Evaluation of In-Brace Coronal and Sagittal Plane Measurements Between CAD/Chêneau-Style and Traditionally Fabricated Wilmington Braces in Adolescent Idiopathic Scoliosis

Abstract

ABSTRACT Introduction Traditional thoracolumbosacral orthosis fabrication involves truncal casting (traditionally fabricated [TF] Wilmington brace [WB]), whereas the newer Chêneau-style brace (computer-aided design [CAD]) involves three-dimensional truncal scanning technology. We sought to evaluate how these two brace styles affect the position of the spine in the coronal and sagittal plane. Materials and Methods Inclusion criteria included adolescent idiopathic scoliosis treated with WB or CAD Chêneau-style brace, major curve Cobb angle 20°–45°, age 10–15 years, Risser 0–3, and radiographs (prebrace and in-brace posteroanterior and lateral). Analysis included 28 CAD Chêneau-style braces and 56 WB patients. Results There was no difference between groups regarding age, sex, body mass index, major curve location, major curve degree, sagittal plane curvature, and pelvic parameters. In-brace analysis demonstrated decreased sagittal plane curvatures and increased T1 pelvic angle in both groups; both had significantly reduced major curve correction. Coronal plane major curve correction ratio of the two groups was similar (P = 0.236). In the CAD Chêneau-style brace group, the thoracolumbar junction became more kyphotic (P = 0.03). In the WB group, both coronal balance and thoracic trunk shift were leftward (P = 0.001). Both groups had a significant increase in T1 pelvic angle, but this increase was higher in the CAD Chêneau-style brace group (P = 0.045). Conclusions Both braces exert a flattening effect on the spine and positive global sagittal balance. Coronal plane major curve correction was similar for both groups. Coronal plane trunk shift and C7 coronal balance were significantly changed leftward after WB application. Kyphotic thoracolumbar transition and forward tilt of the spine (T1 pelvic angle) were significantly greater in CAD Chêneau-style brace than WB. Clinical Relevance A Chêneau-style brace fabricated with CAD/computer-aided manufacturing technology can produce a brace comparable to one fabricated by traditional methods using cast molding.