Could Novel Spinal Braces with Flexibility, Robotic Components, and Individualized Design Generate Sufficient Biomechanical Treatment Efficacy in Patients with Scoliosis?

Background: Patients with adolescent idiopathic scoliosis (AIS) require effective bracing to control curve progression. However, most traditional spinal braces commonly pose challenges in terms of undesired bulkiness and restricted mobility. Recent advancements have focused on innovative brace designs, utilizing novel materials and structural configurations to improve wearability and functionality. However, it remains unclear how effective these next-generation braces are biomechanically compared to traditional braces. Objectives: This review aimed to analyze the design features of next-generation AIS braces and assess their biomechanical effectiveness via reviewing contemporary studies. Methods: Studies on newly designed scoliosis braces over the past decade were searched in databases, including Web of Science, PubMed, ScienceDirect, Wiley, EBCOHost and SpringerLink. The Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies was adopted to evaluate the quality of the included studies. The data extracted for biomechanical effect analysis included brace components/materials, design principle, interfacial pressure, morphological changes, and intercomparison parameters. Results: A total of 19 studies encompassing 12 different kinds of braces met the inclusion/exclusion criteria. Clinical effectiveness was reported in 14 studies, with an average short-term Cobb angle correction of 25.4% (range: 12.41–34.3%) and long-term correction of 18.22% (range: 15.79–19.3%). This result aligned broadly with the previously reported efficacy of the traditional braces in short-term cases (range: 12.36–31.33%), but was lower than the long-term ones (range: 23.02–33.6%). Two included studies reported an interface pressure range between 6.0 kPa and 24.4 kPa for novel braces, which was comparable to that of the traditional braces (4.8–30.0 kPa). Additionally, five of six studies reported the trunk asymmetric parameters and demonstrated improvement in trunk alignment. Conclusions: This study demonstrates that most newly designed scoliosis braces could achieve comparable biomechanical efficacy to the conventional designs, particularly in interface pressure management and Cobb angle correction. However, future clinical adoption of these novel braces requires further improvements of ergonomic design and three-dimensional correction, as well as more investigation and rigorous evidence on the long-term treatment outcomes and cost-effectiveness.