Biomechanical analysis of surgical scoliosis treatments

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Surgical treatment of adolescent idiopathic scoliosis (AIS) is very complex and modern instrumentation techniques offer multiple possibilities. There are numerous guidelines, which aid the surgeon in choosing the proper surgical approach. However, there still exists no clear consensus on the optimal strategy. So, the surgical approach depends particularly on the individual surgeon and the type of scoliosis. The goal of this study is to systematically document and biomechanically analyse the different surgical strategies for AIS-patients. The study is split up into three work-packages: WP-1: A survey will be conducted to document the discrepancies in the surgical strategies. Experienced scoliosis surgeons from Germany, Europe and all over the world will be asked to plan surgeries on patients with AIS. The surgical planning will be documented by a questionnaire. The suitability of the questionnaire was tested within a preliminary multi-centre-survey with 8 centres, which has also allowed us to sharpen the priorities of this project. WP-2: With in-vitro tests the biomechanical influence of the discrepancies of the surgical survey will be quantified, including the influence of different resection steps on the stiffness on the spine and their correction potential. Subsequently, selected short and multi-level anterior and posterior instrumentation techniques will be compared. The in-vitro tests will be performed with our spine-tester, which allows extensive biomechanical analyses of multi-level spines with the attached ribcage. WP-3: Numerical models of the individual patient cases from the survey will be generated to investigate the discrepancies in the manifold surgical treatments. The modelling will be calibrated using the in vitro data of the surgical approaches. To validate the simulation of the surgical treatments, the numerical results will be compared with post-operative images. By modelling the complete spine including the chest while considering a wide scope of data from surgeons, patients, and in-vitro experiments, we expect to gain a better understanding of the impact of empirical surgical approaches. The model will help make predictions of surgical outcomes and might improve the surgical treatment. An important long-term objective is the investigation of the degenerative scoliosis treatment. Compared to AIS, this scoliosis type includes degenerative processes and is, therefore, considered strongly multi-factorial. The results of our proposed study will provide fundamental knowledge for tackling also degenerative scoliosis in future investigations.