title: Biomechanical simulation and analysis of scoliosis correction using a fusionless intravertebral epiphyseal device.
abstract: METHODS
  Computer simulations to analyze the biomechanics of a novel compression-based fusionless device (hemistaple) that does not cross the disc for the treatment of adolescent idiopathic scoliosis.
  
  
  OBJECTIVE
  To biomechanically model, simulate, and analyze the hemistaple action using a human finite element model (FEM).
  
  
  BACKGROUND
  A new fusionless growth sparing instrumentation device (hemistaple), which locally compresses the growth plate without spanning the disc, was previously developed and successively tested on different animal models.
  
  
  METHODS
  Patient-specific FEMs of the spine, rib cage, and pelvis were built using radiographs of 10 scoliotic adolescents (11.7 ± 0.9 yr; Cobb thoracic: 35° ± 7°, lumbar: 24° ± 6°). A validated algorithm allowed simulating the growth (0.8-1.1 mm/yr/vertebra) and growth modulation process (Hueter-Volkmann principle) during a period of 2 years. Four instrumentation configurations on the convex curves were individually simulated (Config 1: 5 thoracic vertebrae with hemistaples on superior endplates; Config 2: same as Config 1 with hemistaples on both endplates; Config 3: same as Config 1 + 4 lumbar vertebrae; Config 4: same as Config 2 + 4 lumbar vertebrae).
  
  
  RESULTS
  Without hemistaples, on average the thoracic and lumbar Cobb angles, respectively, progressed from 35° to 56° and 24° to 30°, whereas the vertebral wedging at curve apices progressed from 5° to 12°. With the hemistaple Config 1, the Cobb angles progressed but were limited to 42° and 26°, whereas the wedging ended at 8°. With Config 3, Cobb and wedging were kept nearly constant (38°, 21°, 7°). With hemistaples on both endplates (Config 2, Config 4), the Cobb and wedging were all reduced (thoracic Cobb for Config 2 and 4: 24° and 15°; lumbar Cobb: 21° and 11°; wedging: 2° and 1°).
  
  
  CONCLUSIONS
  This study suggests that the hemistaple has the biomechanical potential to control the scoliosis progression and highlights the importance of the instrumentation configuration to correct the spinal deformities. It biomechanically supports the new fusionless device concept as an alternative for the early treatment of idiopathic scoliosis.
  
  
  METHODS
  5.
authors.affiliation: *Department of Mechanical Engineering, Polytechnique Montréal, Montréal, Québec, Canada; and †Sainte-Justine University Hospital Center, Montréal, Québec, Canada.
authors.forename: Julien
authors.initials: J
authors.lastname: Clin
authors.forename: Carl-Éric
authors.initials: CÉ
authors.lastname: Aubin
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D015331:Cohort Studies; D003198:Computer Simulation; D020342:Finite Element Analysis; D006801:Humans; D008953:Models, Anatomic; D008954:Models, Biological; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D010388:Pelvis / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012272:Ribs / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D013131:Spine / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*