Scoliosis in-brace curve correction and patient preference of CAD/CAM versus plaster molded TLSOs

Abstract

Purpose CAD/CAM technology is a newer technique for creating spinal orthoses than standard plaster molded methods. To our knowledge there has been only one previous study of CAD/CAM braces. The purpose of our study was to compare patient preference and in-brace correction of Cobb angle between plaster molded thoracolumbosacral orthoses (TLSO) and CAD/CAM designed TLSOs in a series of patients with scoliosis. Methods Ten patients with an average initial Cobb angle of 30.8°(range 18°-46°) had both a plaster molded TLSO and a CAD/CAM TLSO fabricated for them. In each case, the decision to brace was made by the treating surgeon based on curve magnitude and skeletal maturity. After 3 weeks of 23 h a day wear, in-brace correction of the Cobb angle was measured for each brace based on standard PA spine radiographs. After 3 months of use, patients were asked which brace they preferred. Results For the CAD/CAM brace, the mean curve correction after 3 months was 51% compared to 44% in the plaster molded TLSO cohort. (p = 0.46). Seven out of nine patients preferred the CAD/CAM TLSO over the plaster molded TLSO. There were no brace complications in either group. Conclusion In our matched cohort study, CAD/CAM TLSOs had at least equivalent if not superior correction of the Cobb angle compared to standard plaster molded TLSOs; 78% of our patients preferred the CAD/CAM brace over the standard TLSO.

Efficacy of Computer-Aided Design and Manufacturing Versus Computer-Aided Design and Finite Element Modeling Technologies in Brace Management of Idiopathic Scoliosis: A Narrative Review

“…The conventional method of spine brace manufacturing includes molding a negative cast from the patient's trunk and manually modifying the positive mold according to the spinal curve pattern [27,28] (Fig. 1).…”

“…1. Conventional method of casting scoliosis braces in which patients are placed in a modified riser frame [28]. [20,[31][32][33][34].…”

“…"The results demonstrated that the mean rectification time of the CAD/CAM method was shorter than that of the conventional manual method by 108.3 minutes (63.5%)" [37]. Additionally, modern brace-manufacturing techniques help orthotists better educate and provide medical advice to patients in addition to achieving a higher hygiene level and less material consumption because of omitting the casting phase [28][29][30]37]. In the previous decade, the application of 3D printing, as a form of the CAD-CAM method, has expanded rapidly in clinical practice, such as in orthosis manufacturing [38][39][40][41].…”

Prospective study and new concepts based on scoliosis detorsion of the first 225 early in-brace radiological results with the new Lyon brace: ARTbrace

“…For Wong the in-brace reduction with the manual method is 0.321 versus 0.419 for the CAD/CAM method, which is non-significant [15]. Sankar reaches the same conclusion, but notes that patients prefer the CAD/CAM mould [16]. …”

European Braces for Conservative Scoliosis Treatment

“…The brace applies external corrective forces to the trunk with the aim to halt the curve progression or to correct www.intechopen.com it during growth, [The Scoliosis Research Society Brace Manual, Rigo et al 2006, Grivas et al 2003, Negrini et al2010a or to avoid further progression of an already established pathological curve in adulthood. To achieve these goals, rigid supports or elastic bands can be used [Coillard et al 2003, Wong et al 2008 and braces can be custom-made or prefabricated , Sankar et al 2007, Wong et 2005a, 2005b. The spinal correction is accomplished by the application of mechanical forces with the intention to reduce the pathological compression on given parts of the vertebral column (usually the concave side), while increasing it on others, (usually the convex side).…”