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Treatment of this type of scoliosis most frequently inâ€" volves the use of a special brace worn externally on the body. The brace helps to maintain proper erect posâ€" ture during daily activity. In some cases, when the brace does not work and the spine becomes more, unstable. surgical intervention beâ€" comes necessary. It‘s a far cry from a power dam site in some developing country to an operating room in the Hospital for Sick Children, but Dr. Greg McNeice of the University of Waterioo is at home funcâ€" tioning in either environâ€" ment. As a professor and reâ€" searcher, Dr. McNeice uses finite element analysis techâ€" niques combined with three dimensional _ computerized shaping techniques to design dams and> establish the stresses they are subject to during service load. In the hospital he uses the same techniques to perform stress analysis of human bone, joint replacement prostheses, and special spinâ€" al correction rods. Although Dr. McNeite conducts research in adult orthopaedics at both Wellesâ€" ley and Toronto General hoâ€" spitals, his weekly trek to Toronto also involves surâ€" gical research on children suffering from scoliosis, which is an abnormal sideâ€" ways curvature of the spine. There are many forms of scoliosis: the origin of the type Dr. McNeice is inâ€" volved with is unknown and the special cases that require his participation inâ€" volve children from the ages four to 10. These children would, without surgical treatment, completely colâ€" lapse and suffocate. Scolioâ€" sis occurs most frequently among girls. In addition to complications in the pulâ€" monary and respiratory functions of the body a very serious psychological probâ€" lem arises as a result of the cosmetic aspects of the deâ€" formity. This, of course, beâ€" comes more serious as the patient enters adolescence and the early teens. During surgery the spine is distracted using a Harâ€" rington rod and two spinal hooks. The rod is placed beâ€" tween the two hooks which in turn are distracted steaâ€" dily until the spine is straightened. This operation also involves spinal fusion: bone is removed from the iliac crest and laid posâ€" teriorily on the spine to allow full fusion. After 8â€"12 weeks this bone will form a longitudinal strut which acts as a reinforcement to a spinâ€" al column. Once the fusion takes, forces in the rod and hooks decrease to negligible levels; in many cases the entire device is left in the body. Waterloo engineer lends expertise At the Hospital for Sick Children this operation is oftem carried out on patients whose bone has almost fully grown...patients in late adoâ€" lescence or early teens. Dr. McNeice has also been involved in cases involâ€" ving younger patients, ho wever, who have not yet enâ€" tered the growth spurt. If the above procedure were used on these younger pa« tients they would end up as adults with very short trunks and very long legs Furthermore, attempts to use a Harrington rod with out spinal fusion have proâ€" Page 8 â€" Waterioo Chronlgc Wednesday, September 13, 1978 Engineering principles used to improve rod. To an engineer, this would be an obvious case of overâ€" stressing and fatigue fracâ€" ture, and Dr. McNeice has been asked to look into the problem. *‘*We started by looking at the fracture and fatigue characteristics of these rods,"" he says. ‘"This led to a completely new design...a new type of rod that has now been implanted in children at HSC." Dr. McNeice is always present in the operating room during both trial and final surgeries because he feels "this is a team effort and if you‘re planning to do a good job from a design point of view you have to apâ€" preciate the problem fully. You have to actually see a number of operations perâ€" formed prior to your atâ€" tempted design in order to appreciate how little space the surgeon has to work in and how careful he must be operating so close to a child‘s spinal cord," he says. Dr. McNeice has made additional contributions to the monitoring and treatâ€" ment of scoliosis. He has designed a special platform device on which the patient stands to be xâ€" rayed. This device controls the position of the patient during each clinical exâ€" amination so any change in the spine which may have occurred between examinaâ€" tion dates can be accurately measured. Earlier studies he had conducied showed there could be an error of as much as 15 degrees in the curvature measurement in a series of xâ€"rays on the same patient. Such an error could be very serious when one considers that a 50 degree curve usually calls for surâ€" gery. This error is simply an artifact, resulting from misâ€" alighment of the patient from one examination to the next. duced perplexing problems for the orthopaedic surgeonâ€" s,; when the patients return, the rod had fractured. Dr. McNeice has also found new ways to measure the severity of deformity. Until now the practice has been to measure the degree of curvature of the spine as seen in one xâ€"ray taken from the front. As Dr. McNeice explains: ‘"‘This is quite sufficient for gross measurement but for cases in which the deforâ€" mity has peculiar advanâ€" cement this angle of meaâ€" surement is most inaccuraâ€" te." Dr.McNeice has deve loped a computer program which takes data from two xâ€"rays and recreates the spine in three dimensions alâ€" lowing the computer to plot any projection of the spine the surgeon wishes. One particular plot that has proved interesting conâ€" sists of a bird‘s eye view of the spine as seen from above the head. The scolioâ€" tic spine resembles a spiral staircase and,. when viewed from the top. produces a form of a loop By having the computer tilt this view so the loop becomes closed. the projected area of this closed loop can be calculatâ€" ed The closed loop area has become a very sensitive measure of the degree of scoliosis and seems to comâ€" bine the entire threeâ€"dimenâ€" sional response of the spine and its deformity into a sinâ€" gle parameter. A number of additional parameters including the true length of the spine, the degree of progressive colâ€" lapse in the overall spine and the spatial balance of the head with respect to the pelvis are produced by the computer. This computer analysis has been entirely automated to the point where the computer plot provides all the necessary views and the values of the various parameters toâ€" gether on a standard 8â€"*> _ x 11"" sheet of paper which is now included directly into the patient‘s chart Such a view had never been possible with convenâ€" tional xâ€"ray analysis. threeâ€"year grant The success demonstrated by Dr. McNeice and his coâ€" researchers is clearly eviâ€" denced by the fact that the Hospital for Sick Children‘s Foundation recently awardâ€" ed him a threeâ€"year grant to study the disease using these computerized techâ€" niques This has enabled him to have a fullâ€"time reâ€" search engineer. James Raso. a tormer master‘s deâ€" gree student from civil enâ€" gineering at Waterloo, conâ€" duct the daily xâ€"rav analyâ€" Dr. Greg McNeice, University of Waterloo ctvil engineering professor, is seen in his lab on campus. He applies techniques developed to measure stresses in structures such as bridges and dams to a variety of human skeletal problems. One area of concern is scoliosis. Above, he is holding a rod he designed recently, used to correct spinal deformities of the type illustrated by the spine on the right. In the background.are seen xâ€"ray films of a patient‘s spine which had experienced metal fatigue fracture of the conventional rod type. Foundation awarded Dr. McNeice has also deâ€" veloped three dimensional physical models of the spine which can be manipulated. using spatial coordinates, to duplicate the condrtion of any particular patient‘s spine. These spine models have been constructed in UW‘s engineering machine shop ard are now used in the Hospital for Sick Children to explain to a concerned parent the exact deformity involved in a child, or to reâ€" produce the progressive colâ€" lapsing curves from one exâ€" amination to the next. Such visual ards are extremely important, says Dr. Mcâ€" Neice, in relating the meâ€" chanical response of the spine to what the orthopaeâ€" dist is so used to seeing in a standard xâ€"ray sis. data reduction and patient examination. Mr. Raso is resident in the Hospital for Sick Children and spends a good deal of time with the orthopaedist. at his office and in the clinâ€" ic, assessing various paâ€" tients and selecting those they wish to monitor. Dr. McNeice is developing a more sophisticated threeâ€" dimensional computer model which will include the entire torso of the patient, based on data taken from thenew form of xâ€"ray tomoâ€" graphy introduced recently in some medical health cenâ€" tres This device is called a Dr. McNeice says there are many other ways for an engineer to apply and deveâ€" lop his skill and knowledge in the interest of improving medical treatment of this particular ailment. For inâ€" stance, there could be a monitoring device to esâ€" tablish whether a patient is wearing a prescribed brace for the length of time the doctor has ordered. Or there C.T. sceanner which stands for ‘*computerized tomoâ€" graphy‘" scanner; it enables xâ€"rays to be taken across any section of an obâ€" ject...which in this case would be the chest or abâ€" dominal region. Once data is collected from three slices across the torso the new program will create both the internal and external deâ€" formity and, in turn. will allow any horizontal or verâ€" tical section to be plotted automatically by computer for purposes of investigating further progression of the deformity. The Heaven on Earth Learning Centre, 1056 Highland Rd. W.,. offers a stained glass course with Glenna Pendleton The course, which includes design, cutting and leading, begins on Sunday, Sept. 17 and runs for four weeks between the hours of 2 pm. and 4 pm. It is limited to four people The cost is $14 for members and $20 for others. For more inâ€" formation phone 743â€"8662 Stained glass course could be more sophisticated ways of designing complete timeâ€"dependent _ corrective surgical longâ€"term treatâ€" ment systems which would allow a small but continuous set of forces to be applied to the spine for the purposes of correcting it gradually. during normal patient acâ€" tivity. Engineers need to get involved to be effective But he emphasizes that engineers who wish to conâ€" tribute to the development or improvement of a health care system must become directly involved. They canâ€" not operate by remote conâ€" trol or in isolation from the real environment. Such an engineer must be capable of establishing rapport with and gaining the respect of medical doctors if he or she is to be truly effective in asâ€" sisting in the treatment of a patient.