In silico patient-specific optimization of correction strategies for thoracic adolescent idiopathic scoliosis.
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 th...
| Publicado en: | Clinical Biomechanics Vol. 81 |
|---|---|
| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Jan2021
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=148310574&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 148310574 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02680033 JB1 jtl: Clinical Biomechanics issn: 02680033 maglogo: N pubinfo: dt: Jan2021 vid: 81 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 148310574 148310574 148310574 10.1016/j.clinbiomech.2020.105200 148310574 ppct: 1 formats: tig: atl: In silico patient-specific optimization of correction strategies for thoracic adolescent idiopathic scoliosis. aug: au: La Barbera, Luigi Larson, A. Noelle Rawlinson, Jeremy Aubin, Carl-Eric affil: Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Québec, Canada sug: subj: Scoliosis, Idiopathic, Adolescent Surgery Thoracic Vertebrae Surgery Human Algorithms Decision Making Intraoperative Care Computer Simulation ab: 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. 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. 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. 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. • 1080 virtual correction strategies simulated typical instrumentation parameters • The algorithm optimized 3D correction and mobility for thoracic scoliosis • Surgeon-dependent correction objectives affected the optimal strategies • Optimal strategies had better coronal/transverse correction, higher screw density • Optimal strategies included high stiffness differentially/highly contoured rods pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|