Credibility assessment of patient-specific biomechanical models to investigate proximal junctional failure in clinical cases with adult spine deformity using ASME V&amp;V40 standard

Poncelas, Maeva Lopez; Barbera, Luigi La; Rawlinson, Jeremy; Crandall, Dennis G.; Cé, Aubin

doi:10.1080/10255842.2021.1968380

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…In addition, we cannot provide a quantitative justification regarding the prediction accuracy because no steps were used to ensure the credibility of our model in predicting the right values. Although computational models are increasingly used to support surgical planning, varying levels of model verification and validation limit the level of confidence in their predictive potential ( Poncelas et al, 2021 ). Recently, Poncelas et al performed a credibility assessment of their model to investigate proximal junctional failure in clinical cases with adult spine deformity using ASMEV&V40 standard ( Poncelas et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although computational models are increasingly used to support surgical planning, varying levels of model verification and validation limit the level of confidence in their predictive potential ( Poncelas et al, 2021 ). Recently, Poncelas et al performed a credibility assessment of their model to investigate proximal junctional failure in clinical cases with adult spine deformity using ASMEV&V40 standard ( Poncelas et al, 2021 ). We should also assess the credibility of our model for AIS surgery using the recommended strategies in the future.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcome Prediction Using a Four-Dimensional Planning Simulation System With Finite Element Analysis Incorporating Pre-bent Rods in Adolescent Idiopathic Scoliosis: Simulation for Spatiotemporal Anatomical Correction Technique

Tachi

Kato

Abe

et al. 2021

Front. Bioeng. Biotechnol.

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An optimal surgical strategy for adolescent idiopathic scoliosis (AIS) is to provide maximal deformity correction while preserving spinal mobile segments as much as possible and obtaining a balanced posture. From a spatiotemporal deformity correction standpoint, we recently showed that anatomical four-dimensional (4D) spinal correction could be accomplished by curving the rod. In the surgical procedure, two rods are bent identically to confirm spinal anatomical alignment without referring to the intraoperative alignment of the deformity. Therefore, anatomically designed rods have been developed as notch-free, pre-bent rods for easier anatomical reconstruction. In addition to providing the best spinal instrumentation configurations as pre-bent rods, prediction of surgical outcome along with its biomechanical impact can be obtained by simulation of the surgical procedures with computer modeling. However, an objective model that can simulate the surgical outcome in patients with AIS has not been completely elucidated. The present study aimed to compare simulated deformity corrections based on our newly developed spatiotemporal morphological 4D planning simulation system incorporating pre-bent rods and actual deformity corrections in patients with AIS. A consecutive series of 47 patients who underwent anatomical posterior correction for AIS curves were prospectively evaluated. After multilevel facetectomy, except for the lowest instrumented segment, 11 types of pre-bent rods were used. Patient demographic data, radiographic measurements, and sagittal rod angles were analyzed within 1 week of surgery. Our simulation system incorporating pre-bent rods showed a significant correlation with the actual postoperative spinal alignment. The present study demonstrated the feasibility of our simulation system and the ability to simulate the surgical procedure using the pre-bent rods. The simulation system can be used to minimize the differences between the optimal and possible outcomes related to the instrumentation levels and rod shapes. Preoperative assumption of rod shape and length can contribute to a reduction in operative time which decreases blood loss and risk of infection. The results of the finite element analysis in the simulation system measured for each individual patient would also provide a more realistic representation of the surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Outcome Prediction Using a Four-Dimensional Planning Simulation System With Finite Element Analysis Incorporating Pre-bent Rods in Adolescent Idiopathic Scoliosis: Simulation for Spatiotemporal Anatomical Correction Technique

Tachi

Kato

Abe

et al. 2021

Front. Bioeng. Biotechnol.

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“…A patient-specific multibody spinal model, previously developed and validated to study PJF pathomechanisms, was used for this study [11,12,14,15]. This model was based on the 3D geometry of the patients, built using vertebral and pelvic landmarks identified on preoperative lateral and coronal radiographs and 3D reconstruction techniques [16].…”

Section: Multibody Modeling and Simulationmentioning

confidence: 99%

“…Multiaxial pedicle screws (PS) were modeled as rigid bodies for the threaded shaft and screw head, connected by a revolute joint to represent the multiaxial motion. The PS shank was connected to the vertebral pedicle by a nonlinear spring representing the mechanical properties of its anchorage with the bone [15,20]. The initial shape of the rods was defined from the postoperative radiographs and a calibration algorithm was performed to find their initial unloaded shape, so that following the simulation of the correction of the instrumentation in the erect position, the elastically deformed rods corresponded to those in the reference postoperative radiographs [21].…”

Section: Multibody Modeling and Simulationmentioning

confidence: 99%

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Proximal junctional failure after surgical instrumentation in adult spinal deformity: biomechanical assessment of proximal instrumentation stiffness

et al. 2022

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Study design Assessment of different proximal instrumentation stiffness features to minimize the mechanical proximal junctional failure-related risks through computer-based biomechanical models. Objective To biomechanically assess variations of proximal instrumentation and loads acting on the spine and construct to minimize proximal junctional failure (PJF) risks. Summary of background dataThe use of less-stiff fixation such as hooks or tensioned bands, compared to pedicle screws, at the proximal instrumentation level are considered to allow for a gradual transition in stiffness with the adjacent levels, but the impact of such flexible fixation on the loads balance and complications such as PJF remain uncertain. Methods Six patients with adult spine deformity who underwent posterior spinal instrumentation were used to numerically model and simulate the surgical steps, erected posture, and flexion functional loading in patient-specific multibody analyses. Three types of upper-level fixation (pedicle screws (PS), supralaminar hooks (SH), and sublaminar bands (SB) with tensions of 50, 250, and 350 N) and rod stiffness (CoCr/6 mm, CoCr/5.5 mm, Ti/5.5 mm) were simulated. The loads acting on the spine and implants of the 90 simulated configurations were analyzed using Kruskal-Wallis statistical tests. Results Simulated high-tensioned bands decreased the sagittal moment at the adjacent level proximal to the instrumentation (1.3 Nm at 250 N; 2.5 Nm at 350 N) compared to screws alone (PS) (15.6 Nm). At one level above, the high-tensioned SB increased the sagittal moment (17.7 Nm-SB vs. 15.5 Nm-PS) and bending moment on the rods (5.4 Nm and 5.7 Nm vs. 0.6 Nm) (p < 0.05). SB with 50 N tension yielded smaller changes in load transition compared to higher tension, with moments of 8.1 Nm and 16.8 Nm one and two levels above the instrumentation. The sagittal moment at the upper implantvertebra connection decreased with the rod stiffness (1.0 Nm for CoCr/6 mm vs. 0.7 Nm for Ti/5.5 mm; p < 0.05). Conclusion Simulated sublaminar bands with lower tension produced smaller changes in the load transition across proximal junctional levels. Decreasing the rod stiffness further modified these changes, with a decrease in loads associated with bone failure, however, lower stiffness did increase the rod breakage risk. Level of evidence N/A.

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Developing and Validating a Model of Humeral Stem Primary Stability, Intended for In Silico Clinical Trials

Maquer,

Mueri,

Henderson

et al. 2024

Ann Biomed Eng

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Credibility assessment of patient-specific biomechanical models to investigate proximal junctional failure in clinical cases with adult spine deformity using ASME V&V40 standard

Cited by 7 publications

References 39 publications

Surgical Outcome Prediction Using a Four-Dimensional Planning Simulation System With Finite Element Analysis Incorporating Pre-bent Rods in Adolescent Idiopathic Scoliosis: Simulation for Spatiotemporal Anatomical Correction Technique

Surgical Outcome Prediction Using a Four-Dimensional Planning Simulation System With Finite Element Analysis Incorporating Pre-bent Rods in Adolescent Idiopathic Scoliosis: Simulation for Spatiotemporal Anatomical Correction Technique

Proximal junctional failure after surgical instrumentation in adult spinal deformity: biomechanical assessment of proximal instrumentation stiffness

Developing and Validating a Model of Humeral Stem Primary Stability, Intended for In Silico Clinical Trials

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