# Using Two X-Ray Images to Create a Parameterized Scoliotic Spine Model and Analyze Disk Stress Adjacent to Spinal Fixation—A Finite Element Analysis

## TL;DR

This study creates a personalized 3D spine model from X-rays to analyze stress changes in spinal segments after scoliosis surgery.

## Contribution

A novel method for creating a parameterized finite element model of the scoliotic spine using biplanar X-ray images.

## Key findings

- The FE model showed decreased stress in the cranial segment adjacent to spinal fixation.
- Stress increased in the caudal segment after surgery.
- X-ray and CT measurements of spinal angles differed by less than 7 mm.

## Abstract

Posterior instrumentation is used to treat severe adolescent idiopathic scoliosis (AIS) with a Cobb angle greater than 40 degrees. Clinical studies indicate that AIS patients may develop adjacent segment degeneration (ASD) post-surgery. However, there is limited research on the biomechanical effects on adjacent segments after surgery, and straightforward methods for creating finite element (FE) models that reflect vertebral deformation are lacking. Therefore, this study aims to use biplanar X-ray images to establish a case-specific, parameterized FE model reflecting coronal plane vertebral deformation and employ FE analysis to compare pre- and postoperative changes in the range of motion (ROM), endplate stress, and intervertebral disk stress of adjacent segments. We developed an FE model from biplanar X-ray images of a patient with AIS, using ANSYS software to establish pre- and postoperative models. The shape of the preoperative model was validated using computed tomography (CT) reconstruction. A flexion moment was applied to C7 of the spine model to achieve the same forward bending angle in the pre- and postoperative models. This study successfully developed a case-specific parameterized FE model based on X-ray images. The differences between Cobb angle and thoracolumbar kyphosis angle measurements in X-ray images and CT reconstructions were 6.5 and 5.4 mm. This FE model was used to analyze biomechanical effects on motion segments adjacent to the fixation site, revealing a decrease in maximum endplate and disk stress in the cranial segment and an increase in stress in the caudal segment.