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Finite element simulation of various strategies for scoliosis surgical correction

Yoann Lafon-Jalby 
Abstract : The numerical simulation for the scoliosis surgical correction could be helpful in establishing the best surgical planning for a given patient. Previous research at the Laboratoire de Biomécanique yielded a preliminary finite-element model, and demonstrated the feasibility of a patient-specific simulation. However its extreme tediousness and its lack of self-reliance made it difficult to be used in a clinical environment. The objective of our work is to take over this finite-element model, in order: first, to improve two key-parameters, i.e. automation for the assessment of patient-specific mechanical properties, and robustness (numerical stability and self-reliance) for the simulation of surgery. Second, to model various clinical cases in order to evaluate the clinical relevance of the model and to better understand mechanisms of correction. The mechanical properties identification of the spine, from in vivo data (clinical lateral bending test), was automated thanks to an optimization method driven by a priori knowledge. The precision of this tool has been estimated according to in vivo data from the clinical records of thirty scoliotic patients. A stable and user-free simulation was built for the scoliosis surgical correction for two different techniques: by the rod rotation - Cotrel-Dubousset (CD) instrumentation - and by in situ bending (CIS). In particular, a specific algorithm defines and simulates the sequences of in situ bendings in agreement with the clinical expertise. The biomechanical coherence of the surgery simulation was estimated, according to the post-operative in vivo data (from the clinical records of twenty and ten scoliotic patients operated respectively by the CD and CIS surgeries), and to the clinical literature for the per-operative surgical steps. Finally, several surgical alternatives were evaluated, and various concepts of correction were analyzed from a biomechanical point of view. Our work on the personalized surgery simulation provides promising prospects for the future: such a clinical tool could help surgeon in understanding the mechanisms of correction, and in performing his pre-operative surgical planning.
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Submitted on : Monday, February 19, 2007 - 8:00:00 AM
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  • HAL Id : pastel-00002151, version 1



Yoann Lafon-Jalby. Finite element simulation of various strategies for scoliosis surgical correction. Engineering Sciences [physics]. Arts et Métiers ParisTech, 2006. English. ⟨NNT : 2006ENAM0061⟩. ⟨pastel-00002151⟩



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