The potential of proximal junctional kyphosis prevention using a novel tether pedicle screw construct: an in silico study comparing the influence of standard and dynamic techniques on adjacent-level range of motion and load pattern

OBJECTIVE

A tether pedicle screw (TPS) enables individual stepless pretensioning and is placed at one or two levels above the upper instrumented vertebra (UIV+1 and UIV+2, respectively). This study aimed to evaluate a novel customized TPS for the prevention of proximal junctional kyphosis (PJK) and to investigate the potential to generate a smoother force transition from cranial to long fusion during trunk flexion, instead of an abrupt change at the UIV, following adult spinal deformity surgery.

METHODS

A finite element model was designed based on an adult patient with spinal deformity instrumented from T10 to S1. Five different sagittal balance types and implant configurations were tested. The proximal range of motion (ROM) and intervertebral stress were examined, with a special focus on their respective discontinuities.

RESULTS

Tension shielding at UIV/UIV+1 by the TPS was consistent irrespective of sagittal profiles. The use of TPSs at UIV+1 and UIV+2 increased the efficacy in reducing spinal ROM discontinuity at UIV/UIV+1, as compared with the use of TPSs at UIV+1 only. Through the use of two pairs of TPSs cranial to the UIV, the optimal tension configuration could be defined to avoid a reduction effect at UIV+1. Neither the addition of transition rods to the TPSs nor the use of transition rods in combination with standard pedicle screws improved the junctional mechanics when compared with TPSs at UIV+1/UIV+2.

CONCLUSIONS

A smoother motion discontinuity at the UIV can be achieved via implementation of a TPS strategy. This new technology shows favorable in silico mechanics for reducing the risk of PJK.

Real-time biomechanics using the finite element method and machine learning: Review and perspective

PURPOSE

The finite element method (FEM) is the preferred method to simulate phenomena in anatomical structures. However, purely FEM-based mechanical simulations require considerable time, limiting their use in clinical applications that require real-time responses, such as haptics simulators. Machine learning (ML) approaches have been proposed to help with the reduction of the required time. The present paper reviews cases where ML could help to generate faster simulations, without considerably affecting the performance results.

METHODS

This review details the ML approaches used, considering the anatomical structures involved, the data collection strategies, the selected ML algorithms, with corresponding features, the metrics used for validation, and the resulting time gains.

RESULTS

A total of 41 references were found. ML algorithms are mainly trained with FEM-based simulations in 32 publications. The preferred ML approach is neural networks, including deep learning in 35 publications. Tissue deformation is simulated in 18 applications, but other features are also considered. The average distance error and mean squared error are the most frequently used performance metrics, in 14 and 17 publications, respectively. The time gains were considerable, going from hours or minutes for purely FEM-based simulations to milliseconds, when using ML.

CONCLUSIONS

ML algorithms can be used to accelerate FEM-based biomechanical simulations of anatomical structures, possibly reaching real-time responses. Fast and real-time simulations of anatomical structures, generated with ML algorithms, can help to reduce the time required by FEM-based simulations and accelerate their adoption in the clinical practice.

Mechanobiological analysis of porcine spines instrumented with intra-vertebral staples

OBJECTIVE

To characterize growth plate histology of porcine spines instrumented with a new intra-vertebral staple.

METHODS

Spinal segments (T7-T9) previously instrumented with an intra-vertebral staple (experimental group, n=7) or non-instrumented (control group, n=4) underwent average growth rate (AGR), and histomorphometric measurements: heights of proliferative (PZH) and hypertrophic (HZH) growth plate zones, hypertrophic cells height (CH), and the number of proliferative chondrocytes per column (CC). These measurements were done over three regions: (1) left side; (2) middle; (3) right side (instrumented side). The two groups were analyzed by comparing the difference between results for regions 1 and 3 (Dif-R1R3).

RESULTS

A significantly higher Dif-R1R3 was found for AGR and HZH for the experimental group as compared with controls. This Dif-R1R3 was also significantly higher for CC at T8 level, CH at T7 level and PZH at both levels. No significant changes for the Dif-R1R3 were observed in the adjacent vertebrae (T11-T12).

CONCLUSIONS

This study confirmed the local growth modulation capacity of the intra-vertebral staple, translated at the histomorphometric level by a significant reduction in all parameters, but not in all spinal levels. Further analyses are needed to confirm the regional effect, especially for the intervertebral disc and other connective tissues.