title: The effect of soft tissue properties on spinal flexibility in scoliosis: biomechanical simulation of fulcrum bending.
abstract: METHODS
  Biomechanical analysis of the scoliotic thoracolumbar spine and ribcage using a three-dimensional finite element model.
  
  
  OBJECTIVE
  To explore how the mechanical properties of spinal ligaments and intervertebral discs affect coronal curve flexibility in the fulcrum bending test.
  
  
  BACKGROUND
  Preoperative coronal curve flexibility assessment is of key importance in the surgical planning process for scoliosis correction. The fulcrum bending radiograph is one flexibility assessment technique which has been shown to be highly predictive of potential curve correction using posterior surgery; however, little is known about the extent to which soft tissue structures govern spinal flexibility.
  
  
  METHODS
  CT-derived spinal anatomy for a 14-year-old female adolescent idiopathic scoliosis patient was used to develop the three-dimensional finite element model. Physiologic loading conditions representing the gravitational body weight forces acting on the spine when the patient lies on their side over the fulcrum bolster were simulated. Initial mechanical properties for the spinal soft tissues were derived from existing literature. In 6 separate analyses, the disc collagen fiber and ligament stiffness values were reduced by 10%, 25%, and 40% respectively, and the effects of reduced tissue stiffness on fulcrum flexibility were assessed by comparison with the initial model. Finally, the effect of discectomy on fulcrum flexibility was simulated for thoracic levels T5-T12.
  
  
  RESULTS
  Reducing disc collagen fiber stiffness resulted in a greater change in segmental rotations in the fulcrum bending test than reducing ligament stiffness. However, reductions of up to 40% in disc collagen fiber stiffness and ligament stiffness produced no clinically measurable increase in fulcrum flexibility. By contrast, after removal of the discs, the simulated fulcrum flexibility increased by more than 80% compared with the initial case.
  
  
  CONCLUSIONS
  Homogeneous reduction in either the disc collagen fiber or ligament stiffness had minimal influence on scoliotic curve reducibility. However, discectomy simulation shows that the intervertebral discs are of critical importance in determining spinal flexibility.
authors.affiliation: Paediatric Spine Research Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. j2.little@qut.edu.au
authors.forename: J Paige
authors.initials: JP
authors.lastname: Little
authors.forename: Clayton J
authors.initials: CJ
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena / Q000502:physiology; D003094:Collagen / Q000502:physiology; D003198:Computer Simulation; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000502:physiology*; D008022:Ligaments / Q000033:anatomy & histology / Q000502:physiology*; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000502:physiology; D009068:Movement / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery; D013131:Spine / Q000033:anatomy & histology / Q000502:physiology*; D013314:Stress, Mechanical; D013718:Tensile Strength / Q000502:physiology; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing / Q000502:physiology
chemical_list: D003094:Collagen