Advancing cervical spine finite element analysis: validation of foraminal ligaments and a nerve root submodel under helmet loads

Neck pain is a highly prevalent condition in the general population, but the addition of helmet loads contributes to the neck pain that 97% of fighter pilots report. The mechanism for neck pain in pilots is unknown; however, there is likely nerve root (NR) dysfunction involved. This study implemented a spinal cord, NRs, and novel foraminal ligaments into the previously validated VIVA OpenHBM. After performing sensitivity analyses and validating added tissues, helmet loads and muscle forces were applied. The results indicate that helmet loads generate compression on NRs that temporarily impair blood flow and impulse propagation in a neutral posture.