Treat the person, not the X Rays or the disorder
1. Clinical Signs
2. Biomechanical Signs
3. Radiographic Signs
The use of CAD-CAM technology in the treatment of adolescent idiopathic scoliosis:
•First reported in Spine in 2005 by a team of French physicians and researchers.1
•Second was quickly followed the same year by the preliminary outcomes of a second medical team in China. 2
•The following is an introduction to a third CAD- CAM assisted approach developed by
Dr. Miguel Gomez, of Bogotá, Colombia.
In introducing his approach, it is important to underscore that CAD-CAM should be seen as a single tool within the process and that the effectiveness of the bracing system is mostly dependent upon the experience and attention to detail on the part of the treating clinicians. Many of the principles introduced came from Dr. Gomez's two decades of experience treating spinal deformities by traditional methods of hand casting and hand model rectification. However, the ability to apply these principles in a consistent, reproducible manner has been enhanced by the CAD technology.
• Inputs
Optimal use of a CAD-CAM based system requires multiple inputs. Each treatment plan begins with a careful evaluation of the patient's deformity and in the coronal, sagittal and transverse planes documented by digital photography.
• Patient Measurements
As part of the clinical evaluation, over 25 anthropometric measurements are taken that include lengths, MLs, APs and circumferences as well as the geometry in all 3 planes.
• Flexibility
Flexibility of the spinal column is difficult to quantify, but important in predicting and ensuring maximal in-brace correction for each case.
Flexibility of the spinal column is difficult to quantify, but important in predicting and ensuring maximal in-brace correction for each case.
• Balance Assessment
A final component to the patient assessment is careful observations of the patient's overall balance. This is done in both the sagital and coronal plane and can be performed with the assistance of a laser level.
A final component to the patient assessment is careful observations of the patient's overall balance. This is done in both the sagital and coronal plane and can be performed with the assistance of a laser level.
• Fitting
During the fitting appointment, accurate fit of the orthosis is verified. Trim lines are adjusted as needed to facilitate patient comfort and compliance.
• Follow-up
As with any spine bracing system, the effectiveness of the orthosis is ultimately verified radiographically. At this point, the clinician should verify that the results obtained by the orthosis are consistent with the flexibility of the individual curve, both with respect to the Cobb angles and decompensation.
As with any spine bracing system, the effectiveness of the orthosis is ultimately verified radiographically. At this point, the clinician should verify that the results obtained by the orthosis are consistent with the flexibility of the individual curve, both with respect to the Cobb angles and decompensation.
• Outcomes
The bracing system described is currently being utilized at Texas Children's Hospital in Houston Texas, the University of Oklahoma in Oklahoma City, Texas Scottish Rite Hospital in Dallas Texas, and Children's Memorial Hospital in Chicago. The system has been in use for three years with positive preliminary outcomes. Long term outcome studies are underway.
The bracing system described is currently being utilized at Texas Children's Hospital in Houston Texas, the University of Oklahoma in Oklahoma City, Texas Scottish Rite Hospital in Dallas Texas, and Children's Memorial Hospital in Chicago. The system has been in use for three years with positive preliminary outcomes. Long term outcome studies are underway.
References:
1 Corttolorda J et al. Orthoses for mild scoliosis: a prospective study comparing traditional plaster mold manufacturing with fast, not contact, 3-dimensional acquisition. Spine. 2005; 15(4): 399-405.
2 Wong MS, Cheng JCY, Lo KH. A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis. Prosthet Orthot mi, 2005; 29(1): 105-111.
1 Corttolorda J et al. Orthoses for mild scoliosis: a prospective study comparing traditional plaster mold manufacturing with fast, not contact, 3-dimensional acquisition. Spine. 2005; 15(4): 399-405.
2 Wong MS, Cheng JCY, Lo KH. A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis. Prosthet Orthot mi, 2005; 29(1): 105-111.