Abstract
BackgroundA large variability in adolescent idiopathic scoliosis (AIS) correction objectives and instrumentation strategies was documented. The hypothesis was that different correction objectives will lead to different instrumentation strategies. The objective of this study was to develop a numerical model to optimize the instrumentation configurations under given correction objectives.MethodsEleven surgeons from the Spinal Deformity Study Group independently provided their respective correction objectives for the same patient. For each surgeon, 702 surgical configurations were simulated to search for the most favourable one for his particular objectives. The influence of correction objectives on the resulting surgical strategies was then evaluated.ResultsFusion levels (mean 11.2, SD 2.1), rod shapes, and implant patterns were significantly influenced by correction objectives (p < 0.05). Different surgeon-specified correction objectives produced different instrumentation strategies for the same patient.ConclusionsInstrumentation configurations can be optimized with respect to a given set of correction objectives.
Highlights
A large variability in adolescent idiopathic scoliosis (AIS) correction objectives and instrumentation strategies was documented
The resulting instrumentation configurations obtained from the optimization procedure are summarized in
The upper instrumented level ranged from T2 to T5, while the lowest instrumented vertebra ranged from L1 to L4 (Table 2 and Figure 2)
Summary
A large variability in adolescent idiopathic scoliosis (AIS) correction objectives and instrumentation strategies was documented. The hypothesis was that different correction objectives will lead to different instrumentation strategies. The objective of this study was to develop a numerical model to optimize the instrumentation configurations under given correction objectives. Adolescent idiopathic scoliosis (AIS) is a threedimensional (3D) local and global deformation of the spine [1], which may require spinal instrumentation and fusion for severe cases [2]. The main objectives of the surgical procedure are to correct the deformity, to obtain a balanced posture and preserve spinal mobility [3]. The strategies to achieve these objectives are based on an accurate selection of fusion levels and an adequate application of corrective forces through spinal instrumentation [4,5]. With contemporary advanced instrumentation systems and techniques, surgeons have a wide range of choices to achieve the goals of surgery, such as various implant types, diverse rod materials, diameter and shape possibilities as well as many intraoperative reduction manoeuvres
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