title: Biomechanical assessment of the pediatric cervical spine under bending and tensile loading.
abstract: METHODS
  Cadaveric head-neck complexes from pediatric donors aged 2-12 years were subjected to a test battery consisting of nondestructive flexion-extension bending, nondestructive tensile step-and-hold tests, and tensile distraction loading to failure.
  
  
  OBJECTIVE
  To characterize the biomechanical response of the pediatric cervical spine in flexion-extension bending, and the response and tolerance of the pediatric cervical spine in tensile distraction loading.
  
  
  BACKGROUND
  Except for a 19th century study on stillborn infants, to our knowledge, there are no published data from human cadaveric studies on the response and tolerance of the pediatric cervical spine.
  
  
  METHODS
  Ten unembalmed pediatric head-neck complexes with intact ligamentous cervical spines were sectioned from pediatric donors aged 2-12 years. Each specimen was potted at the level of T2 and subjected to quasi-static nondestructive flexion-extension bending by a pure moment applied to the neck. Following the flexion-extension testing, each specimen was preconditioned in tension and subjected to a series of nondestructive tensile step-and-hold tests followed by tensile distraction loading to failure using a mini-Bionix MTS machine (MTS Systems Corp.).
  
  
  RESULTS
  The average +/- standard deviation rotational stiffness of the skull-C2, C2-T2, and skull-T2 spinal segments was 0.72 +/- 0.07, 0.07 +/- 0.02, and 0.04 +/- 0.01 Nm/degree, respectively. Average rotational stiffness was independent of age for the range of pediatric ages tested. In the destructive tensile tests, failure occurred at an average distraction force of 726 +/- 171 N and an average distraction displacement of 20 +/- 3 mm. The average ultimate distraction force recorded for the 2-4-year-old specimens (595 +/- 143 N) was significantly lower (P < 0.05) than the corresponding average recorded for the 6-12-year-old specimens (868 +/- 71 N). Average +/- standard deviation linear stiffness in tensile loading was 34.7 +/- 5.7 N/mm. Pediatric age did not have a statistically significant effect on the average linear stiffness.
  
  
  CONCLUSIONS
  The current study provides valuable new information on the response and tolerance of the pediatric cervical spine to quasi-static flexion-extension and tensile distraction loading.
authors.affiliation: Department of Anatomy, Southern Medical University, Guangzhou, China. jouyang@fimmu.com
authors.forename: Jun
authors.initials: J
authors.lastname: Ouyang
authors.forename: Qingan
authors.initials: Q
authors.lastname: Zhu
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhao
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Xu
authors.forename: Weisheng
authors.initials: W
authors.lastname: Chen
authors.forename: Shizhen
authors.initials: S
authors.lastname: Zhong
mesh_terms: D001696:Biomechanical Phenomena / Q000295:instrumentation / Q000379:methods*; D002574:Cervical Vertebrae / Q000473:pathology / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology; D013131:Spine / Q000473:pathology / Q000502:physiology; D013718:Tensile Strength / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology*