3D-printed brace in the treatment of adolescent idiopathic scoliosis: a study protocol of a prospective randomised controlled trial

Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model

Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis.

Predicting spinal column profile from surface topography via 3D non-contact surface scanning

INTRODUCTION

3D Non-Contact surface scanning (3DSS) is used in both biomechanical and clinical studies to capture accurate 3D images of the human torso, and to better understand the shape and posture of the spine-both healthy and pathological. This study sought to determine the efficacy and accuracy of using 3DSS of the posterior torso, to determine the curvature of the spinal column in the lateral lying position.

METHODS

A cohort of 50 healthy adults underwent 3DSS and Magnetic Resonance Imaging (MRI) to correlate the contours of the external spine surface with the internal spinal column. The correlation analysis was composed of two phases: (1) MRI vertebral points vs MRI external spine surface markers; and (2) MRI external spine surface markers vs 3DSS external spine surface markers. The first phase compared the profiles of fiducial markers (vitamin capsules) adhered to the skin surface over the spinous processes against the coordinates of the spinous processes-assessing the linear distance between the profiles, and similarity of curvature, in the sagittal and coronal planes. The second phase compared 3DSS external spine surface markers with the MRI external spine surface markers in both planes, with further qualitative assessment for postural changes.

RESULTS

The distance between the MRI vertebral points and MRI external spine surface markers showed strong statistically significant correlation with BMI in both sagittal and coronal planes. Kolmogorov-Smirnov (KS) tests showed similar no significant difference in curvature, k, in almost all participants on both planes. In the second phase, the coronal 3DSS external spine surface profiles were statistically different to the MRI external spine surface markers in 44% of participants. Qualitative assessment showed postural changes between MRI and 3DSS measurements in these participants.

CONCLUSION

These study findings demonstrate the utility and accuracy of using anatomical landmarks overlaid on the spinous processes, to identify the position of the spinal bones using 3DSS. Using this method, it will be possible to predict the internal spinal curvature from surface topography, provided that the thickness of the overlaying subcutaneous adipose layer is considered, thus enabling postural analysis of spinal shape and curvature to be carried out in biomechanical and clinical studies without the need for radiographic imaging.

Additive Manufacturing of Spinal Braces: Evaluation of Production Process and Postural Stability in Patients with Scoliosis

Spinal orthoses produced using additive manufacturing show great potential for obtaining patient-specific solutions in clinical applications, reducing manual operations, time consumption, and material waste. This study was conducted to evaluate the production process of spinal orthoses produced by additive manufacturing, and to test the effects of 3D-printed braces on postural stability in patients with adolescent idiopathic scoliosis and osteogenesis imperfecta. Ten patients were recruited consecutively and were asked to wear a spinal orthosis produced by additive manufacturing for 2 weeks. The four phases of the production process for each brace were evaluated separately on a scale from 0 (not acceptable) to 3 (optimal). Postural stability in the unbraced and the two braced conditions (3D-printed and conventional) was assessed using validated metrics obtained from a wearable inertial sensor. The production process was evaluated as good in four cases, acceptable in five cases, and not acceptable in one case, due to problems in the printing phase. No statistically significant differences were observed in any of the postural balance metrics between the 3D-printed and conventional brace. On the other hand, postural balance metrics improved significantly with both types of braces with respect to the unbraced condition. Spinal orthoses produced with an innovative production process based on digital scans, CAD, and 3D printing are valid alternatives to conventionally produced orthoses, providing equivalent postural stability.

Effect of Window and Hole Pattern Cut-Outs on Design Optimization of 3D Printed Braces

Background

There are many different Thoracic Lumbar Sacral Orthosis style brace designs available in the market for the correction of scoliosis deformity. Hole cut out patterns, are commonly used in brace designs. These cut-outs may be subdivided into two groups: hole patterns and windows. Hole patterns are an array of holes which are implemented to lighten the weight of a brace and allow for the skin to breathe. Windows provide space for spinal derotation and/or breathing. From an examination of the literature, it appears that a systematic analysis of the effect of these cut-outs on the structural integrity and functionality of the brace has not been undertaken. Furthermore, there is a lack of understanding on the effect of spacing, size and geometry of the cut-outs on the mechanical behavior of the brace.

Method of Approach

In this study, Finite Element Analysis is employed to examine the mechanical response of the brace to these cut-outs. Geometry for the Thoracic Lumbar Sacral Orthosis was obtained by scanning an existing brace using an optical scan and converted into a Computer Aided Design model. A systematic approach was undertaken where cut-out geometry, spacing and size was varied. The deformation and stress in the thickness of the brace was ascertained from the Finite Element Analysis. An appropriate factor of safety for the structural analysis was determined using a standardized approach and used to quantify the structural integrity of the brace due to the cut-out. Various geometries were analyzed for the hole patterns including circle, triangle, diamond, and hexagon. For the window, the geometries considered were circle, trapezoidal and the "bib" geometry.

Results

It was found that linear hole patterns where the holes are aligned do not provide a desirable structural factor safety. Furthermore, among all the possible geometries, the hexagonal cut-out was the best structurally while reducing the weight of the brace the most. The optimal spacing was found to be 12 mm, and the optimal hole surface area was found to be 78.54 mm2. For the windows in the abdominal area, the "bib" shape provided the best structural integrity and generated the lowest amount of deformation. An increase in the size of this window had a small effect on the stress but an almost negligible effect on the deformation.

Conclusions

A hexagonal hole pattern should be used with a spacing of 12 mm and each hole should have a surface area of 78.54 mm2. Windows in the abdominal area should be of "bib" shape. The size of the window cut-outs does not affect the brace stress and deformation significantly. Thus, the size of these windows should be based on the functional aspects of the brace, i.e., the minimum required size needed to permit the patient to breathe comfortably as in the case of the abdominal window or to allow for proper derotation, as in the case of the derotation window.