediatric spine is an important challenge which offers to revolutionize the treatment of pediatric spinal pathologies, for example adolescent idiopathic scoliosis (AIS). In particular, modeling of the intervertebral disc (IVD) is a unique challenge due to its structural and mechanical complexity. This is compounded by limited ability to non-invasively interrogate key mechanical parameters of a patient's IVD. In this work, we seek to better understand the link between mechanical properties and mechanical behavior of patient specific FE models of the pediatric lumbar spine. A parametric study of IVD parameter was conducted, coupled with insights from current knowledge of the pediatric IVD. In particular, the combined effects of parameters was investigated. Recommendations are made toward areas of importance in patient specific FE modeling of the pediatric IVD. In particular, collagen fiber bundles of the IVD are found to dominate IVD mechanical behavior and are thus recommended as an area of primary focus for patient specific FE models. In addition, areas requiring further experimental research are identified. This work provides a valuable building block toward the development of patient specific models of the pediatric spine.

Finite element modeling to compare craniocervical motion in two age-matched pediatric patients without or with Down syndrome: implications for the role of bony geometry in craniocervical junction instability

OBJECTIVE

Instability of the craniocervical junction (CCJ) is a well-known finding in patients with Down syndrome (DS); however, the relative contributions of bony morphology versus ligamentous laxity responsible for abnormal CCJ motion are unknown. Using finite element modeling, the authors of this study attempted to quantify those relative differences.

METHODS

Two CCJ finite element models were created for age-matched pediatric patients, a patient with DS and a control without DS. Soft tissues and ligamentous structures were added based on bony landmarks from the CT scans. Ligament stiffness values were assigned using published adult ligament stiffness properties. Range of motion (ROM) testing determined that model behavior most closely matched pediatric cadaveric data when ligament stiffness values were scaled down to 25% of those found in adults. These values, along with those assigned to the other soft-tissue materials, were identical for each model to ensure that the only variable between the two was the bone morphology. The finite element models were then subjected to three types of simulations to assess ROM, anterior-posterior (AP) translation displacement, and axial tension.

RESULTS

The DS model exhibited more laxity than the normal model at all levels for all of the cardinal ROMs and AP translation. For the CCJ, the flexion-extension, lateral bending, axial rotation, and AP translation values predicted by the DS model were 40.7%, 52.1%, 26.1%, and 39.8% higher, respectively, than those for the normal model. When simulating axial tension, the soft-tissue structural stiffness values predicted by the DS and normal models were nearly identical.

CONCLUSIONS

The increased laxity exhibited by the DS model in the cardinal ROMs and AP translation, along with the nearly identical soft-tissue structural stiffness values exhibited in axial tension, calls into question the previously held notion that ligamentous laxity is the sole explanation for craniocervical instability in DS.

Parametric study of anterior percutaneous endoscopic cervical discectomy (APECD)

Anterior percutaneous endoscopic cervical discectomy (APECD) is a common treatment for cervical spondylotic radiculopathy (CSR). In this study, the effects of various channel diameters and approach angles on cervical vertebrae on postoperative outcomes in APECD surgery were explored. A finite element model of intact cervical C₃-C₇ was constructed and then modified to obtain six surgical models. Range of motion (ROM) and intradiscal pressure (IDP) were calculated under different conditions of flexion (Fle), extension (Ext), lateral bending, and axial rotation. During Fle and bending to the left (LB), the ROM was closer to the intact model when the angle of approach was 90°. During bending to the left (LB) and rotation to the left (LR), the ROM changed considerably (43.2%, 33.7%, respectively) where the angle of approach was 45°. As the surgical channel diameter increased, the extent of the change in ROM compared with the intact model also increased. IDP decreased by 48% and 49%, respectively, compared with the intact model at the C₅-C₆ segment where the angle of approach was 45° and 60° during Fle, while it changed little at 90°, by less than 10%. The IDP was increased noticeably by 117.6%, 82.1%, and 105.8%, for channel diameters of 2, 3 and 4 mm, respectively. And declined noticeably during LB and LR (LB: 27.1%, 27.1%, 38.5%; LR: 37.4%, 35.5%, 48.7%). The results demonstrated that the shorter the surgical path, the smaller surgical diameter, the less the biomechanical influence on the cervical vertebra.

Development of a finite element biomechanical whole spine model for analyzing lumbar spine loads under caudocephalad acceleration

Background:Spine injury risk due to military conflict is an ongoing concern among defense organizations throughout the world. A better understanding of spine biomechanics could assist in developing protection devices to reduce injuries caused by caudocephalad acceleration (+Gz) in under-body blasts (UBB). Although some finite element (FE) human models have demonstrated reasonable lumbar spine biofidelity, they were either partial spine models or not validated for UBB-type loading modes at the lumbar functional spinal unit (FSU) level, thus limiting their ability to analyze UBB-associated occupant kinematics.Methods:An FE functional representation of the human spine with simplified geometry was developed to study the lumbar spine responses under +Gz loading. Fifty-seven load curves obtained from post mortem human subject experiments were used to optimize the model.Results:The model was cumulatively validated for compression, flexion, extension, and anterior-, posterior-, and lateral-shears of the lumbar spine and flexion and extension of the cervical spine. The thoracic spine was optimized for flexion and compression. The cumulative CORrelation and Analysis (CORA) rating for the lumbar spine was 0.766 and the cervical spine was 0.818; both surpassed the 0.7 objective goal. The model's element size was confirmed as converged.Conclusions:An FE functional representation of the human spine was developed for +Gz lumbar load analysis. The lumbar and cervical spines were demonstrated to be quantitatively biofidelic to the FSU level for multi-directional loading and bending typically experienced in +Gz loading, filling the capability gap in current models.

The potential of spring distraction to dynamically correct complex spinal deformities in the growing child

Purpose

Current treatment of progressive early onset scoliosis involves growth-friendly instrumentation if conservative treatment fails. These implants guide growth by passive sliding or repeated lengthenings. None of these techniques provide dynamic correction after implantation. We developed the spring distraction system (SDS), by using one or multiple compressed springs positioned around a standard sliding rod, to provide active continuous distraction of the spine to stimulate growth and further correction. The purpose of this study was to determine feasibility and proof of concept of the SDS.

Methods

We developed a versatile, dynamic spring distraction system for patients who would benefit from active continuous distraction. This prospective case series evaluates four patients with exceptional and progressive congenital spine deformities.

Results

Four patients had a mean age of 6.8 years at surgery with a mean follow-up of 36 months (range 25–45). The mean progressive thoracic lordosis, which was the reason for initiating surgical treatment in two patients, changed from 32° lordosis preoperatively to 1° kyphosis post-operatively. During follow-up, this further improved to 32° thoracic kyphosis. In the two other patients, with cervicothorcacic scoliosis, the main coronal curve improved from 79° pre-operatively to 56° post-operatively and further improved to 42°. The mean T1-S1 spine growth during follow-up for all patients was 1.3 cm/year. There was one reoperation because of skin problems and no device-failures.

Conclusion

These early results show the feasibility and the proof of concept of spring-based distraction as a dynamic growth-enhancing system with the potential of further correction of the deformity after implantation.

The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study

Remodelling and adaptation of bone within the pelvis is believed to be influenced by the mechanical strains generated during locomotion. Variation in the cortical bone thickness observed in the prenatal ilium has been linked to the musculoskeletal loading associated with in utero movements; for example the development of a thicker gluteal cortex is a possible response to contractions of the gluteal muscles. This study examines if the strains generated in the prenatal iliac cortex due to musculoskeletal loading in utero are capable of initiating bone remodelling to either maintain homeostasis or form new bone. Computational modelling techniques were used firstly to predict the muscle forces and resultant joint reaction force acting on the pelvis during a range of in utero movements. Finite element analyses were subsequently performed to calculate the von Mises strains induced in the prenatal ilium. The results demonstrated that strains generated in the iliac cortex were above the thresholds suggested to regulate bone remodelling to either maintain homeostasis or form new bone. Further simulations are required to investigate the extent to which the heterogeneous cortex forms in response to these strains (i.e., remodelling) or if developmental bone modelling plays a more pivotal role.

Anisotropic and strain rate-dependent mechanical properties and constitutive modeling of the cancellous bone from piglet cervical vertebrae

BACKGROUND AND OBJECTIVE

Characterizing the mechanical properties of the cancellous bone from the cervical vertebrae of child or child surrogate is important for the development of spine finite element models and the investigation of injury mechanism, however, there is currently no public data available as far as we know.

METHODS

Compression tests were conducted on the specimens from the cervical vertebrae of 8-week-old piglets (child surrogates) in axial and radial directions at the strain rates of 0.01, 0.1, 1 and 10/s. The influences of directionality and strain rate on the mechanical properties of the vertebral cancellous bone were statistically investigated. The typical transversely isotropic model, which was added a strain rate item and a plasticity item, was implemented into LS-DYNA finite element code. Based on the material subroutine code, simulation was conducted on the vertebral tissue under compression in axial and radial directions at different strain rates.

RESULTS

The mechanical properties of the cancellous bone of cervical vertebrae were obtained and most of the stress-strain curves showed major linear elastic stage and short plastic stage before fracture. Significant anisotropic behavior was observed for the vertebral tissue in axial and radial directions. The elastic modulus, ultimate stress,yield stress, and ultimate strain of the speimens in axial direction was obtained, with on average, 2.5 ± 0.6 times, 2.1 ± 0.15 times, and 2.1 ± 0.1 times higher and 0.86 ± 0.076 times lower respecitvely, than those in radial direction. In addition, with the strain rate varying from 0.01/s to 10/s, the mechanical parameters, like elastic modulus, yield and ultimte stresses exhibited significant strain rate effect, however, no significant difference was found for the ultimate strain.

CONCLUSIONS

The cervical vertebrae showed significant anisotropic and strain rate-dependent behaviors. The self-developed subroutine codes based on the strain rate-dependent transversely isotropic elastic and plastic constitutive model can simulate the behaviors well.

Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study

Purpose

Percutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) as alternatives to anterior cervical discectomy and fusion (ACDF) are extensively used in the treatment of patients with cervical spondylotic radiculopathy. The possibility of avoiding the risk of accelerated degeneration of the adjacent segments caused by fusion is claimed to be the theoretical advantage of these approaches; however, there is a paucity of supportive evidence from biomechanical data. Therefore, this study investigated and compared the effects of PCF, PEACD, and ACDF on the adjacent segments and operative segments of the cervical spine from a biomechanical standpoint.

Method

A normal and intact three-dimensional finite element digital model of C4-C7 was constructed and validated, and the finite element models of PEACD, PCF, and ACDF were obtained by modifying the C4-C7 model. All models were exposed to identical conditions of load during flexion, extension, axial rotation, and lateral bending. We calculated the range of motion (ROM), intervertebral disc pressure (IDP), and facet joint contact force (FJCF) of the operative segment and the adjacent segment in different motion conditions.

Result

The conventional ACDF had a remarkable influence on the ROM and IDP of the operative segment and the adjacent segments. In the PEACD model, the change of ROM was not noticeable; the IDP of the operative segment was significantly smaller, whereas the change of IDP of the adjacent segment was insignificant. In the PCF model, the ROM and IDP of all segments remained unaffected.During extension, the facet joint contact force changed significantly after ACDF, and it changed slightly after PECAD and PCF.

Conclusion

By comparatively analyzing the biomechanical changes of the cervical spine after PCF, PEACD, and ACDF using the finite element method, we suggested that PCF and PEACD were more suitable for surgical intervention of cervical spondylotic radiculopathy than ACDF from a biomechanical point of view and PCF may outperform PEACD.

Development, validation, and application of ligamentous cervical spinal segment C6-C7 of a six-year-old child and an adult

BACKGROUND AND OBJECTIVE

The cervical spine is one of the primary regions that is easily injured in traffic accidents. Although adult cervical spine finite element models have been widely adopted to investigate the cervical injury, few efforts have been made with respect to the development and application of FE models of the pediatric cervical spine, especially that of a six-year-old child. The objective of this study is to develop and validate high quality cervical spinal segment C6-C7 FE models of a six-year-old child and an adult, and to further investigate the differences of C6-C7 between the child and adult under different loading conditions.

METHODS

The cervical spinal segment C6-C7 FE models were developed by a structured multiblock method, and were verified under flexion, extension, axial rotation, and lateral bending conditions. The validated models were used to investigate the differences of C6-C7 between the child and adult under different loading conditions.

RESULTS

The global angular displacement of C6-C7, the ligament elongation ratio, and the maximum effective strain of annulus fibrosus of the child were obviously larger than those of the adult under the same loading conditions. Regarding the loading forms, the flexion angular displacement of C6-C7 of the child was obviously larger than those of the extension and lateral bending, while for the adult cervical segment C6-C7, no obvious differences existed. The elongation ratio of different ligaments was highly dependent on the types of loadings. The maximum effective strain of annulus fibrosus under flexion, extension and lateral bending loads occurred at the compressive region of the front, rear, and one compressive lateral side, in which the annulus fibrosus was more susceptible to injury under the lateral bending condition, compared with those of the flexion and extension conditions.

CONCLUSIONS

Both the developed child and adult cervical spinal segment C6-C7 FE models exhibited high biofidelity. The responses (angular displacement, the ligament elongation ratio, and the maximum effective strain of annulus fibrosus) of the child and adult are dependent on the loading types, and the responses of the child were obviously larger than those of the adult under the same loading conditions.

Porcine growth plate experimental study and estimation of human pediatric growth plate properties

Growth plate (GP) is a type of tissue widely found in child's immature skeleton. It may have significant influence on the overall injury pattern since it has distinguishing mechanical properties compared to the surrounding bony tissue. For more accurate material modeling and advanced pediatric human body modeling, it is imperative to investigate the material property of GPs in different loading conditions. In this study, a series of tensile and shearing experiments on porcine bone-GP-bone units were carried out. Total 113 specimens of bone-GP-bone unit from the femoral head, distal femur, and proximal tibia of four 20-weeks-old piglets were tested, under different strain rates (average 0.0053 to 1.907 s^-1 for tensile tests, and 0.0085 to 3.037 s^-1 for shearing tests). Randomized block ANOVA was conducted to determine the effects of anatomic region and strain rate on the material properties of GPs. It was found that, strain rate is a significant factor for modulus and ultimate stress for both tensile and shearing tests; the ultimate strains are not sensitive to the input factors in both tensile and shearing tests; the GPs at knee region could be grouped due to similar properties, but statistically different from the femoral head GP. Additionally, the tensile test data from the experimental study were comparing to the limited data obtained from tests on human subjects reported in the literature. An optimal conversion factor was derived to correlate the material properties of 20-week-old piglet GPs and 10 YO child GPs. As a result, the estimated material properties of 10 YO child GPs from different regions in different loading conditions became available given the conversion law stays legitimate. These estimated material properties for 10 YO child GPs were reported in the form of tensile and shearing stress-strain curves and could be subsequently utilized for human GP tissue material modeling and child injury mechanism studies.

Development and validation of a semi-automatic landmark extraction method for mesh morphing

Currently, landmark-based mesh morphing technology is widely used to rapidly obtain meshes with specific geometry, which is suitable to develop parametric human finite element (FE) models. However it takes too much time for landmark extraction to obtain high geometric accuracy. The purpose of this study is to develop and validate a semi-automatic landmark extraction method to reduce the time of manual selection of landmarks without sacrificing the accuracy of identifying landmarks in the process of mesh morphing. A few contour edge landmarks were extracted manually. Mathematical landmarks and pseudo-landmarks were extracted automatically by user-defined algorithm. The radial basis function (RBF) was used to morph the baseline FE model into the target geometry based on these landmarks. The cervical vertebra (C5), rib (R7) and femur were selected as the target geometries to verify the effectiveness of the method. The maximum mean geometric error of the three types of target geometries was less than 1 mm. The mesh quality of the morphed FE model was similar to that of the baseline FE model. Compared to the traditional manual method, 2/3 to 3/4 of the time for landmark extraction was saved by the semi-automatic method.

FEBio finite element models of the human lumbar spine

Finite element analysis has proven to be a viable method for assessing many structure-function relationships in the human lumbar spine. Several validated models of the spine have been published, but they typically rely on commercial packages and are difficult to share between labs. The goal of this study is to present the development of the first open-access models of the human lumbar spine in FEBio. This modeling framework currently targets three deficient areas in the field of lumbar spine modeling: 1) open-access models, 2) accessibility for multiple meshing schemes, and 3) options to include advanced hyperelastic and biphasic constitutive models.

Morphing the feature-based multi-blocks of normative/healthy vertebral geometries to scoliosis vertebral geometries: development of personalized finite element models

Personalized Finite Element (FE) models and hexahedral elements are preferred for biomechanical investigations. Feature-based multi-block methods are used to develop anatomically accurate personalized FE models with hexahedral mesh. It is tedious to manually construct multi-blocks for large number of geometries on an individual basis to develop personalized FE models. Mesh-morphing method mitigates the aforementioned tediousness in meshing personalized geometries every time, but leads to element warping and loss of geometrical data. Such issues increase in magnitude when normative spine FE model is morphed to scoliosis-affected spinal geometry. The only way to bypass the issue of hex-mesh distortion or loss of geometry as a result of morphing is to rely on manually constructing the multi-blocks for scoliosis-affected spine geometry of each individual, which is time intensive. A method to semi-automate the construction of multi-blocks on the geometry of scoliosis vertebrae from the existing multi-blocks of normative vertebrae is demonstrated in this paper. High-quality hexahedral elements were generated on the scoliosis vertebrae from the morphed multi-blocks of normative vertebrae. Time taken was 3 months to construct the multi-blocks for normative spine and less than a day for scoliosis. Efforts taken to construct multi-blocks on personalized scoliosis spinal geometries are significantly reduced by morphing existing multi-blocks.

Performances of the PIPER scalable child human body model in accident reconstruction

Human body models (HBMs) have the potential to provide significant insights into the pediatric response to impact. This study describes a scalable/posable approach to perform child accident reconstructions using the Position and Personalize Advanced Human Body Models for Injury Prediction (PIPER) scalable child HBM of different ages and in different positions obtained by the PIPER tool. Overall, the PIPER scalable child HBM managed reasonably well to predict the injury severity and location of the children involved in real-life crash scenarios documented in the medical records. The developed methodology and workflow is essential for future work to determine child injury tolerances based on the full Child Advanced Safety Project for European Roads (CASPER) accident reconstruction database. With the workflow presented in this study, the open-source PIPER scalable HBM combined with the PIPER tool is also foreseen to have implications for improved safety designs for a better protection of children in traffic accidents.

Numerical simulations of the 10-year-old head response in drop impacts and compression tests

BACKGROUND AND OBJECTIVE

Studies on traumatic injuries of children indicate that impact to the head is a major cause of severe injury and high mortality. However, regulatory and ethical concerns very much limit development and validation of computer models representing the pediatric head. The purpose of this study was to develop a child head finite element model with high-biofidelity to be used for studying pediatric head injury mechanisms.

METHODS

A newly developed 10-year-old (YO) pediatric finite element head model was limitedly validated for kinematic and kinetic responses against data from quasi-static compressions and drop tests obtained from an experimental study involving a child-cadaver specimen. The validated model was subsequently used for a fall accident reconstruction and associated injury analysis.

RESULTS

The model predicted the same shape of acceleration-time histories as was found in drop tests with the largest discrepancy of -8.2% in the peak acceleration at a drop height of 15 cm. Force-deflection responses predicted by the model for compression loading had a maximum discrepancy of 7.5% at a strain rate of 0.3 s(-1). The model-predicted maximum von Mises stress (σv) and principal strain (εp) in the skull, intracranial pressure (ICP), maximum σv and maximum εp in the brain, head injury criterion (HIC), brain injury criterion (BrIC), and head impact power (HIP) were used for analyzing risks of injury in the accident reconstruction.

CONCLUSIONS

Based on the results of the injury analyses, the following conclusions can be drawn: (1) ICP cannot be used to accurately predict the locations of brain injury, but it may reflect the overall energy level of the impact event. (2) The brain regions predicted by the model to have high σv coincide with the locations of subdural hematoma with transtentorial herniation and the impact position of an actual injury. (3) The brain regions with high εp predicted by the model coincide with locations commonly found where diffuse axonal injuries (DAI) due to blunt-impact and rapid acceleration have taken place.

Development and initial evaluation of a finite element model of the pediatric craniocervical junction

OBJECT There is a significant deficiency in understanding the biomechanics of the pediatric craniocervical junction (CCJ) (occiput-C2), primarily because of a lack of human pediatric cadaveric tissue and the relatively small number of treated patients. To overcome this deficiency, a finite element model (FEM) of the pediatric CCJ was created using pediatric geometry and parameterized adult material properties. The model was evaluated under the physiological range of motion (ROM) for flexion-extension, axial rotation, and lateral bending and under tensile loading. METHODS This research utilizes the FEM method, which is a numerical solution technique for discretizing and analyzing systems. The FEM method has been widely used in the field of biomechanics. A CT scan of a 13-month-old female patient was used to create the 3D geometry and surfaces of the FEM model, and an open-source FEM software suite was used to apply the material properties and boundary and loading conditions and analyze the model. The published adult ligament properties were reduced to 50%, 25%, and 10% of the original stiffness in various iterations of the model, and the resulting ROMs for flexion-extension, axial rotation, and lateral bending were compared. The flexion-extension ROMs and tensile stiffness that were predicted by the model were evaluated using previously published experimental measurements from pediatric cadaveric tissues. RESULTS The model predicted a ROM within 1 standard deviation of the published pediatric ROM data for flexion-extension at 10% of adult ligament stiffness. The model's response in terms of axial tension also coincided well with published experimental tension characterization data. The model behaved relatively stiffer in extension than in flexion. The axial rotation and lateral bending results showed symmetric ROM, but there are currently no published pediatric experimental data available for comparison. The model predicts a relatively stiffer ROM in both axial rotation and lateral bending in comparison with flexion-extension. As expected, the flexion-extension, axial rotation, and lateral bending ROMs increased with the decrease in ligament stiffness. CONCLUSIONS An FEM of the pediatric CCJ was created that accurately predicts flexion-extension ROM and axial force displacement of occiput-C2 when the ligament material properties are reduced to 10% of the published adult ligament properties. This model gives a reasonable prediction of pediatric cervical spine ligament stiffness, the relationship between flexion-extension ROM, and ligament stiffness at the CCJ. The creation of this model using open-source software means that other researchers will be able to use the model as a starting point for research.

Computational Modeling of Traffic Related Thoracic Injury of a 10-Year-Old Child Using Subject-Specific Modeling Technique

Traffic injuries have become a major health-related issue to school-aged children. To study this type of injury with numerical simulations, a finite element model was developed to represent the full body of a 10-year-old (YO) child. The model has been validated against test data at both body-part and full-body levels in previous studies. Representing only the average 10-YO child, this model did not include subject-specific attributes, such as the variations in size and shape among different children. In this paper, a new modeling approach was used to morph this baseline model to a subject-specific model, based on anthropometric data collected from pediatric subjects. This mesh-morphing method was then used to rapidly morph the baseline mesh into the subject-specific geometry while maintaining a good mesh quality. The morphed model was subsequently applied to simulate a real-world motor vehicle crash accident. A lung injury observed in the accident was well captured by the subject-specific model. The findings of this study demonstrate the feasibility of the proposed morphing approach to develop subject-specific human models, and confirm their capability in prediction of traffic injuries.