Biomechanical Analysis of Vertebral Derotation Techniques for the Surgical Correction of Thoracic Scoliosis

Martino, Jérôme; Aubin, Carl‐Éric; Wang, Xiaoyu; Parent, Stefan

doi:10.1097/brs.0b013e31827a641e

Cited by 17 publications

(20 citation statements)

References 30 publications

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“…Only a few published papers proposed methods for the estimation of the instrumentation loads during and after deformity correction. In the studies conducted with the S3 simulator, topics, such as the optimum screw patterns to minimize the forces required to achieve the desired corrections in adolescent scoliotic subjects (Wang et al, 2012b ), the efficacy of some correction maneuvers (Wang et al, 2011 ; Martino et al, 2013 ) and of different instrumentations (Wang et al, 2012a ) were investigated. Abe and coworkers (Abe et al, 2015 ) predicted the corrective forces in 20 adolescent patients based on the changes in rod geometry and finite element analysis, based on post-operative CT scans.…”

Section: Discussionmentioning

confidence: 99%

Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

Galbusera

Bassani

Barbera

et al. 2015

Front. Bioeng. Biotechnol.

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In decades of technical developments after the first surgical corrections of spinal deformities, the set of devices, techniques, and tools available to the surgeons has widened dramatically. Nevertheless, the rate of complications due to mechanical failure of the fixation or the instrumentation remains rather high. Indeed, basic and clinical research about the principles of deformity correction and the optimal surgical strategies (i.e., the choice of the fusion length, the most appropriate instrumentation, and the degree of tolerable correction) did not progress as much as the implantable devices and the surgical techniques. In this work, a software approach for the biomechanical simulation of the correction of patient-specific spinal deformities aimed to the identification of its biomechanical principles is presented. The method is based on three-dimensional reconstructions of the spinal anatomy obtained from biplanar radiographic images. A user-friendly graphical user interface allows for the planning of the desired deformity correction and to simulate the implantation of pedicle screws. Robust meshing of the instrumented spine is provided by using consolidated computational geometry and meshing libraries. Based on a finite element simulation, the program is able to predict the loads and stresses acting in the instrumentation as well as those in the biological tissues. A simple test case (reduction of a low-grade spondylolisthesis at L3–L4) was simulated as a proof of concept, and showed plausible results. Despite the numerous limitations of this approach which will be addressed in future implementations, the preliminary outcome is promising and encourages a wide effort toward its refinement.

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Section: Discussionmentioning

confidence: 99%

Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

Galbusera

Bassani

Barbera

et al. 2015

Front. Bioeng. Biotechnol.

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“…[22][23][24] Improved understanding of the forces acting on the deformity 2,25 has led to refinements of correction strategies, fixation devices, and implant materials. 4,7,[26][27][28][29][30][31][32][33] More recently, the possibilities of shortening the required arthrodesis [33][34][35] using less soft tissue dissection, 16,36 and using fewer implants 18,37-40 have been investigated in an effort to decrease fusion-related morbidity, 13,14 retain maximum spinal motion, and decrease costs. 17 The concept of dynamic segmental fixation to guide spinal growth without fusion has also been explored.…”

Section: Discussionmentioning

confidence: 99%

Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study

et al. 2018

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Background: This trial reports the 2-year and immediate postremoval clinical outcomes of a novel posterior apical short-segment (PASS) correction technique allowing for correction and stabilization of adolescent idiopathic scoliosis (AIS) with limited fusion.Methods: Twenty-one consecutive female AIS patients were treated at 4 institutions with this novel technique. Arthrodesis was limited to the short apical curve after correction with translational and derotational forces applied to upper and lower instrumented levels. Instrumentation spanned fused and unfused segments with motion and flexibility of unfused segments maintained. The long concave rods were removed at maturity. Radiographic data collected included preoperative and postoperative data for up to 2 years as well as after long rod removal.Results: All 21 patients are beyond 2 years postsurgery. Average age at surgery was 14.2 years (11-17 years). A mean of 10.5 6 1 levels per patient were stabilized and 5.0 6 0.5 levels (48%) were fused. Cobb angle improved from 56.18 6 8.08 to 20.88 6 7.88 (62.2% improvement) at 1 year and 20.98 6 8.48, (62.0% improvement) at 2 years postsurgery. In levels instrumented but not fused, motion was 268 6 68 preoperatively compared to 108 6 48 at 1 year postsurgery, demonstrating 38% maintenance of mobility in nonfused segments. There was no report of implant-related complications.Conclusions: PASS correction technique corrected the deformity profile in AIS patients with a lower implant density while sparing 52% of the instrumented levels from fusion through the 2-year follow-up.

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“…Mono-axial pedicle screws, compared with multi-axial screws, are known to allow better correction of scoliosis and significantly improved rib cage symmetry when using the DVBD technique. 20,21 This better correction of rotational deformity in the transverse plane can be attributed to no degree of freedom between the head and the body of the pedicle screw. 21 A third type of pedicle screw was introduced, the head of which pivots in only one plane (sagittal), and theoretically, it provides more effortless rod loading whilst maintaining the ability of mono-axial screws to de-rotate the spine.…”

Section: Biomechanics Of Correctionmentioning

confidence: 99%

“…20,21 This better correction of rotational deformity in the transverse plane can be attributed to no degree of freedom between the head and the body of the pedicle screw. 21 A third type of pedicle screw was introduced, the head of which pivots in only one plane (sagittal), and theoretically, it provides more effortless rod loading whilst maintaining the ability of mono-axial screws to de-rotate the spine. 22 In 2011, Wang et al reported the MDOF system in which screws are connected to rods with post-connectors providing 6°-of-freedom (translation in two planes and rotation in four planes) relative motion while mono-axial screws provide 2°-of-freedom (only translation and rotation).…”

Section: Biomechanics Of Correctionmentioning

confidence: 99%

Correction manoeuvres in the surgical treatment of spinal deformities

Şenköylü

Çetinkaya

2017

EFORT Open Reviews

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Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities.The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior.The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distraction-compression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever.Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170002. Originally published online at www.efortopenreviews.org

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Biomechanical Analysis of Vertebral Derotation Techniques for the Surgical Correction of Thoracic Scoliosis

Abstract: Biomechanically, it is possible to significantly improve the correction of thoracic scoliotic deformities, particularly in the transverse plane, when using vertebral derotation maneuvers.

Cited by 17 publications

References 30 publications

Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study

Correction manoeuvres in the surgical treatment of spinal deformities

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