Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity

Overbergh, Thomas; Severijns, Pieter; Beaucage-Gauvreau, Erica; Jonkers, Ilse; Moke, Lieven; Scheys, Lennart

doi:10.1016/j.jbiomech.2020.109946

Cited by 14 publications

(38 citation statements)

References 51 publications

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“…Indeed, our study design did not allow investigating the effects of skin motion artifacts on marker-based spinal alignment measurement during motion. Future research assessing these artifacts during different positions (semi-static) ( Overbergh et al, 2020 ) or during a range of clinically relevant dynamic movements is required, to further increase confidence in marker-based spinal kinematic results during motion.…”

Section: Discussionmentioning

confidence: 99%

“…A trained physiotherapist (5 years of experience in motion analysis) equipped all subjects, through manual palpation with the subject standing upright, with six single retro-reflective markers placed on the spinous processes of C7, T5, T9, T12, L3 and on the sacrum (in the middle between left and right posterior superior iliac spine) as well as six clusters, each consisting of three markers, placed on the spinous processes of T1, T3, T7, T11, L2, L4 ( Overbergh et al, 2020 ; Severijns et al, 2020 ; Figure 1 ). All subjects underwent a full-spine biplanar radiographic examination (EOS imaging, Paris, France) in the finger-on-clavicle position.…”

Section: Methodsmentioning

confidence: 99%

“…3D positions of both markers and anatomical landmarks were extracted from biplanar radiographic images. One single person, trained in analyzing radiographic images, manually identified the following three points from the sagittal and coronal radiographic images for each selected vertebral level ( Overbergh et al, 2020 ; Figure 2 ):…”

Section: Methodsmentioning

confidence: 99%

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Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

Severijns

Overbergh

Schmid

et al. 2021

Front. Bioeng. Biotechnol.

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Spinal alignment measurement in spinal deformity research has recently shifted from using mainly two-dimensional static radiography toward skin marker-based motion capture approaches, allowing three-dimensional (3D) assessments during dynamic conditions. The validity and accuracy of such skin marker-based methods is highly depending on correct marker placement. In this study we quantified, for the first time, the 3D spinal palpation error in adult spinal deformity (ASD) and compared it to the error in healthy spines. Secondly, the impact of incorrect marker placement on the accuracy of marker-based spinal alignment measurement was investigated. 3D, mediolateral and inferosuperior palpation errors for thoracolumbar and lumbar vertebral levels were measured on biplanar images by extracting 3D positions of skin-mounted markers and their corresponding anatomical landmarks in 20 ASD and 10 healthy control subjects. Relationships were investigated between palpation error and radiographic spinal alignment (lordosis and scoliosis), as well as body morphology [BMI and soft tissue (ST) thickness]. Marker-based spinal alignment was measured using a previously validated method, in which a polynomial is fit through the marker positions of a motion trial and which allows for radiograph-based marker position correction. To assess the impact of palpation error on spinal alignment measurement, the agreement was investigated between lordosis and scoliosis measured by a polynomial fit through, respectively, (1) the uncorrected marker positions, (2) the palpation error-corrected (optimal) marker positions, and (3) the anatomically corrected marker positions (toward the vertebral body), and their radiographic equivalents expressed as Cobb angles (ground truth), using Spearman correlations and root mean square errors (RMSE). The results of this study showed that, although overall accuracy of spinal level identification was similar across groups, mediolateral palpation was less accurate in the ASD group (ASDmean: 6.8 mm; Controlmean: 2.5 mm; p = 0.002). Significant correlations with palpation error indicated that determining factors for marker misplacement were spinal malalignment, in particular scoliotic deformity (r = 0.77; p < 0.001), in the ASD group and body morphology [i.e., increased BMI (rs = 0.78; p = 0.008) and ST thickness (rs = 0.66; p = 0.038)] in healthy spines. Improved spinal alignment measurements after palpation error correction, shows the need for radiograph-based marker correction methods, and therefore, should be considered when interpreting spinal kinematics.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

Severijns

Overbergh

Schmid

et al. 2021

Front. Bioeng. Biotechnol.

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“…This study aimed at evaluating the kinematic variability associated with both intrinsic and extrinsic sources of error (Schwartz et al, 2004), of a subject-specific spino-pelvic modeling method previously developed to quantify intervertebral joint motion in ASD subjects (Overbergh et al, 2020). The test-retest reliability (intrinsic intra-subject and extrinsic intra-operator variability) of the kinematics within individual subjects was evaluated over a 2-week time interval.…”

Section: Discussionmentioning

confidence: 99%

“…However, to improve the rigor and objectivity of the results prior to clinical interpretation, it is imperative to verify the simulation results of modeling methods both in terms of accuracy and reliability (Schwartz et al, 2004;Hicks et al, 2015). The accuracy of the above-mentioned subject-specific biplanar radiograph-based modeling method, as well as its accuracy in estimating spine kinematics, was validated previously (Overbergh et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Subject-Specific Spino-Pelvic Models Reliably Measure Spinal Kinematics During Seated Forward Bending in Adult Spinal Deformity

Overbergh

Severijns

Beaucage-Gauvreau

et al. 2021

Front. Bioeng. Biotechnol.

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Image-based subject-specific models and simulations are recently being introduced to complement current state-of-the-art mostly static insights of the adult spinal deformity (ASD) pathology and improve the often poor surgical outcomes. Although the accuracy of a recently developed subject-specific modeling and simulation framework has already been quantified, its reliability to perform marker-driven kinematic analyses has not yet been investigated. The aim of this work was to evaluate the reliability of this subject-specific framework to measure spine kinematics in ASD patients, in terms of 1) the overall test-retest repeatability; 2) the inter-operator agreement of spine kinematic estimates; and, 3) the uncertainty of those spine kinematics to operator-dependent parameters of the framework. To evaluate the overall repeatability 1], four ASD subjects and one control subject participated in a test-retest study with a 2-week interval. At both time instances, subject-specific spino-pelvic models were created by one operator to simulate a recorded forward trunk flexion motion. Next, to evaluate inter-operator agreement 2], three trained operators each created a model for three ASD subjects to simulate the same forward trunk flexion motion. Intraclass correlation coefficients (ICC’s) of the range of motion (ROM) of conventional spino-pelvic parameters [lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT), T1-and T9-spino-pelvic inclination (T1/T9-SPI)] were used to evaluate kinematic reliability 1] and inter-operator agreement 2]. Lastly, a Monte-Carlo probabilistic simulation was used to evaluate the uncertainty of the intervertebral joint kinematics to operator variability in the framework, for three ASD subjects 3]. LL, SVA, and T1/T9-SPI had an excellent test-retest reliability for the ROM, while TK and PT did not. Inter-operator agreement was excellent, with ICC values higher than test-retest reliability. These results indicate that operator-induced uncertainty has a limited impact on kinematic simulations of spine flexion, while test-retest reliability has a much higher variability. The definition of the intervertebral joints in the framework was identified as the most sensitive operator-dependent parameter. Nevertheless, intervertebral joint estimations had small mean 90% confidence intervals (1.04°–1.75°). This work will contribute to understanding the limitations of kinematic simulations in ASD patients, thus leading to a better evaluation of future hypotheses.

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Effects of geometric individualisation of a human spine model on load sharing: neuro-musculoskeletal simulation reveals significant differences in ligament and muscle contribution

Meszaros-Beller

Hammer

Riede

et al. 2023

Biomech Model Mechanobiol

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In spine research, two possibilities to generate models exist: generic (population-based) models representing the average human and subject-specific representations of individuals. Despite the increasing interest in subject specificity, individualisation of spine models remains challenging. Neuro-musculoskeletal (NMS) models enable the analysis and prediction of dynamic motions by incorporating active muscles attaching to bones that are connected using articulating joints under the assumption of rigid body dynamics. In this study, we used forward-dynamic simulations to compare a generic NMS multibody model of the thoracolumbar spine including fully articulated vertebrae, detailed musculature, passive ligaments and linear intervertebral disc (IVD) models with an individualised model to assess the contribution of individual biological structures. Individualisation was achieved by integrating skeletal geometry from computed tomography and custom-selected muscle and ligament paths. Both models underwent a gravitational settling process and a forward flexion-to-extension movement. The model-specific load distribution in an equilibrated upright position and local stiffness in the L4/5 functional spinal unit (FSU) is compared. Load sharing between occurring internal forces generated by individual biological structures and their contribution to the FSU stiffness was computed. The main finding of our simulations is an apparent shift in load sharing with individualisation from an equally distributed element contribution of IVD, ligaments and muscles in the generic spine model to a predominant muscle contribution in the individualised model depending on the analysed spine level.

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Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity

Cited by 14 publications

References 51 publications

Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

Spinal Palpation Error and Its Impact on Skin Marker-Based Spinal Alignment Measurement in Adult Spinal Deformity

Subject-Specific Spino-Pelvic Models Reliably Measure Spinal Kinematics During Seated Forward Bending in Adult Spinal Deformity

Effects of geometric individualisation of a human spine model on load sharing: neuro-musculoskeletal simulation reveals significant differences in ligament and muscle contribution

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