Scoliosis Correction Objectives in Adolescent Idiopathic Scoliosis

Majdouline, Younes; Cé, Aubin; Robitaille, Martin; Sarwark, John F.; Labelle, Hubert

doi:10.1097/bpo.0b013e31815588d8

Cited by 61 publications

(35 citation statements)

References 32 publications

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“…This variability may be attributed to the different surgeon surgical objectives [26], which in this method constitute the relative weightings assigned in the objective function. Different surgical objectives will influence the optimal strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Different surgical objectives will influence the optimal strategy. The next challenge is to investigate how variability in surgical objectives [26] will influence the optimal instrumentation strategy and global correction for the same patient [27].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, variability can be attributed to the experience, preferences of the surgeon, and the lack of standardized strategies of instrumentation and the objectives of surgical correction [26]. To study how the objectives of surgical correction can influence such variability, 25 experienced surgeons were asked to rank different scoliotic spine parameters [26]. The surgeons ranked sagittal and coronal balance as the most important factors while the ranking of the remaining parameters varied widely.…”

Section: Introductionmentioning

confidence: 99%

“…Decisions regarding the levels to instrument, the number of implants, and rods to be used and rod shape are mainly dependent on the surgeons' experience. Thus, variability can be attributed to the experience, preferences of the surgeon, and the lack of standardized strategies of instrumentation and the objectives of surgical correction [26]. To study how the objectives of surgical correction can influence such variability, 25 experienced surgeons were asked to rank different scoliotic spine parameters [26].…”

Section: Introductionmentioning

confidence: 99%

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Computer simulation for the optimization of instrumentation strategies in adolescent idiopathic scoliosis

Majdouline

Aubin

Sangole

2009

Med Biol Eng Comput

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Recent studies reveal a large variability of instrumentation strategies in adolescent idiopathic scoliosis (AIS). Determination of the optimal configuration remains controversial. This study aims to develop a method to define the optimal surgical instrumentation strategy using a computer model implemented in a spine surgery simulator (S3). A total of 702 different strategies were simulated on a scoliotic patient using S3. Each configuration was assessed using objective functions that represented different correction objectives. Twelve geometric parameters were used in the three anatomic planes and mobility, and their relative weights were defined by a spine surgeon according to his objectives for correction of scoliosis. Six instrumentation parameters were manipulated in a uniform experimental design framework. An interpolation technique was used to build an approximation model from the simulation results and to locate instrumentation parameters minimizing the objective function. Small or no differences in the correction between the simulated optimal strategy and the real postoperative results of the instrumented segments were observed in the three planes. But the same overall correction was obtained by using fewer implants (only screws) and less instrumented levels. This study demonstrates the potential and feasibility of using a spine surgery simulator to optimize the planning of surgical instrumentation in AIS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computer simulation for the optimization of instrumentation strategies in adolescent idiopathic scoliosis

Majdouline

Aubin

Sangole

2009

Med Biol Eng Comput

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“…Therefore, this additional control was not taken into account in this study. The discrepancies among clinical studies may also be attributed to the surgeon-specific objectives [23] and techniques [24,25]. With the recent advances in correction techniques, some surgeons prefer the additional control on the deformed spine, while others much less.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of alternative densities of pedicle screws for the treatment of adolescent idiopathic scoliosis

2011

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Purpose The objective of this computational study was to compare the biomechanical effects of different implant densities in terms of curve reduction and the force levels at the implant-vertebra interface and on the intervertebral elements. Methods Eight cases were randomly picked among patients who have undergone a posterior spinal instrumentation for adolescent idiopathic scoliosis (AIS). For each case, two computer simulations were performed, one with the actual surgery implant pattern and another with the same fusion levels but an alternative implant pattern proposed by an experienced surgeon. The two implant patterns for each case were respectively put into higher and lower implant density group. The spinal correction and the force levels at bone-implant interface and on the intervertebral elements were analyzed and compared between the two groups. Results There were on average 13% more pedicle screws and 30% more bilaterally placed pedicle screws in the higher versus lower density group. The difference in the density of screws (92% vs. 79%) did not lead to significant difference in terms of the resulting main thoracic (MT) Cobb angle, and the MT apical axial vertebral rotation. The average and maximum implant-vertebra force levels were about 50 and 65%, respectively higher in the higher versus lower density group, but without consistent distribution patterns. The average intervertebral forces did not significantly differ between the two groups. Conclusions With the same fusion levels, lower density screws allowed achieving similar deformity correction and it was more likely to have lower screw-vertebra loads.

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Effects of alternative instrumentation strategies in adolescent idiopathic scoliosis: A biomechanical analysis

Robitaille

Aubin

2008

Journal Orthopaedic Research

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The recent advent of modern instrumentation systems has improved the correction of scoliosis, but complicated the surgical decision-making process, especially with the introduction of diverse spinal fixation devices, new preoperative corrective maneuvers, and the reevaluation of many rules concerning the selection of fusion levels and other guidelines for surgical correction. Our objective was to assess the biomechanical effects of different instrumentation strategies for the same scoliotic cases. Several instrumentation strategies suggested by a group of 32 experienced senior surgeons for five cases were individually simulated using a validated computer model implemented in a spine surgery simulator. The resulting geometric indices varied among the five cases (e.g., range of main thoracic Cobb angles: 5-178, 16-298, 25-448, 15-348, 16-328; kyphosis: 22-338, 20-548, 33-558, 24-498, 29-468; and lordosis: 10-528, 24-388, 26-548, 8-288, 34-538). The average correction was better with pedicle screws (71%) than with hooks (51%) and hybrid constructs (67%). For the first time, to our knowledge, the effect of different instrumentation strategies was compared on the same patients, which is possible only with a surgery simulator. A large variability of instrumentation strategies existed among experienced surgeons and produced rather different results. This study questions the criteria for optimal configuration and standards to design the best surgical construct. ß

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Scoliosis Correction Objectives in Adolescent Idiopathic Scoliosis

Cited by 61 publications

References 32 publications

Computer simulation for the optimization of instrumentation strategies in adolescent idiopathic scoliosis

Computer simulation for the optimization of instrumentation strategies in adolescent idiopathic scoliosis

Biomechanical comparison of alternative densities of pedicle screws for the treatment of adolescent idiopathic scoliosis

Effects of alternative instrumentation strategies in adolescent idiopathic scoliosis: A biomechanical analysis

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