Intra-operative measurement of applied forces during anterior scoliosis correction.

BACKGROUND: Spinal instrumentation and fusion for the treatment of scoliosis is primarily a mechanical intervention to correct the deformity and halt further progression. While implant-related complications remain a concern, little is known about the magnitudes of the forces applied to the spine during surgery, which may affect post-surgical outcomes. In this study, the compressive forces applied to each spinal segment during anterior instrumentation were measured in a series of patients with Adolescent Idiopathic Scoliosis. METHODS: A force transducer was designed and retrofit to a routinely used surgical tool, and compressive forces applied to each segment during surgery were measured for 15 scoliosis patients. Cobb angle correction achieved by each force was measured on intra-operative fluoroscope images. Relative changes in orientation of the screw within the vertebra were also measured to detect intra-operative screw plough. FINDINGS: Intra-operative forces were measured for a total of 95 spinal segments. The mean applied compressive force was 540N (SD 230N, range 88N-1019N). There was a clear trend for higher forces to be applied at segments toward the apex of the scoliosis. Fluoroscopic evidence of screw plough was detected at 10 segments (10.5%). INTERPRETATION: The magnitude of forces applied during anterior scoliosis correction vary over a broad range. These forces do reach magnitudes capable of causing intra-operative vertebral body screw plough. Surgeons should be aware there is a risk for tissue overload during correction, however the clinical implications of intra-operative screw plough remain unclear. The dataset presented here is valuable for providing realistic input parameters for in silico surgical simulations.

Movement asymmetry in working polo horses.

REASONS FOR PERFORMING STUDY: The high, repetitive demands imposed on polo horses in training and competition may predispose them to musculoskeletal injuries and lameness. OBJECTIVES: To quantify movement symmetry and lameness in a population of polo horses, and to investigate the existence of a relationship with age. STUDY DESIGN: Convenience sampled cross-sectional study. METHODS: Sixty polo horses were equipped with inertial measurement units (IMUs) attached to the poll, and between the tubera sacrale. Six movement symmetry measures were calculated for vertical head and pelvic displacement during in-hand trot and compared with values for perfect symmetry, compared between left and right limb lame horses, and compared with published thresholds for lameness. Regression lines were calculated as a function of age of horse. RESULTS: Based on 2 different sets of published asymmetry thresholds 52-53% of the horses were quantified with head movement asymmetry and 27-50% with pelvic movement asymmetry resulting in 60-67% of horses being classified with movement asymmetry outside published guideline values for either the forelimbs, hindlimbs or both. Neither forelimb nor hindlimb asymmetries were preferentially left or right sided, with directional asymmetry values across all horses not different from perfect symmetry and absolute values not different between left and right lame horses (P values >0.6 for all forelimb symmetry measures and >0.2 for all hindlimb symmetry measures). None of the symmetry parameters increased or decreased significantly with age. CONCLUSIONS: A large proportion of polo horses show gait asymmetries consistent with previously defined thresholds for lameness. These do not appear to be lateralised or associated with age.