International Symposium on Biomedical Engineering, ISBE 2016

Contrabending and Reverse Twist as A Basic Biomechanical Force To Correct

Deformity In Scoliosis Problem
RahyussalimAJ1,AlfariqL1,KurniawatiT2,AnshoriF1,AbdullahA1
1

Department of Orthopaedic and Traumatology Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital.
2
Stem Cell Integrated Medical Service Unit Cipto Mangunkusumo Hospital-Faculty of Medicine Universitas Indonesia.

Abstract
Prevalence of Adolescent idiopathic scoliosis is 0.475.2 %, The female to male ratio ranges from 1.5:1 to 3:1. an important feature of scoliotic
deformity is the vertebral axial rotation that accompanies the vertebral axial rotation and the vertebral deviation. objective of this study was to
learn about basic biomechanical force in bending and twisting. We did a systematic literature search using medical databases online. the
adolescent growth spine growth is danger period for progression referred. In the deformed spine, the loads translates as concentrations of tensions
in specific vertebral areas. There are various technique based on biomechanical force
Keywords:; biomechanical, bending, rotational forces, scoliosis

1. Introduction
Adolescent idiopathic scoliosis (AIS) is a common disease with an overall prevalence of 0.475.2 % in the current literature.
The female to male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age. In particular, the prevalence of
curves with higher Cobb angles is substantially higher in girls than in boys: The female to male ratio rises from 1.4:1 in curves
from 10_ to 20_ up to 7.2:1 in curves. Curve pattern and prevalence of scoliosis is not only influenced by gender, but also by
genetic factors and age of onset. [1]
There are not many studies that provide data of high relevance regarding prevalence of AIS. Several studies that do provide
such data have substantial weaknesses like varying definitions of scoliosis, study protocols, and agegroups, missing standards for
omparison and inclusion of curves, although international consensus is given that per definition scoliosis is a deformity.The study
of Kamtsiuris was conducted in Germany by the Robert Koch Institute (RKI). 17,641 children (8,656 girls, 8,995 boys) were
interviewed and examined for chronicle diseases, children from 0 to 17 years participated. [1]
The study of Suh was conducted in Korea. 1,134,890 children participated (584,554 boys and 550,336 girls). Two age groups
were investigated: 1012 years and 1314 years. The study of Nery was conducted in Brasil. 1,340 children participated (684
boys, 656 girls). Mean age was 12.7 years. The study of Daruwalla was conducted in Singapore. 110,744 children were examined
(60,167 girls, 50,577 boys). Three age groups were investigated 1112 and 1617 years (only girls were investigated in the last
group). Twenty years later Wong conducted another study in Singapore and investigated 72,699 children (37,141 girls and 35,558
boys). The study of Cilli was conducted in Turkey. 3,175 children participated (1,538 girls, 1,637 boys). Children from 10 to 15
years were enrolled.[1]
The evolutionary process of the skeletal deformities, and of the spine in particular, is conditioned by both biological factors
and by the mechanical behaviour imposed by the new geometry of the system the entire spine, during the movements deriving
from the natural dynamics, is subject to an elastic deformation. The spine structure has the capability of quickly returning to the
primitive configuration when the actions that have produced the same deformation cease.[3]
The capability of returning, after every elastic deformation, to a ready and complete recovery of the natural state proves that
the bound could be considered to have little importance in comparison to the elastic one. Moreover, geometry's alteration induces
a new model of the stress distribution, to which follows a concentration of tensions in specific areas of the vertebrae, of the disks
and of the capsulo-legamentosus apparatus. Such a mechanical behaviour can produce a permanent condition of unstable
equilibrium. Therefore, the geometric configuration of the curve can progressively change, as time passes, due to mechanical
factors. [3]
objective of this study was to learn about basic biomechanical force in bending and twisting so to help clinician for better
correcting procedure in scoliotic deformity and to propose a method using Finite Element Analysis to compute the threedimensional forces acting on the spine from implant rod deformation in scoliosis deformity surgery. [2]
an important feature of scoliotic deformity is the vertebral axial rotation that accompanies the vertebral axial rotation which
accompanies the vertebral deviation. Mechanism interactions within the spine have been implicated in causing vertebral rotation

with lateral deviation. The magnitude of vertebral axial rotation correlates with the lateral deviation of vertebrae form spinal axis
and the rotation is maxial near the curve apex. The relationship between vertebral deviation and axial rotation is not understood.4

2. Methods
We did a systematic literature search by using medical databases online. We searched the literature using keywords
[biomechanic], [scoliosis], [bending] and [twisting]. Search engine PUBMED, Ebscohost, Cochrane, Proquest, Researchgate,
and Science Direct were used to explore the online database

3. Results and Discussion

Infanto-juvenile scoliosis is characterized by the quick evolution, until the spine reaches the skeletal maturity. The plasticity
of the bone tissue in growth mostly contributes to the worsening of the scoliotic curve. In the deformed spine, the action of the
loads translates as concentrations of tensions in specific vertebral areas, and determines, due to the plastic reaction to the
actions, typical of the growing bone, an asymmetrical development of the pedicles, of the vertebral soma and of the neural arch.
The consequence is that, during growth, the scoliosis gets worse as the result of the progressive deformation of the vertebrae
curve.[3]
Nowadays, the tendency to worsen recognizes, as principal cause, the instability of the movement segments included within
the curve. In the adulthood the instability shows as a progressive elasto-plastics deformation of the ligamentosus and diskal
structures. It follows a deterioration of the restraining reactions with the formation of abnormal bounds. This modifies all the
angular movements of the motion segments, in the three dimensions of the space. Instability is expressed by a progressive
alteration of the geometric relationships between the single vertebrae, which determines subluxation phenomena in rotation and
kyphosis of the movement segments included in the curve. [3]
As for the capacity of the biological structure to react to the induced loads, particular importance has the viscous-elastic
ownership of the restraining elements. These, in fact, undergo many variations in relationship to both the age of the patient and
the location of the deformity, and are able to condition, from a quantitative point of view, the phenomena expressed by mechanical
factors.[3]
The progression of spinal deformity is thought to be primary biomechanical. Lateral curvature alters the spinal and muscular
geometry and muscle activation patterns and causes asymmetrical loading of vertebrae. This assymetric loading of vertebrae, in
turn, is thought to promotes assymetrical growth of spine and progress deformity . the adolescent growth spurt is the danger period
for progression. The mechanical modulation of growth in physes ofter is referred to as the Hueter-volkmann law proposes that
growth is retarded by increased mechanical compression, and accelerated by reduced loading in comparison with normal values.5

We found new technique based on biomechanical force, that is Single Concave Correction Technique (SCCT) which works
mainly on the concave side to provide adequate correction. This technique has been used and reported to be successful after 6
month follow up. The principle of direct contra bending manipulation technique is the fact that we need higher energy or force to
Withstand resistance or the curve load in order to realign the bent spinal curve which can be obtained by two methods, namely, to

decrease the curve resistance force or to increase the force to straighten the curve. In order to decrease the curve resistance force,
soft tissue release or osteotomy procedure can be done, while to increase the realigning force the screws must be placed accurately
into the pedicle, creating a linear segmental curve and increasing curve leverage power manually or using machine (robotic). [6]
To optimize the direct contra bending manipulation, the spine is divided into three segments, the upper thoracic segment (T3
T7), the lower thoracic segment (T8T12), and the lumbar segment (L1L5) based on different thoracic and lumbar sagittal
alignments. The thoracic segments are divided into two in order to split thoracic curve stiffness and facilitate the correction
process.[6] Salmingo et al. reported the magnitude of corrective forces acting on the deformed implant rods after surgery. The
maximum corrective force obtained was 439 N.The measured torsional force ranged from 22-57 N and The average pullout
force was 2413 N. [7][8]

4. Conclusion
Worsening of the scoliosis is the expression of a progressive deformation of the vertebrae, induced by an abnormal
concentration of loads that amount of force and load is torsional and lateral bending dan make stress distribution into abnormal
amount, especially into deformed spine, and referred by Hueter-Volkmann Law.
new technique based on biomechanical force, that is SCCT which works mainly based on biomechanical force on the concave
side to provide adequate correction. This technique has been used and reported to be successful The therapeutic act must aim to
reduce significantly and to produce an inversion of the loads. The average true corrective forces were 50 30 N. The average
bone-screw forces were 229 140 N, 141 99 N, and 103 42 N, respectively, for monoaxial 205 136 N, polyaxial 125 93
N, and dorsoaxial screws 65 39 N

references
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[2]

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[3]

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Biomechanics C, X-ray RSJJ. Corrective force analysis for scoliosis from implant rod deformation. 2012;(April 2016).

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structural scoliotic curves of the spine. 2002; (March 2016).

[7]

Adolescent Idiopathic Scoliosis ( AIS ): An Overview of the Etiology and Basic Management Principles. 2003;299306.

[8]

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[9]

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Anterior Release Procedure to Achieve Maximum Correction on Severe Adult Idiopathic Scoliosis. 2016;2016.