Personalized 3D reconstruction of the rib cage for clinical assessment of trunk deformities

Scoliosis is a 3D deformity of the spine and rib cage. Extensive validation of 3D reconstruction methods of the spine from biplanar radiography has already been published. In this article, we propose a novel method to reconstruct the rib cage, using the same biplanar views as for the 3D reconstruction of the spine, to allow clinical assessment of whole trunk deformities. This technique uses a semi-automatic segmentation of the ribs in the postero-anterior X-ray view and an interactive segmentation of partial rib edges in the lateral view. The rib midlines are automatically extracted in 2D and reconstructed in 3D using the epipolar geometry. For the ribs not visible in the lateral view, the method predicts their 3D shape. The accuracy of the proposed method has been assessed using data obtained from a synthetic bone model as a gold standard and has also been evaluated using data of real patients with scoliotic deformities. Results show that the reconstructed ribs enable a reliable evaluation of the rib axial rotation, which will allow a 3D clinical assessment of the spine and rib cage deformities.CIHR / IRS

Non-invasive quantitative assessment of scoliosis spinal surgery outcome

Improving the appearance of the trunk is an important goal of scoliosis surgical treatment, mainly in patients' eyes. Unfortunately, existing methods for assessing postoperative trunk appearance are rather subjective as they rely on a qualitative evaluation of the trunk shape. In this paper, an objective method is proposed to quantify the changes in trunk shape after surgery. Using a non-invasive optical system, the whole trunk surface is acquired and reconstructed in 3D. Trunk shape is described by two functional measurements spanning the trunk length: the lateral deviation and the axial rotation. To measure the pre and postoperative differences, a correction rate is computed for both measurements. On a cohort of 36 scoliosis patients with the same spinal curve type who underwent the same surgical approach, surgery achieved a very good correction of the lateral trunk deviation (median correction of 76%) and a poor to moderate correction of the back axial rotation (median correction of 19%). These results demonstrate that after surgery, patients are still confronted with residual trunk deformity, mainly a persisting hump on the back. That can be explained by the fact that current scoliosis assessment and treatment planning are based solely on radiographic measures of the spinal deformity and do not take trunk deformity into consideration. It is believed that with our novel quantitative trunk shape descriptor, clinicians and surgeons can now objectively assess trunk deformity and postoperative shape and propose new treatment strategies that could better address patients' concern about their appearance. © (2013) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.CIHR / IRS

Changes in Trunk Appearance After Scoliosis Spinal Surgery and Their Relation to Changes in Spinal Measurements

Study Design Retrospective study of surgical outcome. Objectives To evaluate quantitatively the changes in trunk surface deformities after scoliosis spinal surgery in Lenke 1A adolescent idiopathic scoliosis (AIS) patients and to compare it with changes in spinal measurements. Summary of Background Data Most studies documenting scoliosis surgical outcome used either radiographs to evaluate changes in the spinal curve or questionnaires to assess patients health-related quality of life. Because improving trunk appearance is a major reason for patients and their parents to seek treatment, this study focuses on postoperative changes in trunk surface deformities. Recently, a novel approach to quantify trunk deformities in a reliable, automatic, and noninvasive way has been proposed. Methods Forty-nine adolescents with Lenke 1A idiopathic scoliosis treated surgically were included. The back surface rotation and trunk lateral shift were computed on trunk surface acquisitions before and at least 6 months after surgery. We analyzed the effect of age, height, weight, curve severity, and flexibility before surgery, length of follow-up, and the surgical technique. For 25 patients with available three-dimensional (3D) spinal reconstructions, we compared changes in trunk deformities with changes in two-dimensional (2D) and 3D spinal measurements. Results The mean correction rates for the back surface rotation and the trunk lateral shift are 18% and 50%, respectively. Only the surgical technique had a significant effect on the correction rate of the back surface rotation. Direct vertebral derotation and reduction by spine translation provide a better correction of the rib hump (22% and 31% respectively) than the classic rod rotation technique (8%). The reductions of the lumbar Cobb angle and the apical vertebrae transverse rotation explain, respectively, up to 17% and 16% the reduction of the back surface rotation. Conclusions Current surgical techniques perform well in realigning the trunk; however, the correction of the deformity in the transverse plane proves to be more challenging. More analysis on the positive effect of vertebral derotation on the rib hump correction is needed. Level of evidence III.Natural Sciences and Engineering Research Council of Canada (Grant # 222860-2012RGPIN) and MENTOR, a strategic training program of the Canadian Institutes of Health Research

Braitenberg Vehicles as Developmental Neurosimulation

The connection between brain and behavior is a longstanding issue in the areas of behavioral science, artificial intelligence, and neurobiology. Particularly in artificial intelligence research, behavior is generated by a black box approximating the brain. As is standard among models of artificial and biological neural networks, an analogue of the fully mature brain is presented as a blank slate. This model generates outputs and behaviors from a priori associations, yet this does not consider the realities of biological development and developmental learning. Our purpose is to model the development of an artificial organism that exhibits complex behaviors. We will introduce our approach, which is to use Braitenberg Vehicles (BVs) to model the development of an artificial nervous system. The resulting developmental BVs will generate behaviors that range from stimulus responses to group behavior that resembles collective motion. Next, we will situate this work in the domain of artificial brain networks. Then we will focus on broader themes such as embodied cognition, feedback, and emergence. Our perspective will then be exemplified by three software instantiations that demonstrate how a BV-genetic algorithm hybrid model, multisensory Hebbian learning model, and multi-agent approaches can be used to approach BV development. We introduce use cases such as optimized spatial cognition (vehicle-genetic algorithm hybrid model), hinges connecting behavioral and neural models (multisensory Hebbian learning model), and cumulative classification (multi-agent approaches). In conclusion, we will revisit concepts related to our approach and how they might guide future development.Comment: 32 pages, 8 figures, 2 table

A physically based trunk soft tissue modeling for scoliosis surgery planning systems

One of the major concerns of scoliotic patients undergoing spinal correction surgery is the trunk's external appearance after the surgery. This paper presents a novel incremental approach for simulating postoperative trunk shape in scoliosis surgery. Preoperative and postoperative trunk shapes data were obtained using three-dimensional medical imaging techniques for seven patients with adolescent idiopathic scoliosis. Results of qualitative and quantitative evaluations, based on the comparison of the simulated and actual postoperative trunk surfaces, showed an adequate accuracy of the method. Our approach provides a candidate simulation tool to be used in a clinical environment for the surgery planning process.IRSC / CIH

Scoliosis curve type classification from 3D trunk image

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine manifested by asymmetry and deformities of the external surface of the trunk. Classification of scoliosis deformities according to curve type is used to plan management of scoliosis patients. Currently, scoliosis curve type is determined based on X-ray exam. However, cumulative exposure to X-rays radiation significantly increases the risk for certain cancer. In this paper, we propose a robust system that can classify the scoliosis curve type from non invasive acquisition of 3D trunk surface of the patients. The 3D image of the trunk is divided into patches and local geometric descriptors characterizing the surface of the back are computed from each patch and forming the features. We perform the reduction of the dimensionality by using Principal Component Analysis and 53 components were retained. In this work a multi-class classifier is built with Least-squares support vector machine (LS-SVM) which is a kernel classifier. For this study, a new kernel was designed in order to achieve a robust classifier in comparison with polynomial and Gaussian kernel. The proposed system was validated using data of 103 patients with different scoliosis curve types diagnosed and classified by an orthopedic surgeon from the X-ray images. The average rate of successful classification was 93.3% with a better rate of prediction for the major thoracic and lumbar/thoracolumbar types.IRSC / CIH

Biomechanical effect of pedicle screw distribution in AIS instrumentation using a segmental translation technique: computer modeling and simulation

BACKGROUND: Efforts to select the appropriate number of implants in adolescent idiopathic scoliosis (AIS) instrumentation are hampered by a lack of biomechanical studies. The objective was to biomechanically evaluate screw density at different regions in the curve for AIS correction to test the hypothesis that alternative screw patterns do not compromise anticipated correction in AIS when using a segmental translation technique. METHODS: Instrumentation simulations were computationally performed for 10 AIS cases. We simulated simultaneous concave and convex segmental translation for a reference screw pattern (bilateral polyaxial pedicle screws with dorsal height adjustability at every level fused) and four alternative patterns; screws were dropped respectively on convex or concave side at alternate levels or at the periapical levels (21 to 25% fewer screws). Predicted deformity correction and screw forces were compared. RESULTS: Final simulated Cobb angle differences with the alternative screw patterns varied between 1 degrees to 5 degrees (39 simulations) and 8 degrees (1 simulation) compared to the reference maximal density screw pattern. Thoracic kyphosis and apical vertebral rotation were within 2 degrees of the reference screw pattern. Screw forces were 76 +/- 43 N, 96 +/- 58 N, 90 +/- 54 N, 82 +/- 33 N, and 79 +/- 42 N, respectively, for the reference screw pattern and screw dropouts at convex alternate levels, concave alternate levels, convex periapical levels, and concave periapical levels. Bone-screw forces for the alternative patterns were higher than the reference pattern (p 0.28). Alternate dropout screw forces were higher than periapical dropouts (p < 0.05). CONCLUSIONS: Using a simultaneous segmental translation technique, deformity correction can be achieved with 23% fewer screws than maximal density screw pattern, but resulted in 25% higher bone-screw forces. Screw dropouts could be either on the convex side or on the concave side at alternate levels or at periapical levels. Periapical screw dropouts may more likely result in lower bone-screw force increase than alternate level screw dropouts