Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Scoliosis and Spinal Disorders
Published in: Scoliosis and Spinal Disorders 1/2017

Open Access 01-12-2017 | Research

3D correction of AIS in braces designed using CAD/CAM and FEM: a randomized controlled trial

Authors: Nikita Cobetto, Carl-Éric Aubin, Stefan Parent, Soraya Barchi, Isabelle Turgeon, Hubert Labelle

Published in: Scoliosis and Spinal Disorders | Issue 1/2017

Login to get access

Abstract

Background

Recent studies showed that finite element model (FEM) combined to CAD/CAM improves the design of braces for the conservative treatment of adolescent idiopathic scoliosis (AIS), using 2D measurements from in-brace radiographs. We aim to assess the immediate effectiveness on curve correction in all three planes of braces designed using CAD/CAM and numerical simulation compared to braces designed with CAD/CAM only.

Methods

SRS standardized criteria for bracing were followed to recruit 48 AIS patients who were randomized into two groups. For both groups, 3D reconstructions of the spine and patient’s torso, respectively built from bi-planar radiographs and surface topography, were obtained and braces were designed using the CAD/CAM approach. For the test group, 3D reconstructions of the spine and patient’s torso were additionally used to generate a personalized FEM to simulate and iteratively improve the brace design with the objective of curve correction maximization in three planes and brace material minimization.

Results

For the control group (CtrlBraces), average Cobb angle prior to bracing was 29° (thoracic, T) and 25° (lumbar, L) with the planes of maximal curvature (PMC) respectively oriented at 63° and 57° on average with respect to the sagittal plane. Average apical axial rotation prior to bracing was 7° (T) and 9° (L). For the test group (FEMBraces), initial Cobb angles were 33° (T) and 28° (L) with the PMC at 68° (T) and 56° (L) and average apical axial rotation prior to bracing at 9° (T and L). On average, FEMBraces were 50% thinner and had 20% less covering surface than CtrlBraces while reducing T and L curves by 47 and 48%, respectively, compared to 25 and 26% for CtrlBraces. FEMBraces corrected apical axial rotation by 46% compared to 30% for CtrlBraces.

Conclusion

The combination of numerical simulation and CAD/CAM approach allowed designing more efficient braces in all three planes, with the advantages of being lighter than standard CAD/CAM braces. Bracing in AIS may be improved in 3D by the use of this simulation platform. This study is ongoing to recruit more cases and to analyze the long-term effect of bracing.

Trial registration

ClinicalTrials.gov, NCT02285621
Literature
1.
Nachemson AL, Peterson LE. 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. 1995;77:815–22.CrossRefPubMed
2.
3.
Labelle H, Aubin CE, Jackson R, Lenke L, Newton P, Parent S. Seeing the spine in 3D: how will it change what we do? J Pediatr Orthop. 2011;31(1 Suppl):S37–45.CrossRefPubMed
4.
Castro F. Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle. Spine. 2003;3:182–5.
5.
6.
Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatric rehabilitation. 2003;6:201–7.CrossRefPubMed
7.
Clin J, Aubin CE, Sangole A, Labelle H, Parent S. Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine. 2010;35(18):1706–13.CrossRefPubMed
8.
Nault M, Parent S, Phan P, Roy-Beaudry M, Labelle H, Rivard M. A modified Risser grading system predicts the curve acceleration phase of female adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92:1073–81.CrossRefPubMed
9.
Lusini M, Donzelli S, Minnella S, Zaina F, Negrini S. Brace treatment is effective in idiopathic scoliosis over 45°: an observational prospective cohort controlled study. Spine J. 2010;14(9):1951–6.CrossRef
10.
Brox JI, Lange JE, Gunderson RB, Steen H. Good brace compliance reduced curve progression and surgical rates in patients with idiopathic scoliosis. Eur Spine J. 2012;21:1957–63.CrossRefPubMedPubMedCentral
11.
Aulisa GO, Giordano M, Falciglia F, et al. Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner. Scoliosis. 2014;9:6.CrossRefPubMedPubMedCentral
12.
13.
Labelle H, Dansereau J, Bellefleur C, Poitras B. Three-dimensional effect of the Boston brace on the thoracic spine and rib cage. Spine. 1996;21:59–64.CrossRefPubMed
14.
Schmitz A, Kandyba J, Koenig R, Jaeger UE, Gieseke J, Schmitt O. A new method of MR total spine imaging for showing the brace effect in scoliosis. J Orthop Sci. 2001;6:316–9.CrossRefPubMed
15.
Sangole AP, Aubin CE, Labelle H, Stokes IA, Lenke LG, Jackson R, Newton P. Three-dimensional classification of thoracic scoliotic curves. Spine. 2009;34:91–9.CrossRefPubMed
16.
Wong MS. A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis. Prosthet Orthot Int. 2005;29(1):105–11.CrossRefPubMed
17.
Wong MS. Computer-aided design and computer-aided manufacture (CAD/CAM) system for construction of spinal orthosis for patients with adolescent idiopathic scoliosis. Physiother Theory Pract. 2011;27(1):74–9.CrossRefPubMed
18.
Gignac D, Aubin CE, Dansereau J, Labelle H. Optimization method for 3D bracing correction of scoliosis using a finite element model. Eur Spine J. 2000;9:185–90.CrossRefPubMedPubMedCentral
19.
Wynarsky GT, Schultz AB. Optimization of skeletal configuration: studies of scoliosis correction biomechanics. J Biomech. 1991;24(8):721–32.CrossRefPubMed
20.
Perie D, Aubin CE, Lacroix M, Lafon Y, Labelle H. Biomechanical modelling of orthotic treatment of the scoliotic spine including a detailed representation of the brace-torso interface. Med Biol Eng Comput. 2004;42:339–44.CrossRefPubMed
21.
Perie D, Aubin CE, Petit Y, Labelle H, Dansereau J. Personalized biomechanical simulations of orthotic treatment in idiopathic scoliosis. Clin Biomech. 2004;19:190–5.CrossRef
22.
Clin J, Aubin CE, Labelle H. Virtual prototyping of a brace design for the correction of scoliotic deformities. Med Biol Eng Comput. 2007;45:467–73.CrossRefPubMed
23.
Clin J, Aubin CE, Parent S, Labelle H. Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads. Med Biol Eng Comput. 2011;49:743–53.CrossRefPubMed
24.
Desbiens-Blais F, Clin J, Parent S, Labelle H, Aubin CE. New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis. Clin Biomech. 2012;27:999–1005.CrossRef
25.
Cobetto N, Aubin CE, Clin J, Le May S, Desbiens-Blais F, Labelle H, Parent S. 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 Deformity. 2014;2(4):276–84.CrossRefPubMed
26.
Cobetto N, Aubin CE, Parent S, Clin J, Barchi S, Tirgeon I, Labelle H. 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. 2016 [Epub ahead of print].
27.
Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005;30(18):2068–75.CrossRefPubMed
28.
Humbert L, De Guise JA, Aubert B, Godbout B, Skalli W. 3D reconstruction of the spine from bi-planar x-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys. 2009;31:681–7.CrossRefPubMed
29.
Sangole A, Aubin CE, Labelle H, Stokes AF, Lenke L, Jackson R, Newton P. Three-dimensional classification of thoracic scoliotic curves. Spine. 2008;34:91–9.CrossRef
30.
Pomero V, Mitton D, Laporte S, de Guise JA, Skalli W. Fast accurate stereoradiographic 3D-reconstruction of the spine using a combined geometric and statistic model. Clin Biomech. 2004;19(3):240–7.CrossRef
31.
Pazos V, Cheriet F, Dansereau J, Ronsky J, Zernicke RF, Labelle H. Reliability of trunk shape measurements based on 3-D surface reconstructions. Eur Spine J. 2007;16:1882–91.CrossRefPubMedPubMedCentral
32.
Raux S, Kohler R, Garin C, Cunin V, Abelin-Genevois K. Tridimensional trunk surface acquisition for brace manufacturing in idiopathic scoliosis. Eur Spine J. 2014;4:S419–23.CrossRef
33.
Clin J, Aubin CE, Parent S, Labelle H. A biomechanical study of the Charleston brace for the treatment of scoliosis. Spine (Phila Pa 1976). 2010;35(19):E940–7.CrossRef
34.
Aubin C, Descrimes JL, Dansereau J, et al. Geometrical modeling of the spine and the thorax for the biomechanical analysis of scoliotic deformities using the finite element method. Ann Chir. 1995;49:749–61.PubMed
35.
Aubin CE, Dansereau J, de Guise JA, Labelle H. A study of biomechanical coupling between spine and rib cage in the treatment by orthosis of scoliosis. Ann Chir. 1996;50:641–50.PubMed
36.
Howard A, Wright JG, Hedden D. A comparative study of TLSO, Charleston and Milwaukee braces for idiopathic scoliosis. Spine. 1998;23:2404–11.CrossRefPubMed
37.
Aubin CE, Dansereau J, de Guise JA, Labelle H. Rib cage-spine coupling patterns involved in brace treatment of adolescent idiopathic scoliosis. Spine. 1996;22:629–35.CrossRef
38.
Zhang M, Mak A. In vivo friction properties of human skin. Prosthetics Orthot Int. 1999;23:135–41.
39.
Nault ML, Mac-Thiong JM, Roy-Beaudy M, Turgeon I, Deguise J, Labelle H, Parent S. Three-dimensional spinal morphology can differentiate between progressive and non-progressive patients with adolescent idiopathic scoliosis at the initial presentation: a prospective study. Spine. 2014;39:E601–6.CrossRefPubMedPubMedCentral
40.
Al-Aubaidi Z, Shin EJ, Howard A, Zeller R. Three dimensional analysis of brace biomechanical efficacy for patients with AIS. Eur Spine J. 2013;22(11):2445–8.CrossRefPubMedPubMedCentral
Metadata
Title
3D correction of AIS in braces designed using CAD/CAM and FEM: a randomized controlled trial
Authors
Nikita Cobetto
Carl-Éric Aubin
Stefan Parent
Soraya Barchi
Isabelle Turgeon
Hubert Labelle
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Scoliosis and Spinal Disorders / Issue 1/2017
Electronic ISSN: 2397-1789
DOI
https://doi.org/10.1186/s13013-017-0128-9

Other articles of this Issue 1/2017

Scoliosis and Spinal Disorders 1/2017 Go to the issue

Research

Introversion, the prevalent trait of adolescents with idiopathic scoliosis: an observational study

Research

French validation of the Brace Questionnaire (BrQ)

Research

Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study

Research

Results of ultrasound-assisted brace casting for adolescent idiopathic scoliosis

Review

Low back pain in older adults: risk factors, management options and future directions

Research

Curve flexibility in cerebral palsy-related neuromuscular scoliosis: does the intraoperative prone radiograph reveal more flexibility than preoperative radiographs?