Bracing scoliosis: the evolution to CAD/CAM for improved in-brace corrections

Introduction There are a wide variety of brace applications available today with different outcomes and different characteristics. The purpose of this study is to compare in-brace corrections of the series applied today to recent Chêneau series braces as presented in literature. methodology All patients were registered and fulfil the Scoliosis Research Society inclusion criteria for studies on bracing from 2012. A total of 21 female patients matched with the Scoliosis Research Society inclusion criteria. These 21 girls were of an average age of 12.2 years (standard deviation = 1.1). Average Risser stage was 0.38 (standard deviation = 0.68), average Cobb angle was 31.33° (standard deviation = 6.58). In-brace correction from this sample has been compared to the in-brace corrections of other Chêneau samples as published in literature using a test for comparison of two different proportions. Average Cobb angle in the brace was 10.66°; 34% of the initial angle that makes an in-brace correction of 66%. A significant difference is revealed for some samples and the absolute in-brace correction was highest in our sample showing that the application of the actual state of computer-aided design/computeraided manufacturing braces leads to better in-brace corrections than many cast-made braces, and also better in-brace corrections when comparing to computer-aided design/ computer-aided manufacturing braces as published. Conclusion Symmetric braces are outdated. Asymmetric braces allow better in-brace correction when compared to symmetric braces. Asymmetric braces according to the actual, Best Practice® computer-aided design/ computer-aided manufacturing standard allow for improved in-brace corrections promising the best possible radiological and cosmetic end results. Future studies on in-brace corrections and outcomes on brace treatment should use the Scoliosis Research Society inclusion criteria for bracing to improve comparability. Introduction Scoliosis is a three-dimensional deformity of the spine and trunk, which may deteriorate quickly during phases of rapid growth1. Although research is still being conducted on the effects of physiotherapy2 for scoliosis, bracing is recognized to stop progression3 during the pubertal growth spurt. Now, with the newest Chêneau style computer-aided design/ computer-aided manufacturing (CAD/ CAM) bracing under certain circumstances the potential exists to improve curvature radiologically and visually4. With the variety of brace applications available today, there are different characteristics with varying outcomes. Independent studies have shown that soft braces have no advantage over rigid braces5–8. Rigid braces may be symmetric or asymmetric. Examples of symmetric braces are the Boston brace9 or the symmetric, patient-oriented rigid trunk orthosis (SPORT) brace from Italy10. No in-brace corrections are reported for the latter brace (Figure 1). Symmetric braces have pad inlays that push on the most prominent areas of the scoliotic trunk. Asymmetric braces are constructed in an attempt for overcorrection with foam pads used for augmentation in the pressure areas but also for providing spaces on the opposing sides of the pressure areas. The most effective asymmetric brace is the Chêneau brace11. The primary advantage of the Chêneau brace over symmetric braces is the higher in-brace correction11. Its unique structure allows for a correction in three dimensions (in the sagittal, frontal and transverse planes) and allows room for corrective breathing; a concept in sync with principles of non-surgical scoliosis management via Best Practice® based upon Schroth Method principles. The newest Chêneau brace is also manufactured using less material making the brace lighter than previously manufactured braces with the goal of improving comfort and wearability offering increased likelihood of improved patient compliance (Figure 2). It is generally agreed that bracing outcomes are determined by the amount of in-brace correction and compliance12. Therefore, the aim of future developments should be improvement of in-brace correction and comfort. A recent study reveals that not all Chêneau braces are of comparable quality or have the ability to achieve the same in-brace correction. Borysov and Borysov