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Guy A, Coulombe M, Labelle H, Barchi S, Aubin CÉ. Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model. Sci Rep 2024; 14:3300. [PMID: 38332053 PMCID: PMC10853218 DOI: 10.1038/s41598-024-53586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis.
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Affiliation(s)
- Aymeric Guy
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Maxence Coulombe
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Soraya Barchi
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Carl-Éric Aubin
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
- Sainte-Justine University Hospital Center, Montreal, QC, Canada.
- Université de Montréal, Montreal, QC, Canada.
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Luo C, Wu H, Liu W, Wong M. A bibliometric review and visual analysis of orthotic treatment in adolescent idiopathic scoliosis from the Web of Science database and CiteSpace software. Medicine (Baltimore) 2024; 103:e36958. [PMID: 38215101 PMCID: PMC10783366 DOI: 10.1097/md.0000000000036958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
Orthotic treatment has been the primary nonoperative treatment for patients with adolescent idiopathic scoliosis (AIS), however, no bibliometric study has been conducted in this field to date. Therefore, this study aims to analyze potential trends and new advances in the field of orthotic treatment of AIS through a bibliometric analysis and visualization study. Relevant literature included in the Web of Science database from the start of the database to the 1st month of 2023 was retrieved and analyzed using CiteSpace software (version 6.1.R6). Data on the nations, institutions, authors, journals, keywords, and cited references were collected for each publication. A total of 1005 records were included. The most productive countries and institutions were the USA and Hong Kong Polytechnic University, respectively. Spine was the most influential journal, with the highest number of citations. Hubert Labelle had the most publications, whereas Weinstein was the most cited author. The efficacy of orthotic treatment has always been at the frontier of research. Notably, changes in the quality of life after orthotic treatment, success rate or curve progression, new classification systems, and exercises have been the focus of research in recent years. This study enriches the understanding of research landscapes and key contributors in orthotic treatment for AIS.
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Affiliation(s)
- Changliang Luo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Huidong Wu
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Wei Liu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Prosthetic and Orthotic Engineering, School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Mansang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Li K, Wu J, Yang D, Xu H, Wen W, Xu H, Ma G, Han Y. Optimization of in-brace corrective force in adolescents with Lenke type 5 curve using finite element model. J Orthop Surg Res 2023; 18:366. [PMID: 37198649 DOI: 10.1186/s13018-023-03857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Pelvic parameters have been taken into consideration for the evaluation of the outcomes of bracing in AIS. To discuss the stress required to correct the pelvic deformity related to Lenke5 adolescent idiopathic scoliosis (AIS) by finite element analysis, and provide a reference for the shaping of the pelvic region of the brace. METHODS An three-dimensional (3D) corrective force on the pelvic area was defined. Computed tomography images were used to reconstruct a 3D model of Lenke5 AIS. Computer-aided engineering software Abaqus was used to implement finite element analysis. By adjusting the magnitude and position of corrective forces, coronal pelvic coronal plane rotation (PCPR) and Cobb angle (CA) of lumbar curve in the coronal plane, horizontal pelvic axial plane rotation, and apical vertebra rotation (AVR) were minimized to achieve the best effect on the spine and pelvic deformity correction. The proposed corrective conditions were divided into three groups: (1) forces applied on X-axis; (2) forces applied both in the X- and Y-axis; and (3) forces applied along the X-, Y-, and Z-axis at the same time. RESULTS In three groups, CA correction reduced by 31.5%, 42.5%, and 59.8%, and the PCPR changed to 12°, 13°, and 1° from 6.5°, respectively. The best groups of correction forces should simultaneously locate on the sagittal, transverse, and coronal planes of the pelvis. CONCLUSIONS For Lenke5 AIS, 3D correction forces can sufficiently reduce scoliosis and pelvic asymmetrical state. Force applied along the Z-axis is vital to correct the pelvic coronal pelvic tilt associated with Lenke5 AIS.
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Affiliation(s)
- Kepeng Li
- Second Central Hospital of Baoding, Zhuozhou City, Hebei, China
| | - Jincheng Wu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Dongmei Yang
- Southern Medical University, Guangzhou City, Guangdong, China
| | - Hanpeng Xu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Wangqiang Wen
- The First Affiliated Hospital of Hainan Medical University, Haikou City, Hainan, China
| | - Haoxiang Xu
- The Second People's Hospital of Hefei, Anhui, China
| | - Guoju Ma
- Second Central Hospital of Baoding, Zhuozhou City, Hebei, China
| | - Ye Han
- Affiliated Hospital of Hebei University, No. 214, Yuhua Road, Baoding City, Hebei, China.
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Kardash K, Koutras C, Otaduy MA. Design of personalized scoliosis braces based on differentiable biomechanics—Synthetic study. Front Bioeng Biotechnol 2022; 10:1014365. [DOI: 10.3389/fbioe.2022.1014365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
This work describes a computational methodology for the design of braces for adolescent idiopathic scoliosis. The proposed methodology relies on a personalized simulation model of the patient’s trunk, and automatically searches for the brace geometry that optimizes the trade-off between clinical improvement and patient comfort. To do this, we introduce a formulation of differentiable biomechanics of the patient’s trunk, the brace, and their interaction. We design a simulation model that is differentiable with respect to both the deformation state and the brace design parameters, and we show how this differentiable model is used for the efficient update of brace design parameters within a numerical optimization algorithm. To evaluate the proposed methodology, we have obtained trunk models with personalized geometry for five patients of adolescent idiopathic scoliosis, and we have designed Boston-type braces. In a simulation setting, the designed braces improve clinical metrics by 45% on average, under acceptable comfort conditions. In the future, the methodology can be extended beyond synthetic validation, and tested with physical braces on the actual patients.
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Guy A, Coulombe M, Labelle H, Rigo M, Wong MS, Beygi BH, Wynne J, Hresko MT, Ebermeyer E, Vedreine P, Liu XC, Thometz JG, Bissonnette B, Sapaly C, Barchi S, Aubin CÉ. Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis: A Comprehensive Multicenter Study. Spine (Phila Pa 1976) 2022; 47:1103-1110. [PMID: 35275852 DOI: 10.1097/brs.0000000000004353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter numerical study. OBJECTIVE To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs. METHODS Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P ≤ 0.05). RESULTS Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =- 0.53, r = - 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower. CONCLUSIONS The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms' contribution to 3D correction.
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Affiliation(s)
- Aymeric Guy
- Polytechnique Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Maxence Coulombe
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Surgery Department, University of Montreal, Montreal, Quebec, Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
- Surgery Department, University of Montreal, Montreal, Quebec, Canada
| | - Manuel Rigo
- Institute Rigo Quera Salvá S.L.P. Scoliosis Rehabilitation Center, Barcelona, Spain
| | - Man-Sang Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Babak Hassan Beygi
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Michael Timothy Hresko
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
- Boston Children's Hospital, Boston, MA
| | - Eric Ebermeyer
- LBM/Georges Charpak Human Biomechanics Institute, Arts et Métiers ParisTech, Paris, France
- Spine Unit, Bellevue University Hospital Center, Saint-Étienne, France
| | | | - Xue-Cheng Liu
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee, WI
| | - John G Thometz
- Department of Orthopedic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee, WI
| | | | | | - Soraya Barchi
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
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Koutras C, Shayestehpour H, Pérez J, Wong C, Rasmussen J, Tournier M, Nesme M, Otaduy MA. Biomechanical Morphing for Personalized Fitting of Scoliotic Torso Skeleton Models. Front Bioeng Biotechnol 2022; 10:945461. [PMID: 35928945 PMCID: PMC9343806 DOI: 10.3389/fbioe.2022.945461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
The use of patient-specific biomechanical models offers many opportunities in the treatment of adolescent idiopathic scoliosis, such as the design of personalized braces. The first step in the development of these patient-specific models is to fit the geometry of the torso skeleton to the patient’s anatomy. However, existing methods rely on high-quality imaging data. The exposure to radiation of these methods limits their applicability for regular monitoring of patients. We present a method to fit personalized models of the torso skeleton that takes as input biplanar low-dose radiographs. The method morphs a template to fit annotated points on visible portions of the spine, and it relies on a default biomechanical model of the torso for regularization and robust fitting of hardly visible parts of the torso skeleton, such as the rib cage. The proposed method provides an accurate and robust solution to obtain personalized models of the torso skeleton, which can be adopted as part of regular management of scoliosis patients. We have evaluated the method on ten young patients who participated in our study. We have analyzed and compared clinical metrics on the spine and the full torso skeleton, and we have found that the accuracy of the method is at least comparable to other methods that require more demanding imaging methods, while it offers superior robustness to artifacts such as interpenetration of ribs. Normal-dose X-rays were available for one of the patients, and for the other nine we acquired low-dose X-rays, allowing us to validate that the accuracy of the method persisted under less invasive imaging modalities.
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Affiliation(s)
- Christos Koutras
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
- *Correspondence: Christos Koutras,
| | - Hamed Shayestehpour
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Jesús Pérez
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Christian Wong
- Orthopedics Department, University Hospital of Hvidovre, Hvidovre, Denmark
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | | | | | - Miguel A. Otaduy
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
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Wei W, Zhang T, Huang Z, Yang J. Finite element analysis in brace treatment on adolescent idiopathic scoliosis. Med Biol Eng Comput 2022; 60:907-920. [DOI: 10.1007/s11517-022-02524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
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Al-Baghdadi M, Jweeg MJ, Al-Waily M. Analytical and Numerical Investigations of Mechanical Vibration in the Vertical Direction of a Human Body in a Driving Vehicle using Biomechanical Vibration Model. PERTANIKA JOURNAL OF SCIENCE AND TECHNOLOGY 2021. [DOI: 10.47836/pjst.29.4.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The main reason that affects the discomfort in a driving vehicle is the vibration response. The human body vibration leads to many malfunctions in both comfort and performance in human health. As a result, the human body’s simulation in sitting posture in the driving vehicle has a strategic relationship for all Tires and vehicles manufacturers. The digital process simulation of the human body seat vehicle vibration shows two significant advantages. The first advantage is the prevention of the high-cost modifications in the construction stage of the vehicle, while the second one describes the stability test during the undesirable vibrations. This study modelled the human body’s dynamic characterisations, natural frequency, and mechanical response when seated in the driving vehicle with vibration transmissibility in the vertical direction have been using the biomechanical vibration model. The vertical vibrations and the transmissibility of the human body dynamic response are presented in detail. Exciting results have been obtained, and they are significant for human health, which relates to sitting posture in the driving vehicle. It can assist in understanding the influences of low-frequency vibration on human health, comfort, and performance, and therefore it could be applied for ride comfort evaluation. An analytical solution to derive the general equations of motion for the human system was developed. Then, using the vibration analysis technique and the corresponding equations, the accurate dynamic response of the selected mode is identified. Furthermore, the mathematical modelling for free vibration using the finite element analysis has been performed to determine the appropriate values and set its description. Then, the comparison results of the two techniques have been carried out.
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