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Background. As opposed to thoracoplasty (a cosmetic surgical intervention used to reduce the rib hump associated with scoliosis), experimental scoliosis has been produced or reversed on animals by rib shortening or lengthening. In a prior work (J. Orthop. Res., 20, pp. 1121-1128), a finite element modeling (FEM) of rib surgeries was developed to study the biomechanics of their correction mechanisms. Our aims in the present study were to investigate the influence of the rib surgery parameters and to identify optimal configurations. Hence, a specific objective of this study was to develop a method to find surgical parameters maximizing the correction by addressing the issue of high computational cost associated with FEM. Method of Approach. Different configurations of rib shortening or lengthening were simulated using a FEM of the complete torso adapted to the geometry of six patients. Each configuration was assessed using objective functions that represent different correction objectives. Their value was evaluated using the rib surgery simulation for sample locations in the design space specified by an experimental design. Dual kriging (interpolation technique) was used to fit the data from the computer experiment. The resulting approximation model was used to locate parameters minimizing the objective function. Results. The overall coverage of the design space and the use of an approximation model ensured that the optimization algorithm had not found a local minimum but a global optimal correction. The interventions generally produced slight immediate modifications with final geometry presenting between 95-120% of the initial deformation in about 50% of the tested cases. But in optimal cases, important loads (500-2000 N mm) were generated on vertebral endplates in the apical region, which could potentially produce the long-term correction of vertebral wedging by modulating growth. Optimal parameters varied among patients and for different correction objectives. Conclusions. Approximation models make it possible to study and find optimal rib surgery parameters while reducing computational cost. [DOI: 10.1115/1.1933879]

This paper presents an in vivo validation of a method for the three-dimensional (3-D) high-resolution modeling of the human spine, rib cage, and pelvis for the study of spinal deformities. The method uses an adaptation of a standard close-range photogrammetry method called direct linear transformation to reconstruct the 3-D coordinates of anatomical landmarks from three radiographic images of the subject's trunk. It then deforms in 3-D 1-mm-resolution anatomical primitives (reference bones) obtained by serial computed tomography-scan reconstruction of a dry specimen. The free-form deformation is calculated using dual kriging equations. In vivo validation of this method on 40 scoliotic vertebrae gives an overall accuracy of 3.3 [+ or -] 3.8 mm, making it an adequate tool for clinical studies and mechanical analysis purposes. Index Terms--Accuracy, biomedical imaging, geometrical kriging, precision, reconstruction, spine, three-dimensional (3-D), vertebrae, X-ray.

While the etiology and pathogenesis of adolescent idiopathic scoliosis are still not well understood, it is generally recognized that it progresses within a biomechanical process involving asymmetrical loading of the spine and vertebral growth modulation. This study intends to develop a finite element model incorporating vertebral growth and growth modulation in order to represent the progression of scoliotic deformities. The biomechanical model was based on experimental and clinical observations, and was formulated with variables integrating a biomechanical stimulus of growth modulation along directions perpendicular (x) and parallel (y, z) to the growth plates, a sensitivity factor [beta] to that stimulus and time. It was integrated into a finite element model of the thoracic and lumbar spine, which was personalized to the geometry of a female subject without spinal deformity. An imbalance of 2 mm in the right direction at the 8th thoracic vertebra was imposed and two simulations were performed: one with only growth modulation perpendicular to growth plates (Sim1), and the other one with additional components in the transverse plane (Sim2). Semi-quantitative characterization of the scoliotic deformities at each growth cycle was made using regional scoliotic descriptors (thoracic Cobb angle and kyphosis) and local scoliotic descriptors (wedging angle and axial rotation of the thoracic apical vertebra). In all simulations, spinal profiles corresponded to clinically observable configurations. The Cobb angle increased nonlinearly from 0.3[degrees] to 34[degrees] (Sim1) and 20[degrees] (Sim2) from the first to last growth cycle, adequately reproducing the amplifying thoracic scoliotic curve. The sagittal thoracic profile (kyphosis) remained quite constant. Similarly to clinical and experimental observations, vertebral wedging angle of the thoracic apex progressed from 2.6[degrees] to 10.7[degrees] (Sim1) and 7.8[degrees] (Sim2) with curve progression. Concomitantly, vertebral rotation of the thoracic apex increased of 10[degrees] (Sim1) and 6[degrees] (Sim2) clockwise, adequately reproducing the evolution of axial rotation reported in several studies. Similar trends but of lesser magnitude (Sim2) suggests that growth modulation parallel to growth plates tend to counteract the growth modulation effects in longitudinal direction. Overall, the developed model adequately represents the self-sustaining progression of vertebral and spinal scoliotic deformities. This study demonstrates the feasibility of the modeling approach, and compared to other biomechanical studies of scoliosis it achieves a more complete representation of the scoliotic spine. [DOI: 10.1115/1.1516198] Keywords: Idiopathic Scoliosis, Biomechanical Modeling, Growth Modulation, Spine, Vertebra

The main objective of this study was to develop a 3-D X-ray reconstruction system of the spine and rib cage for an accurate 3-D clinical assessment of spinal deformities. The system currently used at Sainte-Justine Hospital in Montreal is based on an implicit calibration technique based on a direct linear transform (DLT), using a sufficiently large rigid object incorporated in the positioning apparatus to locate any anatomical structure to be reconstructed within its bounds. During the time lapse between the two successive X-ray acquisitions required for the 3-D reconstruction, involuntary patient motion introduce errors due to the incorrect epipolar geometry inferred from the stationary object. An approach using a new calibration jacket and explicit calibration algorithm is proposed in this paper. This approach yields accurate results and compensates for involuntary motion occurring between X-ray exposures. Index Terms--Explicit calibration, nonlinear optimization, spinal deformities, X-ray images, 3-D reconstruction.