title: How does implant distribution affect 3D correction and bone-screw forces in thoracic adolescent idiopathic scoliosis spinal instrumentation?
abstract: Optimal implant densities and configurations for thoracic spine instrumentation to treat adolescent idiopathic scoliosis remain unknown. The objective was to computationally assess the biomechanical effects of implant distribution on 3D curve correction and bone-implant forces.
  
  
  
  3D patient-specific biomechanical spine models based on a multibody dynamic approach were created for 9 Lenke 1 patients who underwent posterior instrumentation (main thoracic Cobb: 43°-70°). For each case, a factorial design of experiments was used to generate 128 virtual implant configurations representative of existing implant patterns used in clinical practice. All instances except implant configuration were the same for each surgical scenario simulation.
  
  
  
  Simulation of the 128 implant configurations scenarios (mean implant density=1.32, range: 0.73-2) revealed differences of 2° to 10° in Cobb angle correction, 2° to 7° in thoracic kyphosis and 2° to 7° in apical vertebral rotation. The use of more implants, at the concave side only, was associated with higher Cobb angle correction (r=-0.41 to -0.90). Increased implant density was associated with higher apical vertebral rotation correction for seven cases (r=-0.20 to -0.48). It was also associated with higher bone-screw forces (r=0.22 to 0.64), with an average difference between the least and most constrained instrumentation constructs of 107N per implant at the end of simulated instrumentation.
  
  
  
  Low-density constructs, with implants mainly placed on the concave side, resulted in similar simulated curve correction as the higher-density patterns. Increasing the number of implants allows for only limited improvement of 3D correction and overconstrains the instrumentation construct, resulting in increased forces on the implants.
authors.affiliation: Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montréal, Québec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine Road, Montréal, Québec H3T 1C5, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Le Navéaux
authors.affiliation: Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA.
authors.forename: A Noelle
authors.initials: AN
authors.lastname: Larson
authors.affiliation: Research Center, Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine Road, Montréal, Québec H3T 1C5, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Labelle
authors.affiliation: Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montréal, Québec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine Road, Montréal, Québec H3T 1C5, Canada.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montréal, Québec H3C 3A7, Canada; Research Center, Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine Road, Montréal, Québec H3T 1C5, Canada. Electronic address: carl-eric.aubin@polymtl.ca.
authors.forename: Carl-Éric
authors.initials: CÉ
authors.lastname: Aubin
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D001863:Bone Screws; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011859:Radiography; D012399:Rotation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Adolescent idiopathic scoliosis; Biomechanical modeling; Curve correction; Implant density; Implant distribution; Pedicle screw