Bracing Scoliosis according to‚ Best Practice’ Standards

Introduction: As has been demonstrated before bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of polyethylene (PE) and soft braces. The plaster cast method worldwide seems to be the most practiced technique for the construction of hard braces at the moment. CAD / CAM (Computer Aided Design / Computer Aided Manufacturing) systems are available which allow brace adjustments without plaster. As in the Ukraine the CAD / CAM technology is not affordable, we have tried to build our hand-made braces according to this standard via cast modelling. Aim of this study is to compare in-brace corrections of our brace built according to‚ Best Practice’ Chêneau standards by hand with the published results available in literature on Chêneau braces.

Methods: In-brace correction and compliance clearly determine the outcome of bracing. Therefore, the in-brace correction is one of the most important parameters to estimate brace quality. We have been looking at the results achieved in our department after having been trained in the construction, adjustment and use of ‚Best Practice’ CAD / CAM Chêneau braces. All braces (of 207 patients) made between January 2009 and December 2010 have been reviewed for in-brace correction. As not all of the patients were in the normal range of brace indication, (Cobb 20 – 45°; age 10 – 14 years) we have been looking for the appropriate subset from our database fulfilling the following inclusion criteria: Girls only; diagnosis of an Adolescent Idiopathic Scoliosis (AIS); Cobb 20 – 45°; age 10 – 14 years).

Discussion: 92 Patients fulfilled the inclusion criteria (Cobb 20 – 45°; age 10 – 14 years). Average Cobb angle was 29.2° (SD 6), Average in-brace Cobb angle was 12.8° (SD 6.2). In-brace correction in the whole sample was 56%.

Conclusion: After appropriate training the experienced CPO is able to provide a hand-made standard of braces comparable to the recent CAD / CAM standard of bracing. In principle the results may be repeatable. Further studies on our hand-made series of braces are necessary (1) to evaluate brace comfort and (2) effectiveness using the SRS inclusion criteria. Less experienced technicians are advised to use standardized, expert driven and well established, CAD / CAM services.