In silico patient-specific optimization of correction strategies for thoracic adolescent idiopathic scoliosis
| Autor: | Carl-Eric Aubin, Luigi La Barbera, Jeremy J. Rawlinson, A. Noelle Larson |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Optimization
Male Adolescent Rotation Computer science Bone Screws Biophysics Idiopathic scoliosis Thoracic Vertebrae Adolescent idiopathic scoliosis 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Computer Simulation Sensitivity (control systems) Instrumentation (computer programming) Precision Medicine Child Mechanical Phenomena Orthodontics In silico Biomechanical modelling High stiffness 030229 sport sciences Patient specific Vertebra Biomechanical Phenomena medicine.anatomical_structure Spinal Fusion Treatment Outcome Scoliosis Coronal plane Patient-specific Female Thoracic scoliosis Deformity correction 030217 neurology & neurosurgery Algorithms |
| Zdroj: | Clinical biomechanics (Bristol, Avon). 81 |
| ISSN: | 1879-1271 |
| Popis: | Background With modelling and simulation (or in silico) techniques, patient-specific optimization algorithms represent promising tools to support the surgical decision-making process, particularly in 3D correction of adolescent idiopathic scoliosis, where the best intraoperative instrumentation strategy and the correction goals are debated. Methods 1080 biomechanical intraoperative simulations of a representative pediatric thoracic curve were run according to a full-factorial design approach. Widely accepted instrumentation configurations (5 screw patterns, 4 upper and 3 lower instrumented vertebrae, 6 rod curvatures and 3 rod stiffnesses) were analyzed, assuming concave rod rotation and en bloc derotation as main correction maneuvers. Results in terms of 3D correction and mobility were rated using an objective function for thoracic scoliosis also including surgeon-dependent correction objectives. An extensive sensitivity analysis on correction objectives was performed. Findings Multiple optimal strategies were identified, depending on the selected correction objective. They provided significantly better coronal (67% vs. 55%) correction, using comparable instrumented levels (9.9 ± 1.6 vs. 10.7 ± 2.1), screw patterns and significantly higher implant density (1.6 ± 0.3 vs. 1.4 ± 0.2 screws/vertebra) compared to worst ones. Optimal strategies typically included the neutral and the last touching vertebrae in the construct and high stiffness (CoCr, 6 mm) differentially/highly contoured rods. Interpretation The computerized algorithm determined the best instrumentation parameters to achieve optimal correction for the considered thoracic case. Multiple clinically equivalent strategies may be used, as supported by the variety of considered correction objectives. The current approach could be translated to any scoliotic curves, including surgeon preferences in terms of instrumentation parameters, intraoperative correction maneuvers and correction objectives. |
| Databáze: | OpenAIRE |
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