Abstract
Study Design
Biomechanical study of the Providence brace for the treatment of adolescent idiopathic scoliosis (AIS).
Objectives
To model and assess the effectiveness of Providence nighttime brace.
Summary of Background Data
Providence nighttime brace is an alternative to traditional daytime thoracolumbosacral orthosis for the treatment of moderate scoliotic deformities. It applies three-point pressure to reduce scoliotic curves. The biomechanics of the supine position and Providence brace is still poorly understood.
Methods
Eighteen patients with AIS were recruited at our institution. For each patient, a personalized finite element model (FEM) of the trunk was created. The spine, rib cage, and pelvis geometry was acquired using simultaneous biplanar low-dose radiographs (EOS). The trunk surface was acquired using a three-dimensional surface topography scanner. The interior surface of each patient’s Providence brace was digitized and used to generate an FEM of the brace. Pressures at the brace/skin interface were measured using pressure sensors, and the average pressure distribution was computed. The standing to supine transition and brace installation were computationally simulated.
Results
Simulated standing to supine position induced an average curve correction of 45% and 48% for thoracic and lumbar curves, while adding the brace resulted in an average correction of 62% and 64% (vs. real in-brace correction of 65% and 70%). Simulated pressures had the same distribution as measured ones. Bending moments on apical vertebrae were mostly annulled by the positioning in the supine position, and further overcorrected on average by 10% to 13%, but in the opposite direction.
Conclusions
The supine position is responsible for the major part of coronal curve correction, while the brace itself plays a complementary role. Bending moments induced by the brace generated a rebalancing of pressure on the growth plates, which could help reduce the asymmetric growth of the vertebrae.
Level of Evidence
Level II.
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AS (grants from Natural Sciences and Engineering Research Council of Canada, from Canadian Institutes of Health Research, during the conduct of the study), JC (grants from Canadian Institutes of Health Research, grants from Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; other from Rodin 4D, outside the submitted work), NC (grants from Natural Sciences and Research Council of Canada, grants from Canadian Institutes of Health Research, during the conduct of the study; other from Lagarrigue [Rodin4D], outside the submitted work), HL (grants from Natural Sciences and Research Council of Canada, grants from Canadian Institutes of Health Research, during the conduct of the study; other from Spinologics, grants from Depuy Synthes, outside the submitted work), C-EA (grants from Natural Sciences and Research Council of Canada, grants from Canadian Institutes of Health Research, during the conduct of the study; other from Groupe Lagarrigue, other from Boston Brace, grants and other from Natural Sciences and Engineering Research Council of Canada; Research Chair program with Medtronic of Canada, outside the submitted work).
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional ethical research committee. Informed consent was obtained from all individual participants included in the study and their parents.
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Sattout, A., Clin, J., Cobetto, N. et al. Biomechanical Assessment of Providence Nighttime Brace for the Treatment of Adolescent Idiopathic Scoliosis. Spine Deform 4, 253–260 (2016). https://doi.org/10.1016/j.jspd.2015.12.004
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DOI: https://doi.org/10.1016/j.jspd.2015.12.004