Towards a predictive simulation of brace action in adolescent idiopathic scoliosis.

Bracing is the most common treatment to stop the progression of adolescent idiopathic scoliosis. Finite element modeling could help improve brace design, but model validation is still a challenge. In this work, the clinical relevance of a predictive and subject-specific model for bracing was evaluated in forty-six AIS patients. The model reproduces brace action and the patient's spinopelvic adjustments to keep balance. The model simulated 70% or more patients with geometrical parameters within a preselected tolerance level. Although the model simulation of the sagittal plane could be improved, the approach is promising for a realistic and predictive simulation of brace action.

Coronal trunk imbalance in idiopathic scoliosis: Does gravity line localisation confirm the physical findings?

BACKGROUND: Adolescent idiopathic scoliosis (AIS) can require surgical procedures that have major consequences. Coronal imbalance as assessed clinically using a plumb line is a key criterion for selecting patients to surgery. Nevertheless, the reference standard for assessing postural balance of the trunk is gravity line localisation within a validated frame of reference. Recent studies have established that the gravity line can be localised after body contour reconstruction from biplanar radiographs. The objective of this study was to validate a gravity line localisation method based on biplanar radiographs in a population with AIS then to validate gravity line position versus plumb line position. HYPOTHESIS: Plumb line and gravity line assessments of coronal balance correlate with each other. MATERIAL AND METHODS: A gravity line localisation method based on biplanar radiography was validated in 14 patients with AIS versus force platform as the method of reference. Normal plumb line and gravity line positions were determined in 27 asymptomatic adolescents using biplanar radiography. The results of the two methods were then compared in 53 patients with AIS. RESULTS: The reliability of gravity line localisation in the coronal plane based on biplanar radiography was 2.4mm (95% confidence interval). The distance between the gravity line and the middle of the line connecting the centres of the two femoral heads (HA) showed a strongly significant association with plumb line position computed as the distance from the vertical line through the middle of T1 and the centre of the S1 endplate (T1V/S): r=0.71, p<0.0001. Of the 20 patients with plumb line results indicating coronal imbalance, 11 (55%) had a normal gravity line-to-HA distance. Of the 33 patients with normal plumb line results, 7 (21%) had an abnormal gravity line-to-HA distance. CONCLUSION: The results of this study validate gravity line determination from biplanar radiographs in a population with AIS. Plumb line position correlated significantly with gravity line position but was less accurate for guiding surgical decisions. LEVEL OF EVIDENCE: IV, retrospective study.