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Surgical Planning and Follow-up of Anterior Vertebral Body Growth Modulation in Pediatric Idiopathic Scoliosis Using a Patient-Specific Finite Element Model Integrating Growth Modulation

  • Biomechanics
  • Published:
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Abstract

Study Design

Numerical planning and simulation of immediate and post-two-year growth modulation effects of Anterior Vertebral Body Growth Modulation (AVBGM).

Objectives

To develop a planning tool based on a patient-specific finite element model (FEM) of pediatric scoliosis integrating growth to computationally assess the 3D biomechanical effects of AVBGM.

Summary of Background Data

AVBGM is a recently introduced fusionless compression-based approach for pediatric scoliotic patients presenting progressive curves. Surgical planning is mostly empirical, with reported issues including overcorrection (inversion of the side) of the curve and a lack of control on 3D correction.

Methods

Twenty pediatric scoliotic patients instrumented with AVBGM were assessed. An osseoligamentous FEM of the spine, rib cage, and pelvis was generated before surgery using the patient′s 3D reconstruction obtained from calibrated biplanar radiographs. For each case, different scenarios of AVBGM and two years of vertebral growth and growth modulation due to gravitational loads and forces from AVBGM were simulated. Simulated correction indices in the coronal, sagittal, and transverse planes for the retained scenario were computed and a posteriori compared to actual patient′s postoperative and two years’ follow-up data.

Results

The simulated immediate postoperative Cobb angles were on average within 3° of that of the actual correction, while it was ±5° for kyphosis/lordosis angles, and ±5° for apical axial rotation. For the simulated 2-year postoperative follow-up, correction results were predicted at ±3° for Cobb angles and ±5° for kyphosis/lordosis angles, ±2% for T1–L5 height, and ±4° for apical axial rotation.

Conclusion

A numeric model simulating immediate and post-two-year effects of AVBGM enabled to assess different implant configurations to support surgical planning.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Mechanical Engineering, NSERC/Medtronic Industrial Research Chair in Spine Biomechanics, Polytechnique Montréal, P.O. Box 6079, Downtown Station, H3C 3A7, Montreal, Quebec, Canada

    Nikita Cobetto PhD & Carl-Eric Aubin PhD, PEng

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

    Nikita Cobetto PhD, Carl-Eric Aubin PhD, PEng & Stefan Parent MD, PhD

Authors
  1. Nikita Cobetto PhD
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  2. Carl-Eric Aubin PhD, PEng
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  3. Stefan Parent MD, PhD
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Corresponding author

Correspondence to Carl-Eric Aubin PhD, PEng.

Additional information

Author disclosures: NC (grants from Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; grants from Canadian Institutes of Health Research, outside the submitted work); CEA (grants from Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; other from Medtronic; grants from Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Canada Research Chair, Zimmer CAS, and Canada First Research Excellence Funds, outside the submitted work); SP (grants from Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; other from Scoliosis Research Society and Canadian Spine Society; personal fees from DePuy Synthes Spine, Medtronic, EOS-Imaging, and K2M; grants from DePuy Synthes Spine, Setting Scoliosis Straight Foundation, Medtronic, EOS-Imaging, Spinologics, Canadian Institutes of Health Research, Canadian Foundation for Innovation, and Natural Sciences and Engineering Council of Canada; personal fees from Fonds de Recherche Québec–Santé; grants from Orthopedic Research and Education Foundation and Rick Hansen Institutes; other from Academic Chair in Pediatric Spinal Deformities of CHU Ste-Justine, outside the submitted work; in addition, SP has a patent Spinologics licensed and stock/stock options with Spinologics).

The engineering analysis and simulation portion within this project were separately funded by the Natural Sciences and Engineering Research Council of Canada (Industrial Research Chair program with Medtronic of Canada) (grant number PCIPJ-346145).

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Cobetto, N., Aubin, CE. & Parent, S. Surgical Planning and Follow-up of Anterior Vertebral Body Growth Modulation in Pediatric Idiopathic Scoliosis Using a Patient-Specific Finite Element Model Integrating Growth Modulation. Spine Deform 6, 344–350 (2018). https://doi.org/10.1016/j.jspd.2017.11.006

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  • DOI: https://doi.org/10.1016/j.jspd.2017.11.006

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