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Serial CAD/CAM Bracing

An Alternative to Serial Casting for Early Onset Scoliosis

Thometz, John, MD; Liu, Xue-Cheng, MD, PhD

Journal of Pediatric Orthopaedics: March 2019 - Volume 39 - Issue 3 - p e185–e189
doi: 10.1097/BPO.0000000000001287
Spine

Background: Years of casting for infantile scoliosis can lead to significantly detrimental quality of life for both the child and parents. Concerns have been raised about the long-term negative neurodevelopmental effects of repeated anesthesia on young children. We developed an elongation bending derotation brace (EBDB) that uses primarily a bending derotation force applied to the curve to achieve the same goals as the cast. The goal of the study is to describe the preliminary results of a technique for creation of EBDB for infantile idiopathic scoliosis using computer-aided design/computer-aided milling (CAD/CAM) technology with at least 24 months follow-up.

Methods: Nine patients with infantile idiopathic scoliosis had minimum 2-year follow-up (mean, 3.4 y; range, 2 to 6 y). Mean age at the treatment was 11 months (4 to 24 mo). There were 2 right thoracic, 7 left thoracic curves. CAD/CAM technology was used to create the EBDB after the child was placed in traction and a derotation strap applied. The same rotational forces that are used in the creation of the Mehta-type cast can also be utilized in creating the brace. A laser scanner was used to obtain the spinal geometry. Compliance can be monitored with a heat sensor.

Results: Four patients were full corrected with serial bracing alone (curve ≤10 degrees). Five patients with more rigid curves showed improvement from mean 57 degrees (48 to 62 degrees) to mean 21 degrees (10 to 44 degrees).

Conclusions: This paper describes the preliminary results of a new methodology for creating a patient-specific brace for infantile scoliosis using CAD/CAM technology. This methods shows promising potential to treat the infantile curve without the drawbacks of casting.

Level of Evidence: Level IV.

Department of Orthopedic Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee, WI

No funding received from any organization.

The authors declare no conflicts of interest.

Reprints: John Thometz, MD, 9000 W. Wisconsin Avenue, P.O. Box 1997, Pediatric Orthopaedics, Suite 360, Milwaukee, WI 53201. E-mail: jthometz@chw.org.

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