Purpose The preoperative planning of adolescent idiopathic scoliosis (AIS) remains largely debated. We hypothesized that adopting a biomechanical energetic framework could provide valuable insights for exploring the impact of spinal arthrodesis. Using this approach, we conducted a comparative analysis to quantify discrepancies between in silico simulations derived from preoperative radiographs and the actual three-dimensional spinal alignment obtained from post-operative imaging. Methods Fifty-two consecutive patients with Lenke Type 1 AIS (mean age: 16 years; mean thoracic Cobb angle: 52°) who underwent posterior spinal fusion were included in the analysis. All patients had complete biplanar radiographs at three time points: preoperatively, post-operatively and at two-year follow-up. Discrepancies between in silico simulated surgery, calculated using preoperative radiographs and a biomechanical model, and actual clinical outcomes were quantified using two metrics: maximum coronal/sagittal deviations (MaxC/MaxS) from T1 to L5, and a comprehensive predictability factor (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">${\text{a}}_{\text{c}}$</EquationSource> <EquationSource Format="MATHML"><math> <msub> <mtext>a</mtext> <mtext>c</mtext> </msub> </math></EquationSource> </InlineEquation> and <InlineEquation ID="IEq2"> <EquationSource Format="TEX">${\text{a}}_{\text{s}}$</EquationSource> <EquationSource Format="MATHML"><math> <msub> <mtext>a</mtext> <mtext>s</mtext> </msub> </math></EquationSource> </InlineEquation>) measuring cumulative 3D position discrepancies across 17 vertebral levels, normalized by total spinal length. Results Mean MaxC was 4.7 mm (SD=4.9) and MaxS was 5.7 mm (SD=3.8). Mean values of <InlineEquation ID="IEq3"> <EquationSource Format="TEX">${\mathbf{a}}_{\text{c}}$</EquationSource> <EquationSource Format="MATHML"><math> <msub> <mi mathvariant="bold">a</mi> <mtext>c</mtext> </msub> </math></EquationSource> </InlineEquation> were 3.4% (SD=3.8) and <InlineEquation ID="IEq4"> <EquationSource Format="TEX">${\mathbf{a}}_{\text{s}}$</EquationSource> <EquationSource Format="MATHML"><math> <msub> <mi mathvariant="bold">a</mi> <mtext>s</mtext> </msub> </math></EquationSource> </InlineEquation> were 4.1% (SD=2.6). Of the cohort, 44 patients (90%) showed very good or good agreement in the coronal in silico simulation and 43 patients (88%) in the sagittal in silico simulation. When the coronal and sagittal results were combined, 38 patients (78%) showed very good or good agreement. Conclusion The distribution of biomechanical energy obtained from preoperative radiographs is reliable to simulate spine alignment after arthrodesis in a Lenke 1 AIS cohort.

Spinal energy balance can predict post-operative spine alignment in Lenke 1 Adolescent Idiopathic Scoliosis

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2026年5月6日

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Tristan Langlais,
Jérôme Sales de Gauzy,
Joe Rassi,
Mathilde Bony,
Baptiste Brun-Cottan,
Amandine Eon,
Franck Accadbled,
Pascal Swider,
Pauline Assemat

摘要

Purpose

The preoperative planning of adolescent idiopathic scoliosis (AIS) remains largely debated. We hypothesized that adopting a biomechanical energetic framework could provide valuable insights for exploring the impact of spinal arthrodesis. Using this approach, we conducted a comparative analysis to quantify discrepancies between in silico simulations derived from preoperative radiographs and the actual three-dimensional spinal alignment obtained from post-operative imaging.

Methods

Fifty-two consecutive patients with Lenke Type 1 AIS (mean age: 16 years; mean thoracic Cobb angle: 52°) who underwent posterior spinal fusion were included in the analysis. All patients had complete biplanar radiographs at three time points: preoperatively, post-operatively and at two-year follow-up. Discrepancies between in silico simulated surgery, calculated using preoperative radiographs and a biomechanical model, and actual clinical outcomes were quantified using two metrics: maximum coronal/sagittal deviations (MaxC/MaxS) from T1 to L5, and a comprehensive predictability factor ( ${\text{a}}_{\text{c}}$ $a_{c}$ and ${\text{a}}_{\text{s}}$ $a_{s}$ ) measuring cumulative 3D position discrepancies across 17 vertebral levels, normalized by total spinal length.

Results

Mean MaxC was 4.7 mm (SD=4.9) and MaxS was 5.7 mm (SD=3.8). Mean values of ${\mathbf{a}}_{\text{c}}$ $a_{c}$ were 3.4% (SD=3.8) and ${\mathbf{a}}_{\text{s}}$ $a_{s}$ were 4.1% (SD=2.6). Of the cohort, 44 patients (90%) showed very good or good agreement in the coronal in silico simulation and 43 patients (88%) in the sagittal in silico simulation. When the coronal and sagittal results were combined, 38 patients (78%) showed very good or good agreement.

Conclusion

The distribution of biomechanical energy obtained from preoperative radiographs is reliable to simulate spine alignment after arthrodesis in a Lenke 1 AIS cohort.