Case Study - Mimics Innovation Award Winner

Mechanical Growth Modulation

for Scoliosis Correction
Case presented by Diana Glaser 1, 2 and Peter Newton 2
(1 Orthopedics Biomechanics Research Center, San Diego, USA; 2 Rady Childrens Hospital, San Diego, USA)

Scoliosis, curvature of the spine, develops during growth spurts and affects about 2% of
all adolescents. The standard treatment for large curves is spinal fusion, a surgery that
sacrifices motion and further spinal growth. Dr. Peter Newton from Rady Childrens Hospital
in San Diego, USA, proposed a mechanical tether _ applied to the side of the spine, without
spinal fusion _ that redirects spinal growth. An intensive study of the disorder requires a
3D interdisciplinary analysis incorporating a range of physiological assessments.
The present study combines clinical and engineering know-how confirming that spinal
growth can be mechanically modified. It indicates the critical importance of the third
dimension in understanding complicated spinal deformities and providing guidance for
appropriate treatment.

Problems Associated with Scoliosis Assessment

and Treatment
Spontaneously arising adolescent scoliosis is a complex structural 3D spinal deformity.
Severe scoliosis can lead to symptoms such as pain accompanied by cardiopulmonary
compromise. Currently, there are no pediatric spinal implants that can correct scoliosis
in children without a fusion surgery. Additionally, 3D morphological analyses are rarely
available, even though scoliosis has long been recognized as a three-dimensional
deformity. The third dimension is critically important, but currently scoliosis is
characterized using two-dimensional X-rays.
1
This study introduces growth modulation by applying anterolateral spinal tethers
in a growing mini-pig model. This technique redirects growth, slowing growth at
the outer (concave) side of the curve while allowing for further growth at the inner
(convex) side. This procedure leads to natural straightening of the spine with growth.
Advanced 3D imaging techniques were used to better understand mechanical spinal
growth modulation and its efficacy. No previous research thoroughly or systematically
describes these 3D alterations using 3D CT studies for vertebra reconstruction,
3D micro-CT studies for growth and end plate evaluation and MRI studies for disc
assessment.

3D Reconstructions for a Full Description

2
1 3D reconstruction with spinal orientation
2 MRI scans of the entire spine and
3D disc reconstruction
of Spinal Deformity
Surface reconstructions of individual vertebra and disc space assessment from CT
scans, disc evaluation from MRI, and growth and end plate characterization from
micro-CT were created using the Mimics Innovation Suite. Once complete, the team
exported and loaded STL models of each vertebra, disc, and end plate to a custom
MATLAB application. The 3D reconstruction enabled them to collect an entire range
of critical data for the spinal deformations. This included calculations about principal
axes and points of interest for the vertebra, angles for vertebral body wedging, metrics
for spinal deformation, and more.
 The Mimics Innovation Suite proved invaluable for getting us the 3D spinal
representations needed for our study. 3D models were quickly and reliably
generated and moreover, we were able to import data from a number of different
modalities: MRI, CT, and micro-CT. Manual adjustments and measurements
were easy to carry out and the variety of export options allowed us to use the
models for further data processing.
Diana Glaser, Orthopedics Biomechanics Research Center/ Rady Childrens Hospital, USA

Improved Data Can Lead to Improved Treatment

In ANSYS the muscle was modeled using the two-parameter Mooney-Rivlin material
model because of its computational efficiency. The aim was to compute the pressure
of the socket on the stump and, ideally, to achieve a homogenous pressure distribution.
The team came up with a clever alternative to this computationally hard task, which
provided them with a simpler model with nearly the same results. Optimizing this,
however, is still part of their future work.

3 4 5

3 Micro-CT reconstruction of the growth plate

4 Vertebra orientation, wedging and eigenvector identification
5 Disc space from CT and discs from MRI reconstruction and analysis.
Color map represents the different heights in the discs with red being larger than blue

Mimics Innovation Awards

Acknowledging excellence in Engineering on AnatomyTM
Use the Mimics Innovation Suite for your cutting-edge research

Submit your case as a paper or poster

Win up to 5,000 if selected by the jury of international judges
Be recognized in a press release, on the Materialise website, and in a case study
Present your work at a Materialise event
If you would like more information or to enter the contest, go to: www.materialise.com/MIA

Regulatory Information:
Mimics Innovation Suite currently consists of the following medical device software components: Mimics version 16 and 3-matic version 8 (released 2013). Mimics is intended for use as a software
interface and image segmentation system for the transfer of imaging information from a medical scanner such as a CT scanner or a Magnetic Resonance Imaging scanner. It is also used as
preoperative software for simulating /evaluating surgical treatment options. 3-matic is intended for use as software for computer assisted design and manufacturing of medical exo- and
endoprostheses, patient-specific medical and dental/orthodontic accessories and dental restorations.
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Mimics is a CE-marked product Copyright 2014 Materialise N.V, L-10092 revision 1, 04/2014

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