Three-dimensional models of Lenke3 type adult idiopathic scoliosis simulating orthopedic surgeries

doi:10.3969/j.issn.2095-4344.1210

Abstract

Abstract:

BACKGROUND: Due to diversity and stiffness of adult idiopathic scoliosis, individualized patients need orthopedics and individualized design, which affect the surgical safety and prognosis. Making the surgical scheme should consider the factors affecting the orthopedics of thoracolumbar scoliosis.

OBJECTIVE: To stimulate different surgical methods on the corrected model of Lenke3 type adult idiopathic scoliosis, and to understand the stress of pedicle screw and orthopedic efficacy.

METHODS: In optimized finite element model of Lenke3 type adult idiopathic scoliosis, finite element operations were simulated separately, including simulating different combinations: Case1:posterior vertebral key pedicle screw and posterior capsular release surgery; Case2: posterior vertebral key pedicle screw and posterior capsular release surgery as well as anterior release for thoracic scoliosis; Case3: posterior vertebral key pedicle screw and posterior capsular release surgery and anterior release for lumbar scoliosis; Case4: posterior vertebral key pedicle screw and posterior capsular release surgery and anterior release for thoracolumbar side convex; Case5: posterior vertebral key pedicle screwing and posterior capsular release surgery and anterior thoracolumbar scoliosis release surgery. The effectiveness and the biomechanical characteristics of three-dimensional orthopedics of different surgical programs in patients with Lenke3 type adult idiopathic scoliosis.

RESULTS AND CONCLUSION: (1) Five surgical schemes were completed successfully on the optimized finite element model. (2) The maximum stress value in each pedicle screw was lower than the threshold of the screw itself, which concentrated on the L₄ down side. (3) The orthopedic rates of thoracic spine scoliosis in Case1-5 were 63.9%, 59.9%, 67.6%, 61.5%, 66.4%, respectively, and orthopedic rates of lumbar scoliosis were 39.1%, 32.2%, 36.8%, 42.9%, 49.3%, respectively. (4) The experimental results of thoracic release surgery in Case3 and 5 showed the effectiveness of its orthopedics have no significant increase, but the stress of their respective pedicle screw structure would be significantly reduced. The results of Case4 and 5 showed its stresses in the vertebral body derotation and lumbar/thoracic screws are much better than other groups. (5) These experimental results provide quantitative indicators for finite element biomechanical study on adult idiopathic scoliosis, and subsequently provide some theoretical support to predict therapeutic effect of orthopedic surgery and formulate clinical programs for patient with Lenke3 type of adult idiopathic scoliosis.

Key words: adult idiopathic scoliosis, spine, lumbar release, finite element analysis, key vertebrae, biomechanics, pedicle screw, surgical simulation

CLC Number:

R445

Xin Daqi, Yang Xuejun, Wang Guoqiang, Xiao Yulong, Hu Zhenming, Xing Wenhua, Zhao Yan, Fu Yu, Zhu Yong, Bai Xianming. Three-dimensional models of Lenke3 type adult idiopathic scoliosis simulating orthopedic surgeries [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2529-2537.

Figures/Tables 7

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