Brace yourself (Part-time): part-time bracing leads to curve improvement in juvenile idiopathic scoliosis.

Abstract

The efficacy of bracing for juvenile idiopathic scoliosis (JIS) remains controversial. Although full-time bracing is standard for curves > 25°, part-time bracing for smaller curves (< 25°) may prevent progression. This study evaluates the effectiveness of part-time bracing compared to observation in JIS patients with 15-24° curves, hypothesizing that part-time bracing reduces curve progression and the need for full-time bracing. This retrospective cohort study reviewed skeletally immature JIS patients (4-10 years old) with 15-24° curves. Patients underwent either observation or part-time bracing (8-12 h/day). Minimum two-year outcomes included: (1) curve change (> 5°), (2) progression to > 25° requiring full-time bracing, and (3) prescription for full-time bracing. Eighty-three patients (59% observed, 41% braced) were analyzed. The braced cohort demonstrated slightly higher baseline curves (+ 1.6°, p = 0.01). By final follow-up, braced patients improved by 3.2° (p = 0.05), while the observed cohort worsened by 3.4° (p = 0.05). More braced patients improved > 5° (69% vs. 21%, p < 0.001), whereas more observed patients progressed > 5° (54% vs. 11%, p < 0.001) and to > 25° (54% vs. 20%, p = 0.002). Full-time bracing was prescribed for 63% of observed patients but only 17% of braced patients (p < 0.001). Part-time bracing not only prevents curve progression, but also frequently leads to improved curve magnitude in JIS patients with smaller curves, minimizing the need for full-time bracing.