Advertisement

Prediction of brace effect in scoliotic patients: blinded evaluation of a novel brace simulator—an observational cross-sectional study

  • Aurélien CourvoisierEmail author
  • Matthieu Nesme
  • Julien Gerbelot
  • Alexandre Moreau-Gaudry
  • François Faure
Original Article

Abstract

Purpose

Bracing is the most commonly used treatment for scoliosis. But braces remain predominantly “handcrafted.” Our objective was to create a novel brace simulator using a high-fidelity 3D “avatar” of the patient’s trunk.

Methods

An observational cross-sectional study was constructed. The inclusion criteria were patients with a moderate idiopathic scoliosis (between 15° and 35° of Cobb angle) aged between 9 and 15 years old with an indication of brace treatment. Twenty-nine scoliotic patients, 25 girls and four boys, with a mean age of 12.4 years were included. Twenty right thoracic and 14 left lumbar were measured with a mean Cobb angle of 24°. 3D “avatars” were generated using a novel technology called the “anatomy transfer.” Biomedical simulations were conducted by engineers who were blinded to the clinical effect of the real patient brace. The in-brace Cobb angle effect (real effect) was compared with the virtual numeric in-brace Cobb angle observed using the blindly constructed avatar (simulation effect).

Results

Real and simulated in-brace Cobb angle were compared using a paired two-sided Student’s t test. The real mean Cobb angle was 11° and 17° in the simulation which was statistically significant. The strength of prediction of the simulation was assessed for each individual patient; 76% of the real in-brace Cobb angles had good and moderate prediction (± 10°).

Conclusions

Incorporating high-fidelity copy of the entire 3D shape of the patient’s trunk and multiple 3D-reconstructed bony images into an anatomical reference avatar resulted in moderate-to-good prediction of brace effect in three quarters of patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Brace Scoliosis Brace simulator Avatar Patient specific 

Notes

Acknowledgements

We acknowledge Dr Kelly Dilworth for the manuscript English review.

Funding

Grenoble Alps University Hospital Innovation Grant 2015.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_5948_MOESM1_ESM.pptx (1.5 mb)
Supplementary material 1 (PPTX 1527 kb)

References

  1. 1.
    Dolan LA, Wright JG, Weinstein SL (2014) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 370(7):681.  https://doi.org/10.1056/NEJMc1314229 CrossRefGoogle Scholar
  2. 2.
    Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371(9623):1527–1537.  https://doi.org/10.1016/S0140-6736(08)60658-3 CrossRefGoogle Scholar
  3. 3.
    Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521.  https://doi.org/10.1056/NEJMoa1307337 CrossRefGoogle Scholar
  4. 4.
    Weinstein SL, Dolan LA (2015) The Evidence Base for the Prognosis and Treatment of Adolescent Idiopathic Scoliosis: the 2015 Orthopaedic Research and Education Foundation Clinical Research Award. J Bone Joint Surg Am 97(22):1899–1903.  https://doi.org/10.2106/JBJS.O.00330 CrossRefGoogle Scholar
  5. 5.
    Courvoisier A, Vialle R, Skalli W (2014) EOS 3D Imaging: assessing the impact of brace treatment in adolescent idiopathic scoliosis. Expert Rev Med Devices 11(1):1–3.  https://doi.org/10.1586/17434440.2014.848166 CrossRefGoogle Scholar
  6. 6.
    Courvoisier A, Drevelle X, Dubousset J, Skalli W (2013) Transverse plane 3D analysis of mild scoliosis. Eur Spine J 22(11):2427–2432.  https://doi.org/10.1007/s00586-013-2862-x CrossRefGoogle Scholar
  7. 7.
    Skalli W, Vergari C, Ebermeyer E, Courtois I, Drevelle X, Kohler R, Abelin-Genevois K, Dubousset J (2017) Early detection of progressive adolescent idiopathic scoliosis: a severity index. Spine 2(11):823–830.  https://doi.org/10.1097/brs.0000000000001961 CrossRefGoogle Scholar
  8. 8.
    Courvoisier A, Drevelle X, Vialle R, Dubousset J, Skalli W (2013) 3D analysis of brace treatment in idiopathic scoliosis. Eur Spine J 22(11):2449–2455.  https://doi.org/10.1007/s00586-013-2881-7 CrossRefGoogle Scholar
  9. 9.
    Post M, Verdun S, Roussouly P, Abelin-Genevois K (2018) New sagittal classification of AIS: validation by 3D characterization. Eur Spine J.  https://doi.org/10.1007/s00586-018-5819-2 Google Scholar
  10. 10.
    Clin J, Aubin CE, Parent S, Ronsky J, Labelle H (2006) Biomechanical modeling of brace design. Stud Health Technol Inform 123:255–260Google Scholar
  11. 11.
    Clin J, Aubin CE, Labelle H (2007) Virtual prototyping of a brace design for the correction of scoliotic deformities. Med Biol Eng Comput 45(5):467–473.  https://doi.org/10.1007/s11517-007-0171-4 CrossRefGoogle Scholar
  12. 12.
    Clin J, Aubin CE, Parent S, Labelle H (2010) A biomechanical study of the Charleston brace for the treatment of scoliosis. Spine 35(19):940–947.  https://doi.org/10.1097/brs.0b013e3181c5b5fa CrossRefGoogle Scholar
  13. 13.
    Clin J, Aubin CE, Parent S, Sangole A, Labelle H (2010) Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. Eur Spine J 19(7):1169–1178.  https://doi.org/10.1007/s00586-009-1268-2 CrossRefGoogle Scholar
  14. 14.
    Clin J, Aubin C, Sangole A, Labelle H, Parent S (2010) Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine 35(18):1706–1713.  https://doi.org/10.1097/brs.0b013e3181cb46f6 CrossRefGoogle Scholar
  15. 15.
    Clin J, Aubin C, Parent S, Labelle H (2011) Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads. Med Biol Eng Comput 49(7):743–753.  https://doi.org/10.1007/s11517-011-0737-z CrossRefGoogle Scholar
  16. 16.
    Grant CA, Johnston M, Adam CJ, Little JP (2019) Accuracy of 3D surface scanners for clinical torso and spinal deformity assessment. Med Eng Phys 63:63–71.  https://doi.org/10.1016/j.medengphy.2018.11.004 CrossRefGoogle Scholar
  17. 17.
    Pasha S, Flynn J (2018) Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction. Sci Rep 8(1):16296.  https://doi.org/10.1038/s41598-018-34261-6 CrossRefGoogle Scholar
  18. 18.
    Vergari C, Courtois I, Ebermeyer E, Bouloussa H, Vialle R, Skalli W (2015) Simulation of orthotic treatment in adolescent idiopathic scoliosis using a subject-specific finite element model. Comput Methods Biomech Biomed Eng 18(Suppl 1):2076–2077.  https://doi.org/10.1080/10255842.2015.1069629 CrossRefGoogle Scholar
  19. 19.
    Vergari C, Courtois I, Ebermeyer E, Bouloussa H, Vialle R, Skalli W (2016) Experimental validation of a patient-specific model of orthotic action in adolescent idiopathic scoliosis. Eur Spine J 25(10):3049–3055.  https://doi.org/10.1007/s00586-016-4511-7 CrossRefGoogle Scholar
  20. 20.
    Lateur G, Grobost P, Gerbelot J, Eid A, Griffet J, Courvoisier A (2017) Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25. Orthop Traumatol Surg Res 103(2):275–278.  https://doi.org/10.1016/j.otsr.2016.10.022 CrossRefGoogle Scholar
  21. 21.
    Clin J, Aubin C, Lalonde N, Parent S, Labelle H (2011) A new method to include the gravitational forces in a finite element model of the scoliotic spine. Med Biol Eng Comput 49(8):967–977.  https://doi.org/10.1007/s11517-011-0793-4 CrossRefGoogle Scholar
  22. 22.
    Cobetto N, Aubin CE, Clin J, Le May S, Desbiens-Blais F, Labelle H, Parent S (2014) Braces optimized with computer-assisted design and simulations are lighter, more comfortable, and more efficient than plaster-cast braces for the treatment of adolescent idiopathic scoliosis. Spine Deform 2(4):276–284.  https://doi.org/10.1016/j.jspd.2014.03.005 CrossRefGoogle Scholar
  23. 23.
    Desbiens-Blais F, Clin J, Parent S, Labelle H, Aubin CE (2012) New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis. Clin Biomech 27(10):999–1005.  https://doi.org/10.1016/j.clinbiomech.2012.08.006 CrossRefGoogle Scholar
  24. 24.
    Sattout A, Clin J, Cobetto N, Labelle H, Aubin CE (2016) Biomechanical assessment of providence nighttime brace for the treatment of adolescent idiopathic scoliosis. Spine Deform 4(4):253–260.  https://doi.org/10.1016/j.jspd.2015.12.004 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Aurélien Courvoisier
    • 1
    Email author
  • Matthieu Nesme
    • 2
  • Julien Gerbelot
    • 3
  • Alexandre Moreau-Gaudry
    • 4
  • François Faure
    • 2
  1. 1.Grenoble Alps Scoliosis and Spine Center-Grenoble Alps University Hospital. SPM-TIMC-IMAGGrenoble Cedex 09France
  2. 2.Anatoscope-Cap-Omega Rond-Point Benjamin FranklinMontpellierFrance
  3. 3.Demeure OrthopédieSaint-Martin-d’HèresFrance
  4. 4.CIC-ITTIMC-IMAGLa TroncheFrance

Personalised recommendations