Early Brace Treatment: The New Standard for Adolescent Idiopathic Scoliosis?

Abstract

No direct comparison exists between early bracing of adolescent idiopathic scoliosis (AIS) at curve magnitudes of 15° to 24° vs. observation until the Scoliosis Research Society-recommended criteria of ≥25°. We compared curve improvement and progression between early bracing vs. standard treatment with bracing starting at ≥25°. A retrospective review was performed among patients Risser 0 to 1 with AIS curves 15° to 24° at initial visit who were followed until skeletal maturity or surgery. Patients prescribed rigid thoracolumbar sacral orthoses (TLSO) for curves 15° to 24° (early group) were compared with a control group observed until TLSO prescription at ≥25° (standard group). A subanalysis of open triradiate cartilage status (TRC) was performed. At final follow-up, patients were categorized into curve improvement ≥6°, stable (-5° to +5°), progression ≥6°, and progression to surgical magnitude (≥45°). Among 414 patients (207 early, 207 standard) matched by skeletal maturity, the early group had greater curve improvement (19% vs. 1%, p < 0.001, odds ratio 16.3), greater stability (50% vs. 37%, p = 0.007), less progression ≥6° (31% vs. 62%, p < 0.001), and less progression to a surgical magnitude (6% vs. 14%, p = 0.014) than the standard group. Patients with open TRC highlighted these differences, with the early group demonstrating greater curve improvement (18% vs. 2%, p < 0.01), greater stability (42% vs. 21%, p < 0.001), less progression ≥6° (39% vs. 77%, p < 0.001), and less progression to a surgical magnitude (9% vs. 20%, p = 0.018) than the standard group, especially those with thoracic curves 20° to 24° at initial visit (13% vs. 43%, p = 0.001). The number needed to treat was 3.3. Early brace treatment of AIS curves 15° to 24° is superior to observation until brace initiation at 25°, with a 16-fold increased likelihood of improving curves and reducing progression to a surgical threshold by >50%. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.