Braces Designed Using CAD/CAM Combined or Not With Finite Element Modeling Lead to Effective Treatment and Quality of Life After 2 Years

Guy, Aymeric; Barchi, Soraya; Audet-Duchesne, Elisabeth; Cobetto, Nikita; Parent, Stefan; Raison, Maxime; Aubin, Carl‐Éric

doi:10.1097/brs.0000000000003705

Cited by 25 publications

(24 citation statements)

References 45 publications

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“…A patient-specific FEM simulation of brace donning and tightening was then performed to compute the simulated 3D correction metrics and the pressures exerted on the skin. The FEM used and its validation have been presented in previously published work, 32,33 and is briefly summarized here. For each case, the torso topography scan and the brace model were aligned on the 3D reconstruction.…”

Section: Methodsmentioning

confidence: 99%

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Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis

Guy

Coulombe

Rigo³

et al. 2022

Spine

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Study Design. Multicenter numerical study.Objective. To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis.Summary of Background Data. A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs. Methods. Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P r 0.05). Results. Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =− 0.53, r = − 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower. Conclusions. The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms' contribution to 3D correction.

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Section: Methodsmentioning

confidence: 99%

“…The clinical integration of this FEM was validated in a randomized controlled trial of 120 cases where immediate and 2-year correction was evaluated. [30][31][32] Satisfactory treatment outcomes were achieved (83% of patients stayed <45°over 2 yrs) with lighter and thinner braces covering less torso area.…”

mentioning

confidence: 98%

Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis

Guy

Coulombe

Rigo³

et al. 2022

Spine

Self Cite

View full text Add to dashboard Cite

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“…When scoliosis is between 25 and 40 degrees, brace treatment is required [1]. Randomised controlled trials (RCTs) have confirmed bracing effectiveness [2,3], supporting the conclusions of a large number of observational studies [4][5][6]. Brace effects depend on different factors: the deformity's characteristics, brace type, construction and material used, brace wear dosage, patients' reactions to the brace, and correct and consistent brace wear throughout therapy [7,8].…”

Section: Introductionmentioning

confidence: 81%

Predicting final results of brace treatment of adolescents with idiopathic scoliosis: first out-of-brace radiograph is better than in-brace radiograph—SOSORT 2020 award winner

et al. 2022

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Purpose In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient’s ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph). Design Retrospective cohort study of a prospective dataset. Methods The population was selected based on the following inclusion criteria: AIS, age 10–18 years; Risser score 0–2; Cobb angle 25–40°; brace treatment; availability of all radiographs. Statistics: Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy. Results A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively. Conclusion The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. Level of Evidence 1 Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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“…Several studies have demonstrated significant improvement in the results using CAD/CAM braces compared to the traditional approach, adding concrete scientific evidence (level of evidence II) [78][79][80]. However, these studies cannot offer a prior guarantee for better treatment results, as several other factors play a crucial role in brace treatment.…”

Section: Cad/cam and Smart Materialsmentioning

confidence: 99%

Spinal Deformities and Advancement in Corrective Orthoses

et al. 2020

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Spinal deformity is an abnormality in the spinal curves and can seriously affect the activities of daily life. The conventional way to treat spinal deformities, such as scoliosis, kyphosis, and spondylolisthesis, is to use spinal orthoses (braces). Braces have been used for centuries to apply corrective forces to the spine to treat spinal deformities or to stabilize the spine during postoperative rehabilitation. Braces have not modernized with advancements in technology, and very few braces are equipped with smart sensory design and active actuation. There is a need to enable the orthotists, ergonomics practitioners, and developers to incorporate new technologies into the passive field of bracing. This article presents a review of the conventional passive braces and highlights the advancements in spinal orthoses in terms of improved sensory designs, active actuation mechanisms, and new construction methods (CAD/CAM, three-dimensional (3D) printing). This review includes 26 spinal orthoses, comprised of passive rigid/soft braces, active dynamics braces, and torso training devices for the rehabilitation of the spine.

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Braces Designed Using CAD/CAM Combined or Not With Finite Element Modeling Lead to Effective Treatment and Quality of Life After 2 Years

Cited by 25 publications

References 45 publications

Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis

Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis

Predicting final results of brace treatment of adolescents with idiopathic scoliosis: first out-of-brace radiograph is better than in-brace radiograph—SOSORT 2020 award winner

Spinal Deformities and Advancement in Corrective Orthoses

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