SIB# 394-Predicting Surgical Alignment Goals

The Study:  Spinal sagittal alignment goals based on statistical modelling and musculoskeletal simulations               

The Facts:

a. This article is currently in press.

b. The target for alignment following spinal surgery follows anatomical lines and surgical experience.

c. However, the optimal alignment for any particular patient is often not known.

d. Statistical models have the potential to be used as tools to look at biomechanics.

e. “A statistical model was trained with 60 annotated radiographs to predict physiological sagittal alignment based on position of femoral heads and sacrum.”

f. The authors looked at 11 back pain patients.

g. They predicted what the alignment should be and determined, “Predicted alignments resulted in significantly lowered overall muscle activity and compressive loads …”

h. The authors felt that doing a specific analysis on the individual patient and applying “statistical shape modelling methods together with musculoskeletal simulations for the prediction of patient specific postoperative sagittal alignment showed promising results…”

i. The authors felt spinal alignment outcomes could be improved significantly by using statistical models to establish goals during surgical preplanning.    

Take Home:

The authors are proposing the use of modeling “together with musculoskeletal simulations” in individual cases to help determine the goals for alignment in spinal surgery.

Reviewer's Comments:

For those of you who know me you just have to mention modeling, statistical or otherwise, and you get my attention. Basically modeling is a method to help better understand complex problems. If the modeling proposed by these authors could better predict the appropriate goals for surgical alignment in individual patients I think that might be a great step forward. So say it all together, once again this article shows the very serious interest our medical competitors have in structural alignment in the spine and how spinal misalignment is becoming ever more classified as a surgical condition.

Reviewer:  Roger Coleman DC

Editor: Mark R. Payne DC

Reference: Caprara S, Moschini G, Snedeker JG, Farshad M, Senteler M. Spinal sagittal alignment goals based on statistical modelling and musculoskeletal simulations Sebastiano. J Biomech. 2020 Jan 9:109621. doi: 10.1016/j.jbiomech.2020.109621. [Epub ahead of print]

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/31959392

Link to Article: https://www.sciencedirect.com/science/article/pii/S0021929020300270?via%3Dihub