{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T23:54:46Z","timestamp":1783727686369,"version":"3.55.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> To analyze the stress distribution in the proximal vertebral body and soft tissue of dual growing-rod (GR) with different upper instrumented vertebra (UIV) to determine the optimal UIV.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A ten-year-old male EOS case treated with GR was selected. Based on spiral computed tomography (CT) scanning performed in 0.6\u00a0mm thick slices, a finite element model (FEM) of the preoperative state (M0, the original spine state) of the patient was created. Subsequently, four models with different UIV fixations were numerically analyzed by FEM, including M1 (UIV = T1, i.e., the upper-end vertebrae (UEV) of the upper thoracic curve), M2 (UIV = T2), M3 (UIV = T3) and M4 (UIV = T4, i.e., the lower end vertebrae (LEV) of the upper thoracic curve). Displacement and maximum stress in the proximal vertebral body and soft tissue were measured and compared among the five models.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The spine model was fixed with the sacrum, and the gravity conditions were imposed on each vertebral body according to the research of Clin and Pearsall. The results are as follows:M4 model has the largest overall displacement, while M1 has the least displacement among the four models. Except M2, the maximum normalized stress of UIV increases with the downward movement of UIV. M1 has the lowerest annulus fibrosus stress and highest joint capsule stress, which is characterized by the vertebrae backward leaning, while M4 is the opposite. The supraspinous ligament stress of M3 and M4 is significantly higher than that of M1 and M2. This suggests that UIV downshift increases the tendency of the proximal vertebral bodies to bend forward, thereby increasing the tension of the posterior ligaments (PL).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The UIV of the GR is recommended to be close to the UEV of the upper thoracic curve, which can reduce the stress of the proximal PL, thereby reducing the occurrence of proximal junctional kyphosis (PJK).<\/jats:p>","DOI":"10.3389\/fbioe.2022.978554","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T08:03:51Z","timestamp":1662105831000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The application of finite element analysis to determine the optimal UIV of growing-rod treatment in early-onset scoliosis"],"prefix":"10.3389","volume":"10","author":[{"given":"Aixing","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongtao","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Hai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/bpo.0000000000001985","article-title":"Treatment of early-onset scoliosis: Similar outcomes despite different etiologic subtypes in traditional growing rod graduates","volume":"42","author":"Akbarnia","year":"2022","journal-title":"J. Pediatr. Orthop."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2858","DOI":"10.1097\/brs.0b013e3181b4c75d","article-title":"Biomechanical characteristics of different regions of the human spine: An in vitro study on multilevel spinal segments","volume":"34","author":"Busscher","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"E687","DOI":"10.1097\/brs.0b013e318246d4f2","article-title":"The use of A transition rod may prevent proximal junctional kyphosis in the thoracic spine after scoliosis surgery: A finite element analysis","volume":"37","author":"Cahill","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"E14422","DOI":"10.7759\/cureus.14422","article-title":"Traditional dual growing rod technique in the management of early onset scoliosis and its effects on spinal growth and lung development: The mid-term prospective results","volume":"13","author":"Cengiz","year":"2021","journal-title":"Cureus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1302\/1863-2548.15.210021","article-title":"Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures","volume":"15","author":"Chang","year":"2021","journal-title":"J. Children's. Orthop."},{"key":"B6","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1007\/s11517-011-0793-4","article-title":"A new method to include the gravitational forces in A finite element model of the scoliotic spine","volume":"49","author":"Clin","year":"2011","journal-title":"Med. Biol. Eng. Comput."},{"key":"B7","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3171\/2014.12.spine14419","article-title":"Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using A hybrid testing protocol: A finite-element study","volume":"23","author":"Erbulut","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"B8","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s43390-021-00429-w","article-title":"Proximal junctional kyphosis in pediatric spinal deformity surgery: A systematic review and critical analysis","volume":"10","author":"Erkilinc","year":"2022","journal-title":"Spine Deform."},{"key":"B9","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.jspd.2017.12.012","article-title":"Early-onset scoliosis: Updated treatment techniques and results","volume":"6","author":"Hardesty","year":"2018","journal-title":"Spine Deform."},{"key":"B10","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.1097\/bpo.0000000000001184","article-title":"Early-onset scoliosis: Contemporary decision-making and treatment options","volume":"38","author":"Hasler","year":"2018","journal-title":"J. Pediatr. Orthop."},{"key":"B11","doi-asserted-by":"publisher","first-page":"E132","DOI":"10.1097\/bpo.0000000000002000","article-title":"The effect of surgeon experience on outcomes following growth friendly instrumentation for early onset scoliosis","volume":"42","author":"Heffernan","year":"2022","journal-title":"J. Pediatr. Orthop."},{"key":"B12","doi-asserted-by":"publisher","first-page":"E84","DOI":"10.1097\/bpo.0000000000001400","article-title":"Changes in the position of the junctional vertebrae after posterior spinal fusion in adolescent idiopathic scoliosis: Implication in risk assessment of proximal junctional kyphosis development","volume":"40","author":"Homans","year":"2020","journal-title":"J. Pediatr. Orthop."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1097\/brs.0b013e318271319c","article-title":"Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity","volume":"38","author":"Hostin","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1016\/j.jbiomech.2003.12.026","article-title":"Mechanisms for mechanical damage in the intervertebral disc annulus fibrosus","volume":"37","author":"Iatridis","year":"2004","journal-title":"J. Biomech."},{"key":"B15","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jspd.2013.07.009","article-title":"Computational biomechanical modeling of scoliotic spine: Challenges and opportunities","volume":"1","author":"Jalalian","year":"2013","journal-title":"Spine Deform."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/4826507","article-title":"Biomechanical investigation of the posterior pedicle screw fixation system At level L4-L5 lumbar segment with traditional and cortical trajectories: A finite element study","volume":"2022","author":"Kahaer","year":"2022","journal-title":"J. Healthc. Eng."},{"key":"B17","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.1097\/bpo.0000000000001351","article-title":"The natural history of early-onset scoliosis","volume":"39","author":"Karol","year":"2019","journal-title":"J. Pediatr. Orthop."},{"key":"B18","doi-asserted-by":"publisher","first-page":"918032","DOI":"10.3389\/fbioe.2022.918032","article-title":"Biomechanical analysis of the reasonable cervical range of motion to prevent non-fusion segmental degeneration after single-level acdf","volume":"10","author":"Liang","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1748-7161-7-21","article-title":"Preoperative assessment and evaluation of instrumentation strategies for the treatment of adolescent idiopathic scoliosis: Computer simulation and optimization","volume":"7","author":"Majdouline","year":"2012","journal-title":"Scoliosis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1177\/2192568220935107","article-title":"Incidence of proximal junctional kyphosis with pedicle screws at upper instrumented vertebrae in posterior spinal fusion for adolescent idiopathic scoliosis","volume":"11","author":"Ogura","year":"2021","journal-title":"Glob. Spine J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"E337","DOI":"10.1097\/bsd.0000000000000661","article-title":"Upper instrumented vertebrae distal to T2 leads to A higher incidence of proximal junctional kyphosis during growing-rod treatment for early onset scoliosis","volume":"31","author":"Pan","year":"2018","journal-title":"Clin. Spine Surg. A Spine Publ."},{"key":"B22","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1007\/bf02667349","article-title":"Segmental inertial parameters of the human trunk as determined from computed tomography","volume":"24","author":"Pearsall","year":"1996","journal-title":"Ann. Biomed. Eng."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1097\/brs.0b013e318240fcd3","article-title":"Correlation of posterior ligamentous complex injury and neurological injury to loss of vertebral body height, kyphosis, and canal compromise","volume":"37","author":"Radcliff","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1002\/jor.20654","article-title":"Effects of alternative instrumentation strategies in adolescent idiopathic scoliosis: A biomechanical analysis","volume":"27","author":"Robitaille","year":"2009","journal-title":"J. Orthop. Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/j.jbiomech.2005.02.019","article-title":"Determination of trunk muscle forces for flexion and extension by using A validated finite element model of the lumbar spine and measured in vivo data","volume":"39","author":"Rohlmann","year":"2006","journal-title":"J. Biomech."},{"key":"B26","doi-asserted-by":"publisher","first-page":"S663","DOI":"10.1007\/s00586-010-1382-1","article-title":"Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: A finite element analysis","volume":"21","author":"Schmidt","year":"2012","journal-title":"Eur. Spine J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1302\/2058-5241.5.190087","article-title":"Diverse approaches to scoliosis in young children","volume":"5","author":"Senkoylu","year":"2020","journal-title":"EFORT Open Rev."},{"key":"B28","doi-asserted-by":"publisher","first-page":"E1112","DOI":"10.1016\/j.wneu.2019.04.051","article-title":"Biomechanical analysis of different lumbar interspinous process devices: A finite element study","volume":"127","author":"Shen","year":"2019","journal-title":"World Neurosurg. x."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.17219\/acem\/126289","article-title":"Single vs dual rod constructs in early onset scoliosis treated with magnetically controlled growing rods","volume":"29","author":"Urbanski","year":"2020","journal-title":"Adv. Clin. Exp. Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1080\/10255842.2019.1631286","article-title":"Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: A biomechanical analysis","volume":"22","author":"Wang","year":"2019","journal-title":"Comput. Methods Biomech. Biomed. Engin."},{"key":"B31","doi-asserted-by":"publisher","first-page":"E428","DOI":"10.1097\/bsd.0000000000000127","article-title":"Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis","volume":"29","author":"Watanabe","year":"2016","journal-title":"Clin. Spine Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3389\/fbioe.2020.00154","article-title":"Optimization of three-level cervical hybrid surgery to prevent adjacent segment disease: A finite element study","volume":"8","author":"Wong","year":"2020","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"E60","DOI":"10.1097\/brs.0b013e3181eeaee2","article-title":"Incidence, risk factors and classification of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis","volume":"36","author":"Yagi","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.1016\/j.spinee.2016.06.019","article-title":"A new cervical artificial disc prosthesis based on physiological curvature of end plate: A finite element analysis","volume":"16","author":"Yu","year":"2016","journal-title":"Spine J."},{"key":"B35","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1097\/cm9.0000000000000614","article-title":"Treatment of early-onset scoliosis: Techniques, indications, and complications","volume":"133","author":"Zhang","year":"2020","journal-title":"Chin. Med. J."},{"key":"B36","first-page":"1489","article-title":"Factors associated with postoperative respiratory complications following posterior spinal instrumentation in children with early-onset scoliosis","volume-title":"Orthop. Surg.","author":"Zhang","year":"2022"},{"key":"B37","doi-asserted-by":"publisher","first-page":"E7748","DOI":"10.1590\/1414-431x20197748","article-title":"A biomechanical study on proximal junctional kyphosis following long-segment posterior spinal fusion","volume":"52","author":"Zhu","year":"2019","journal-title":"Braz. J. Med. Biol. Res."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2022.978554\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T08:03:58Z","timestamp":1662105838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2022.978554\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":37,"alternative-id":["10.3389\/fbioe.2022.978554"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2022.978554","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]},"article-number":"978554"}}