Biomechanical study of pediatric human cervical spine: a finite element approach. 
Although considerable effort has been made to understand the biomechanical behavior of the adult cervical spine, relatively little information is available on the response of the pediatric cervical spine to external forces.  Since significant anatomical differences exist between the adult and pediatric cervical spines, distinct biomechanical responses are expected.  The present study quantified the biomechanical responses of human pediatric spines by incorporating their unique developmental anatomical features.  One-, three-, and six-year-old cervical spines were simulated using the finite element modeling technique, and their responses computed and compared with the adult spine response.  The effects of pure overall structural scaling of the adult spine, local component developmental anatomy variations that occur to the actual pediatric spines, and structural scaling combined with local component anatomy variations on the responses of the pediatric spines were studied.  Age- and component-related developmental anatomical features included variations in the ossification centers, cartilages, growth plates, vertebral centrum, facet joints, and annular fibers and nucleus pulposus of the intervertebral discs.  The flexibility responses of the models were determined under pure compression, pure flexion, pure extension, and varying degrees of combined compression-flexion and compression-extension.  The pediatric spine responses obtained with the pure overall (only geometric) scaling of the adult spine indicated that the flexibilities consistently increase in a uniform manner from six- to one-year-old spines under all loading cases.  In contrast, incorporation of local anatomic changes specific to the pediatric spines of the three age groups (maintaining the same adult size) not only resulted in considerable increases in flexibilities, but the responses also varied as a function of the age of the pediatric spine and type of external loading.  When the geometric scaling effects were added to these spines, the increases in flexibilities were slightly higher; however, the pattern of the responses remained the same as found in the previous approach.  These results indicate that inclusion of developmental anatomical changes characteristic of the pediatric spines has more of a predominant effect on biomechanical responses than extrapolating responses of the adult spine based on pure overall geometric scaling.