A novel method for prediction of postoperative global sagittal alignment based on full-body musculoskeletal modeling and posture optimization

Ignasiak, Dominika

doi:10.1016/j.jbiomech.2019.109324

Cited by 11 publications

(9 citation statements)

References 65 publications

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“…When patients in this study were investigated, the current musculoskeletal model displayed moderate improvement over the original version: the T9PA parameter was predicted with accuracy, PPV, NPV, sensitivity, and specificity values as 0.93, 0.93, 0.92, 0.93, and 0.92, respectively, compared with 0.89, 0.88, 0.92, 0.93, and 0.87, for the original model. 19 The cone-of-economy suggests that ideal alignment allows for a balanced standing posture that requires minimal muscle effort. 29 Utilizing this concept, we predicted postoperative sagittal alignment corresponding to minimum muscle activation and, thus, biomechanically, the most ergonomic.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The computational framework adopted in this study has been previously described. 19 Briefly, full-body musculoskeletal models of 21 fusion patients were constructed and analyzed to predict postoperative sagittal postures from preoperative alignment and surgical treatment parameters. Patient-specific models were developed by scaling the generic full-body musculoskeletal model in the AnyBody Modeling System (v. 7.3) by patient body weight and height.…”

Section: Methodsmentioning

confidence: 99%

“…Biomechanical models that account for patient and surgical characteristics can overcome these limitations. Recently, a preliminarily validated framework for predicting postoperative alignment using musculoskeletal modeling has been introduced 19. In this study, we evaluated the clinical validity and performance of this modeling framework in a large cohort of patients with different fusion lengths (FLs).…”

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confidence: 99%

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Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment

Bayoğlu¹,

Witt²,

Chatain³

et al. 2022

Spine

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Study Design. A retrospective radiographic and biomechanical analysis of 108 thoracolumbar fusion patients from two clinical centers.Objective. This study aimed to determine the validity of a computational framework for predicting postoperative patient posture based on preoperative imaging and surgical data in a large clinical sample. Summary of Background Data. Short-term and long-term studies on thoracolumbar fusion patients have discussed that a preoperative predictive model would benefit surgical planning and improve patient outcomes. Clinical studies have shown that postoperative alignment changes at the pelvis and intact spine levels may negatively affect postural balance and quality of life. However, it remains challenging to predict such changes preoperatively because of confounding surgical and patient factors. Materials and Methods. Patient-specific musculoskeletal models incorporated weight, height, body mass index, age, pathologyassociated muscle strength, preoperative sagittal alignment, and surgical treatment details. The sagittal alignment parameters predicted by the simulations were compared with those observed radiographically at a minimum of three months after surgery.Results. Pearson correlation coefficients ranged from r = 0.86 to 0.95, and mean errors ranged from 4.1°to 5.6°. The predictive accuracies for postoperative spinopelvic malalignment (pelvic incidence minus lumbar lordosis > 10°) and sagittal imbalance parameters (TPA > 14°, T9PA > 7.4°, or LPA > 7.2°) were between 81% and 94%. Patients treated with long fusion (greater than five segments) had relatively lower prediction errors for lumbar lordosis and spinopelvic mismatch than those in the local and short groups.Conclusions. The overall model performance with long constructs was superior to those of the local (one to two segments) and short (three to four segments) fusion cases. The clinical framework is a promising tool in development to enhance clinical judgment and to help design treatment strategies for predictable surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment

Bayoğlu¹,

Witt²,

Chatain³

et al. 2022

Spine

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“…Similarly, an instrumented MSK model was created from the intact one. Spinal fusion was modeled by introducing rigid kinematic and kinetic constraints from L1 to L5 vertebrae, guaranteeing rigid connection (no relative motion between vertebrae) and full force and moment transmission ( Ignasiak et al, 2018 ; Ignasiak, 2020 ). The validation of this model was performed against an in vivo study by Rohlmann ( Rohlmann et al, 1997 ), in which bending moments in the posterior rods were measured by means of instrumented implants.…”

Section: Methodsmentioning

confidence: 99%

The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading

Panico

Bassani

Villa

et al. 2021

Front. Bioeng. Biotechnol.

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Simplified loading conditions such as pure moments are frequently used to compare different instrumentation techniques to treat spine disorders. The purpose of this study was to determine if the use of realistic loading conditions such as muscle forces can alter the stresses in the implants with respect to pure moment loading. A musculoskeletal model and a finite element model sharing the same anatomy were built and validated against in vitro data, and coupled in order to drive the finite element model with muscle forces calculated by the musculoskeletal one for a prescribed motion. Intact conditions as well as a L1-L5 posterior fixation with pedicle screws and rods were simulated in flexion-extension and lateral bending. The hardware stresses calculated with the finite element model with instrumentation under simplified and realistic loading conditions were compared. The ROM under simplified loading conditions showed good agreement with in vitro data. As expected, the ROMs between the two types of loading conditions showed relatively small differences. Realistic loading conditions increased the stresses in the pedicle screws and in the posterior rods with respect to simplified loading conditions; an increase of hardware stresses up to 40 MPa in extension for the posterior rods and 57 MPa in flexion for the pedicle screws were observed with respect to simplified loading conditions. This conclusion can be critical for the literature since it means that previous models which used pure moments may have underestimated the stresses in the implants in flexion-extension and in lateral bending.

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Forward dynamics simulation of a simplified neuromuscular-skeletal-exoskeletal model based on the CMA-ES optimization algorithm: framework and case studies

Jin,

Liu,

Zhang

et al. 2024

Multibody Syst Dyn

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A novel method for prediction of postoperative global sagittal alignment based on full-body musculoskeletal modeling and posture optimization

Cited by 11 publications

References 65 publications

Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment

Clinical Validation of a Novel Musculoskeletal Modeling Framework to Predict Postoperative Sagittal Alignment

The Simulation of Muscles Forces Increases the Stresses in Lumbar Fixation Implants with Respect to Pure Moment Loading

Forward dynamics simulation of a simplified neuromuscular-skeletal-exoskeletal model based on the CMA-ES optimization algorithm: framework and case studies

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