Serial CAD/CAM Bracing: An Alternative to Serial Casting for Early Onset Scoliosis

Area of Science:

• Orthopedics
• Biomedical Engineering
• Pediatric Spine Surgery

Background:

• Casting for infantile scoliosis negatively impacts quality of life and raises concerns about neurodevelopmental effects of repeated anesthesia.
• An elongation bending derotation brace (EBDB) was developed to achieve scoliosis correction using bending derotation forces, similar to casting but without its drawbacks.

Purpose of the Study:

• To describe preliminary results of a novel technique for creating an elongation bending derotation brace (EBDB) for infantile idiopathic scoliosis.
• To evaluate the efficacy of CAD/CAM technology in fabricating patient-specific braces for infantile scoliosis with a minimum 24-month follow-up.

Main Methods:

• A cohort of nine patients with infantile idiopathic scoliosis (mean age 11 months) underwent treatment with a custom-fabricated EBDB.
• Computer-aided design/computer-aided milling (CAD/CAM) technology was utilized to create the EBDB, incorporating laser scanning for spinal geometry and heat sensors for compliance monitoring.
• The brace fabrication mimicked the rotational forces used in Mehta-type casting.

Main Results:

• Four patients achieved full correction (curve ≤10 degrees) with serial bracing alone.
• Five patients with more rigid curves demonstrated significant improvement, with mean curve reduction from 57 degrees to 21 degrees.
• The mean follow-up period was 3.4 years (range, 2 to 6 years).

Conclusions:

• The study presents preliminary findings on a new CAD/CAM-based methodology for creating patient-specific braces for infantile scoliosis.
• This EBDB approach shows potential for effectively treating infantile idiopathic scoliosis, offering an alternative to traditional casting.
• The technique avoids the drawbacks associated with repeated casting and anesthesia in young children.