Clinical assessment of immediate in-brace effect of braces designed using CAD/CAM and FEM vs. only CAD/CAM for conservative treatment of AIS, using a randomized blinded and controlled study design.
Forty AIS patients were prospectively recruited and randomized into two groups. For 19 patients (control group), the brace was designed using a scan of patient’s torso and a conventional CAD/CAM approach (CtrlBrace). For the 21 other patients (test group), the brace was additionally designed using finite element modeling (FEM) and 3D reconstructions of spine, rib cage and pelvis (NewBrace). The NewBrace design was simulated and iteratively optimized to maximize the correction and minimize the contact surface and material.
Both groups had comparable age, sex, weight, height, curve type and severity. Scoliosis Research Society standardized criteria for bracing were followed. Average Cobb angle prior to bracing was 27° and 28° for main thoracic (MT) and lumbar (L) curves, respectively, for the control group, while it was 33° and 28° for the test group. CtrlBraces reduced MT and L curves by 8° (29 %) and 10° (40 %), respectively, compared to 14° (43 %) and 13° (46 %) for NewBraces, which were simulated with a difference inferior to 5°. NewBraces were 50 % thinner and had 20 % less covering surface than CtrlBraces.
Braces designed with CAD/CAM and 3D FEM simulation were more efficient and lighter than standard CAD/CAM TLSO’s at first immediate in-brace evaluation. These results suggest that long-term effect of bracing in AIS may be improved using this new platform for brace fabrication.
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Nachemson AL, Peterson LE (1995) Effectiveness of treatment with 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 Joint Surg 77:815–822
Trobisch P, Suess O, Schwab F (2010) Idiopathic scoliosis. Dtsch Ärztebl Int 107(49):875–883
Castro F (2003) Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle. Spine 3:182–185
Negrini S, Atanasio S, Fusco C, Zaina F (2009) Effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies-SOSORT Award 2009 Winner. Scoliosis 4:19
Negrini S, Aulisa AG, Aulisa L et al (2012) 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 7:1–35
Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. New Engl J Med 369(16):1512–1521
Landauer F, Wimmer C, Behensky H (2003) Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatri Rehabil 6:201–207
Clin J, Aubin CE, 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
Nault M, Parent S, Phan P, Roy-Beaudry M, Labelle H, Rivard M (2010) A modified Risser grading system predicts the curve acceleration phase of female adolescent idiopathic scoliosis. J Bone Joint Surg Am 92:1073–1081
Lusini M, Donzelli S, Minnella S, Zaina F, Negrini S (2010) Brace treatment is effective in idiopathic scoliosis over 45°: an observational prospective cohort controlled study. Spine J 14(9):1951–1956
Brox JI, Lange JE, Gunderson RB, Steen H (2012) Good brace compliance reduced curve progression and surgical rates in patients with idiopathic scoliosis. Eur Spine J 21:1957–1963
Aulisa GO, Giordano M, Falciglia F et al (2014) Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner. Scoliosis 9:6
Wong MS (2011) Computer-aided design and computer-aided manufacture (CAD/CAM) system for construction of spinal orthosis for patients with adolescent idiopathic scoliosis. Physiother Theory Pract 27(1):74–79
Wong MS (2005) A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis. Prosthet Orthot Int 29(1):105–111
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 27:999–1005
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, comfortable and more efficient than plaster-casted braces for the treatment of adolescent idiopathic scoliosis. Spine Deform 2(4):276–284
Pazos V, Cheriet F, Dansereau 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
Raux S, Kohler R, Garin C, Cunin V, Abelin-Genevois K (2014) Tridimensinal trunk surface acquisition for brace manufacturing in idiopathic scoliosis. Eur Spine J 4:S419–S423
Aubin C, Descrimes JL, Dansereau J et al (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
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
Wynarsky GT, Schultz AB (1991) Optimization of skeletal configuration: studies of scoliosis correction biomechanics. J Biomech 24(8):721–732
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 Compu 42:339–344
Perie D, Aubin CE, Petit Y, Labelle H, Dansereau J (2004) Personalized biomechanical simulations of orthotic treatment in idiopathic scoliosis. Clin Biomech 19:190–195
Clin J, Aubin CE, Labelle H (2007) Virtual prototyping of a brace design for the correction of scoliotic deformities. Med Biol Eng Compu 45:467–473
Clin J, Aubin CE, Parent S, Labelle H (2011) Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads. Med Biol Eng Compu 49:743–753
Richards BS, Bernstein RM, D’Amato CR, Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine 30(18):2068–2075
Humbert L, de Guise JA, Aubert B, Godbout B, Skalli W (2009) 3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31(6):681–687
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
Howard A, Wright JG, Hedden D (1998) A comparative study of TLSO, Charleston and Milwaukee braces for idiopathic scoliosis. Spine 23:2404–2411
Zhang M, Mak A (1999) In vivo friction properties of human skin. Prosthet Orthot Int 23:135–141
Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am 72(3):320–327
Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am 72(3):328–333
Morton A, Riddle R, Buchanan R, Katz D, Birch J (2008) Accuracy in the prediction and estimation of adherence to bracewear before and during treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 28(3):336–341
Donzelli S, Zaina F, Negrini S (2015) Compliance monitor for scoliosis braces in clinical practice. J Child Orthop (epub ahead of print)
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
Katz DE, Durrani AA (2001) Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26(21):2354–2361
Sattout A, Clin J, Cobetto N, Labelle H, Aubin CE (20165 Biomechanical assessment of Providence nighttime brace for the treatment of adolescent idiopathic scoliosis. Spine Deform (accepted 24 Dec 2015)
Lebel DE, Al-Aubaidi Z, Shin EJ, Howard A, Zeller R (2013) Three dimensional analysis of brace biomechanical efficacy for patients with AIS. Eur Spine J 22(11):2445–2448
Weiss HR, Kleban A (2015) Development of CAD/CAM based brace models for the treatment of patients with scoliosis-classification based approach versus finite element modelling. Asian Spine J 9(5):661–667
Clin J, Aubin CE, Parent S, Labelle H (2010) A biomechanical study of the Charleston brace for the treatment of scoliosis. Spine (Phila Pa 1976) 35(19):E940–E947
Project funded by the Natural Sciences and Engineering Research Council of Canada (RGPIN 239148-11) and the Canadian Institutes of Health Research (MOP-119455). Special thanks to Marie-Chantal Bolduc and Benoit Bissonnette from Orthèse-Prothèse Rive-Sud who contributed to the design and fabrication of the braces, and delivery to the patients.
Conflict of interest
Research and development contract was obtained with Groupe Lagarrigue to develop and transfer a license of the simulation platform. Money was given to the university and the contract was not directly related to the presented RCT study. The RCT study presented in this paper was funded by a peer-reviewed grant from the Canadian Institutes of Health Research. The participating orthotists from Orthèse-Prothèse Rive-Sud received nothing of value to realize this study.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional ethical research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study and their parents.
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Cobetto, N., Aubin, C.E., Parent, S. et al. Effectiveness of braces designed using computer-aided design and manufacturing (CAD/CAM) and finite element simulation compared to CAD/CAM only for the conservative treatment of adolescent idiopathic scoliosis: a prospective randomized controlled trial. Eur Spine J 25, 3056–3064 (2016). https://doi.org/10.1007/s00586-016-4434-3