Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model


The biomechanical influence of thoraco-lumbo-sacral bracing, a commonly employed treatment in scoliosis, is still not fully understood. The aim of this study was to compare the immediate corrections generated by different virtual braces using a patient-specific finite element model (FEM) and to analyze the most influential design factors. The 3D geometry of three patients presenting different types of curves was acquired with a multi-view X-ray technique and surface topography. A personalized FEM of the patients’ trunk and a parametric model of a virtual custom-fit brace were then created. The installation of the braces on the patients was simulated. The influence of 15 design factors on the 3D correction generated by the brace was evaluated following a design of experiments simulation protocol allowing computing the main and two-way interaction effects of the design factors. A total of 12,288 different braces were tested. Results showed a great variability of the braces effectiveness. Of the 15 design factors investigated, according to the 2 modalities chosen for each one, the 5 most influential design factors were the position of the brace opening (posterior vs. anterior), the strap tension, the trochanter extension side, the lordosis design and the rigid shell shape. The position of the brace opening modified the correction mechanism. The trochanter extension position influenced the efficiency of the thoracic and lumbar pads by modifying their lever arm. Increasing the strap tension improved corrections of coronal curves. The lordosis design had an influence in the sagittal plane but not in the coronal plane. This study could help to better understand the brace biomechanics and to rationalize and optimize their design.

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  1. 1.

    Andriacchi TP, Schultz AB, Belytschko TB, Dewald R (1976) Milwaukee brace correction of idiopathic scoliosis. A biomechanical analysis and a retrospective study. J Bone Jt Surg Am 58:806–815

    CAS  Google Scholar 

  2. 2.

    Aubin CE, Dansereau J, de Guise JA, Labelle H (1997) Rib cage-spine coupling patterns involved in brace treatment of adolescent idiopathic scoliosis. Spine 22:629–635

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Aubin CE, Dansereau J, de Guise JA, Labelle H (1996) A study of biomechanical coupling between spine and rib cage in the treatment by orthosis of scoliosis. Ann Chir 50:641–650

    CAS  PubMed  Google Scholar 

  4. 4.

    Aubin CE, Descrimes JL, Dansereau J, Skalli W, Lavaste F, Labelle H (1995) Geometrical modeling of the spine and the thorax for the biomechanical analysis of scoliotic deformities using the finite element method. Ann Chir 49:749–761

    CAS  PubMed  Google Scholar 

  5. 5.

    Box GEP, Hunter JS (2000) The 2 k-p fractional factorial designs. Part I. Technometrics 42:28–47

    Article  Google Scholar 

  6. 6.

    Castro FP Jr (2003) Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle. Spine J 3:180–185

    Article  PubMed  Google Scholar 

  7. 7.

    Cheriet F, Remaki L, Bellefleur C, Koller A, Labelle H, Dansereau J (2002) A new X-ray calibration/reconstruction system for 3D clinical assessment of spinal deformities. Stud Health Technol Inform 91:257–261

    CAS  PubMed  Google Scholar 

  8. 8.

    Clin J, Aubin CE, Labelle H (2007) Virtual prototyping of a brace design for the correction of scoliotic deformities. Med Biol Eng Comput 45:467–473

    Article  PubMed  Google Scholar 

  9. 9.

    Delorme S, Petit Y, de Guise JA, Labelle H, Aubin CE, Dansereau J (2003) Assessment of the 3-d reconstruction and high-resolution geometrical modeling of the human skeletal trunk from 2-D radiographic images. IEEE Trans Biomed Eng 50:989–998

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Emans JB (2003) Boston Brace. srs bracing manual (http://wwwsrsorg/professionals/bracing_manuals/)

  11. 11.

    Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME (1986) The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients. Spine 11:792–801

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Fortin D, Cheriet F, Beausejour M, Debanne P, Joncas J, Labelle H (2007) A 3D visualization tool for the design and customization of spinal braces. Comput Med Imaging Graph 31:614–624

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Gignac D, Aubin CE, Dansereau J, Labelle H (2000) Optimization method for 3D bracing correction of scoliosis using a finite element model. Eur Spine J 9:185–190

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Goldberg CJ, Moore DP, Fogarty EE, Dowling FE (2001) Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine 26:42–47

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Kadoury S, Cheriet F, Dansereau J, Labelle H (2007) Three-dimensional reconstruction of the scoliotic spine and pelvis from uncalibrated biplanar X-ray images. J Spinal Disord Tech 20:160–167

    Article  PubMed  Google Scholar 

  16. 16.

    Kadoury S, Cheriet F, Laporte C, Labelle H (2007) A versatile 3D reconstruction system of the spine and pelvis for clinical assessment of spinal deformities. Med Biol Eng Comput 45:591–602

    Article  PubMed  Google Scholar 

  17. 17.

    Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP (2005) Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther 85:1329–1339

    PubMed  Google Scholar 

  18. 18.

    Mac-Thiong JM, Petit Y, Aubin CE, Delorme S, Dansereau J, Labelle H (2004) Biomechanical evaluation of the Boston brace system for the treatment of adolescent idiopathic scoliosis: relationship between strap tension and brace interface forces. Spine 29:26–32

    Article  PubMed  Google Scholar 

  19. 19.

    Nachemson AL, Peterson LE (1995) Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Jt Surg Am 77:815–822

    CAS  Google Scholar 

  20. 20.

    Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA (1996) Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Jt Surg Am 78:557–567

    CAS  Google Scholar 

  21. 21.

    Patwardhan AG, Bunch WH, Meade KP, Vanderby R Jr, Knight GW (1986) A biomechanical analog of curve progression and orthotic stabilization in idiopathic scoliosis. J Biomech 19:103–117

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Pazos V, Cheriet F, Danserau J, Ronsky J, Zernicke RF, Labelle H (2007) Reliability of trunk shape measurements based on 3-D surface reconstructions. Eur Spine J 16:1882–1891

    Article  PubMed  Google Scholar 

  23. 23.

    Pazos V, Cheriet F, Labelle H, Dansereau J (2002) 3D reconstruction and analysis of the whole trunk surface for non-invasive follow-up of scoliotic deformities. Stud Health Technol Inform 91:296–299

    PubMed  Google Scholar 

  24. 24.

    Pazos V, Cheriet F, Song L, Labelle H, Dansereau J (2005) Accuracy assessment of human trunk surface 3D reconstructions from an optical digitising system. Med Biol Eng Comput 43:11–15

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Perie D, Aubin CE, Lacroix M, Lafon Y, Labelle H (2004) Biomechanical modelling of orthotic treatment of the scoliotic spine including a detailed representation of the brace–torso interface. Med Biol Eng Comput 42:339–344

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Perie D, Aubin CE, Petit Y, Labelle H, Dansereau J (2004) Personalized biomechanical simulations of orthotic treatment in idiopathic scoliosis. Clin Biomech (Bristol, Avon) 19:190–195

    Article  Google Scholar 

  27. 27.

    Petit Y, Aubin CE, Labelle H (2004) Patient-specific mechanical properties of a flexible multi-body model of the scoliotic spine. Med Biol Eng Comput 42:55–60

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Rigo M, Negrini S, Weiss HR, Grivas TB, Maruyama T, Kotwicki T (2006) SOSORT consensus paper on brace action: TLSO biomechanics of correction (investigating the rationale for force vector selection). Scoliosis 1:11

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D (1997) A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Jt Surg Am 79:664–674

    CAS  Google Scholar 

  30. 30.

    Sanders JE, Greve JM, Mitchell SB, Zachariah SG (1998) Material properties of commonly used interface materials and their static coefficients of friction with skin and socks. J Rehabil Res Dev 35:161–176

    CAS  PubMed  Google Scholar 

  31. 31.

    Upadhyay SS, Nelson IW, Ho EK, Hsu LC, Leong JC (1995) New prognostic factors to predict the final outcome of brace treatment in adolescent idiopathic scoliosis. Spine 20:537–545

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    van Rhijn LW, Veraart BE, Plasmans CM (2003) Application of a lumbar brace for thoracic and double thoracic lumbar scoliosis: a comparative study. J Pediatr Orthop B 12:178–182

    Article  PubMed  Google Scholar 

  33. 33.

    Wynarsky GT, Schultz AB (1991) Optimization of skeletal configuration: studies of scoliosis correction biomechanics. J Biomech 24:721–732

    Article  CAS  PubMed  Google Scholar 

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This study was funded by the Natural Sciences and Engineering Research Council of Canada.

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Correspondence to Carl-Eric Aubin.

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Clin, J., Aubin, CE., Parent, S. et al. Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. Eur Spine J 19, 1169–1178 (2010).

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  • Scoliosis
  • Brace
  • Finite element model
  • Design
  • Optimization