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Biomechanical Simulation of Stresses and Strains Exerted on the Spinal Cord and Nerves During Scoliosis Correction Maneuvers

  • Biomechanics
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Biomechanical analysis of the spinal cord and nerves during scoliosis correction maneuvers through numerical simulations.

Objective

To assess the biomechanical effects of scoliosis correction maneuvers and stresses generated on the spinal nervous structures.

Background Data

Important forces are applied during scoliosis correction surgery, which could potentially lead to neurologic complications due to stresses exerted on the nervous structures. The biomechanical impact of the different types of stresses applied on the nervous structures during correction maneuvers is not well understood.

Methods

Three correction techniques were simulated using a hybrid computer modeling approach, personalized to a right thoracic adolescent idiopathic scoliotic case (Cobb angle: 63°): (1) Harrington-type distraction; (2) segmental translation technique; and a (3) segmental rotation—based procedure. A multibody model was used to simulate the kinematics of the instrumentation maneuvers; a second comprehensive finite element model was used to analyze the local stresses and strains on the spinal cord and nerves. Average values of the internal medullar pressure (IMP), shear stresses, nerve compression, and strain were computed over three regions and compared between techniques.

Results

Harrington distraction maneuver generated high stresses and strains over the thoracolumbar region. In the main thoracic region, the segmental translation maneuver technique induced 15% more shear stress, 25% more strain, and 62% lower nerve compression than Harrington distraction maneuver. The segmental rotation—based procedure induced 25% lower shear stresses and 18% more strain, respectively, at the apical level, as well as 72%, 57%, and 7% lower IMP, nerve compression, and strain in the upper thoracic region, compared with Harrington distraction maneuver.

Conclusion

This study quantified the relative stress induced on the spinal cord and spinal nerves for different correction maneuvers using a novel hybrid patient-specific model. Of the three maneuvers studied, the Harrington distraction maneuver induced the most important stresses over the thoracolumbar region.

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Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec, H3C 3A7, Canada

    Juan Henao M.A.Sc. & Carl-Éric Aubin PhD, PEng

  2. Research Center, Sainte-Justine University Hospital Center, 3175 Côte Sainte-Catherine Rd, Montreal, Quebec, H3T 1C5, Canada

    Juan Henao M.A.Sc., Hubert Labelle MD & Carl-Éric Aubin PhD, PEng

  3. iLab-Spine (International Laboratory - Spine Imaging and Biomechanics), Marseille, France

    Juan Henao M.A.Sc., Pierre-Jean Arnoux PhD & Carl-Éric Aubin PhD, PEng

  4. Laboratoire de Biomécanique Appliquée, UMRT24 IFFSTAR/ Aix-Marseille University, Bd. P. Dramard, Faculté de Medecine secteur-Nord, France, 13916, Marseille cedex 20

    Pierre-Jean Arnoux PhD

Authors
  1. Juan Henao M.A.Sc.
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  2. Hubert Labelle MD
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  3. Pierre-Jean Arnoux PhD
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  4. Carl-Éric Aubin PhD, PEng
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Corresponding author

Correspondence to Carl-Éric Aubin PhD, PEng.

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Author disclosures

JH (grants from Natural Sciences and Engineering Research Council of Canada, grants from Institut Français des Sciences et Technologies des Transports, de l’Aménagement et des Réseaux [IFSTTAR], grants from Aix-Marseille University Foundation AMIDEX, during the conduct of the study); HL (other from Spinologics Inc., grants from DePuy Synthes, other from Scoliosis Research Society, grants from Canadian Institutes of Health Research [CIHR], outside the submitted work); PJA (grants from Institut Français des Sicences et Technologies des Transports, de l’Aménagement et des Réseaux [IFSTTAR], grants from Aix-Marseille Foundation AMIDEX, during the conduct of the study); CÉA (grants from Orthopedic Research and Education Foundation, grants from Natural Sciences and Engineering Research Council of Canada [Discovery Grant & Industrial Research Chair with Medtronic of Canada], during the conduct of the study; grants from Medtronic, other from Medtronic, outside the submitted work).

Disclosure

The authors receive a research grant from the NSERC-industrial research chair program with Medtronic of Canada for the realization of this study.

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Henao, J., Labelle, H., Arnoux, PJ. et al. Biomechanical Simulation of Stresses and Strains Exerted on the Spinal Cord and Nerves During Scoliosis Correction Maneuvers. Spine Deform 6, 12–19 (2018). https://doi.org/10.1016/j.jspd.2017.04.008

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  • DOI: https://doi.org/10.1016/j.jspd.2017.04.008

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