title: Development and initial evaluation of a finite element model of the pediatric craniocervical junction.
abstract: 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.
authors.affiliation: Department of Bioengineering and Scientific Computing and Imaging Institute, University of Utah; and.
authors.forename: Rinchen
authors.initials: R
authors.lastname: Phuntsok
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Mazur
authors.affiliation: Department of Bioengineering and Scientific Computing and Imaging Institute, University of Utah; and.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ellis
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Ravindra
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Brockmeyer
mesh_terms: D000293:Adolescent; D001269:Atlanto-Occipital Joint / Q000033:anatomy & histology* / Q000502:physiology*; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008959:Models, Neurological; D009777:Occipital Bone / Q000033:anatomy & histology*; D016059:Range of Motion, Articular / Q000502:physiology*
keywords: CCJ = craniocervical junction; FEM = finite element model; ROM = range of motion; TL = transverse atlantal ligament; TM = tectorial membrane; craniocervical junction; finite element modeling; pediatric; spinal biomechanics; spine