[Biomechanical modeling of instrumentation for the scoliotic spine using flexible elements: a feasibility study]

Surgical instrumentation of the scoliotic spine is a complex procedure with many parameters, such as the spinal segment to operate on, the number and position of the hooks and screws, etc. Biomechanical modeling is a tool which can be used to determine the influence of these parameters. However, technical difficulties due to the large stiffness range of involved components and the large deformations associated with surgical maneuvers are encountered when using the finite elements method. Thus, the objective of this study is to adapt a modeling approach using analysis of flexible mechanisms and evaluate its feasibility. The model combines rigid bodies for the vertebrae and flexible elements representing intervertebral structures. The mechanical properties were calculated from published data and the geometry was personalized with intraoperative measurements. Following the installation of the hooks and screws on the modeled spine, two steps were used to simulate the surgical maneuvers: 1) translation and attachment of the hooks/screws on the first rod; 2) rod rotation. The feasibility of this modeling approach was evaluated by simulating the surgical maneuvers on 2 cases: 1) a physical model; 2) a clinical case. The agreement between intraoperative measurements and simulation results (frontal curvatures are reproduced with over 80% accuracy) shows the feasibility of the modeling approach. This approach also reduces computational convergence problems because of its limited sensitivity to stiffness differences between elements, which demonstrates the advantage of flexible mechanism modeling relative to finite element modeling. Long term goals of subsequent refinements are the development of a tool for surgical correction predictions and for the design of more efficient instrumentation.