Introduction: Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods: One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results: Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions: The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS.

BACKGROUND: Lack of initial in-brace correction is strongly predictive for brace treatment failure in adolescent idiopathic scoliosis (AIS) patients. Computer-aided design (CAD) technology could be useful in quantifying the trunk in 3D and brace characteristics in order to further investigate the effect of brace modifications on initial in-brace correction and subsequently long-term brace treatment success. The purpose of this pilot study was to identify parameters obtained from 3D surface scans which influence the initial in-brace correction (IBC) in a Boston brace in patients with AIS.
METHODS: Twenty-five AIS patients receiving a CAD-based Boston brace were included in this pilot study consisting of 11 patients with Lenke classification type 1 and 14 with type 5 curves. The degree of torso asymmetry and segmental peak positive and negative torso displacements were analyzed with the use of patients\' 3D surface scans and brace models for potential correlations with IBC.
RESULTS: The mean IBC of the major curve on AP view was 15.9% (SD = 9.1%) for the Lenke type 1 curves, and 20.1% (SD = 13.9%) for the type 5 curves. The degree of torso asymmetry was weakly correlated with patient\'s pre-brace major curve Cobb angle and negligible correlated with major curve IBC. Mostly weak or negligible correlations were observed between IBC and the twelve segmental peak displacements for both Lenke type 1 and 5 curves.
CONCLUSIONS: Based on the results of this pilot study, the degree of torso asymmetry and segmental peak torso displacements in the brace model alone are not clearly associated with IBC.

Spinal bracing is a proven effective treatment for children with adolescent idiopathic scoliosis (AIS). Four factors have been reported to affect brace treatment outcome including (1) growth or curve-based risk, (2) the in-brace correction, (3) the brace wear quantity, and (4) the brace wear quality. The in-brace correction is impacted by spinal flexibility. The quality of brace design also affects the in-brace correction and comfort which indirectly affects the brace wear quantity and quality. A traditional polypropylene spinal brace is bulky and uncomfortable, and its manufacturing process is labor intensive. As 3D printing technology becomes more common and advanced, there is a potential to manufacture spinal braces using 3D printing technology. The objectives of this paper were to report the immediate effectiveness and benefits in using 3D printed brace to treat children with AIS. Six children with AIS (5F, 1M; 12.9 ± 1.4 years old; Cobb angle: 26° ± 7°), who were new to brace treatment, were recruited. Spinal flexibility and pressure pad locations were acquired using ultrasound assisted method to ensure braces were designed properly. To manufacture the braces, all participants were scanned by a handheld 3D scanner to obtain their body shapes. The 3D braces were then printed with Nylon 12 material. The average in-brace Cobb angle correction was 10 ± 4° (41 ± 18% correction). The 3D brace was 33% thinner, 26% lighter, 37% lower cost and required 3.7 h less labor time to manufacture when compared with the standard polypropylene brace. As a conclusion, the 3D printed brace had good immediate treatment effectiveness, but the long-time effect is still required time to explore.

To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS).
In this retrospective multicenter study, the patient\'s sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up.
A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11.
C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS.
IV.

BACKGROUND: In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not.
METHODS: All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation.
RESULTS: Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014).
CONCLUSIONS: Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays.
BACKGROUND: ClinicalTrials.gov- NCT02412137 , initial registration date April 2015 LEVEL OF EVIDENCE: III.

UNASSIGNED: Serial casting under general anesthesia, which is considered as a gold standard of treatment for patients with infantile idiopathic scoliosis (IIS), can lead to significant negative neurodevelopmental effects. Therefore, the appropriateness of this type of treatment is controversial. Brace treatment is one alternative method of treatment for IIS patients. However, long-term studies have not yet verified its effectiveness. Thus, the present study aimed to evaluate the effectiveness of brace treatment in patients with IIS until skeletal maturity or spinal fusion.
UNASSIGNED: The medical records of all IIS patients with the referral age of 0-3 years who received brace treatment from June 1986 to November 2013 were reviewed. Those patients with pre-brace Cobb angle > 20° were included and followed up to skeletal maturity or the time of spinal fusion. The Cobb angle was recorded at the time of diagnosis before the initiation of bracing, weaning time, brace discontinuation, and final follow-up. In addition, the maximum in-brace curve correction was measured.
UNASSIGNED: Out of 87 patients with IIS, a total of 29 cases (19 males and 10 females) with the average curve magnitude of 35.62° at the time of diagnosis were included in the study. The average best in-brace correction was 57.32% for successfully treated patients and 36.97% for progression/surgery patients. Based on the results, brace treatment failed for a total of 20 patients (69%), with a scoliosis curvature progress ≥ 45°. Of these patients, 12 cases (60%) reached spinal fusion. Finally, four patients (13%) in the surgery-treated group underwent surgery before the age of 10.
UNASSIGNED: The results revealed that bracing was successful for more than two-thirds of patients with IIS curves, preventing surgery before the age of 10.

Since 2006, the Providence nighttime brace has been used for a conservative treatment for scoliosis. Previous studies comparing the outcomes after full-time bracing and nighttime bracing have reported a comparable outcome with curves < 35°. The aim of this study was to report the outcome after treatment in a cohort of adolescent idiopathic scoliosis patients, with curves between 20° and 45°.
METHODS: One hundred and twenty-four patients with adolescent idiopathic scoliosis were included in this study with Cobb > 20°, remaining growth potential and no previous scoliosis treatment. Providence nighttime treatment, 8 h nightly, was initiated. Treatment was continued until 2 years post-menarcheal for females and until 6-month growth arrest for males. The patients were evaluated using standing radiographs during treatment and 6 and 12 months after termination of bracing.
RESULTS: One hundred and twenty-four patients were included; 80 patients terminated brace treatment and were available for follow-up. Mean in-brace correction was 82%, and curve progression was observed in 9 patients. Brace treatment was success full in 89% of the patients, 88% of the patients braced with curves 20°-29°, 93% of the patients braced with 30°-39° and 77% of the patients braced with curves 40°-45°. Five of the 80 AIS patients were referred to surgery: 4 due to progression and 1 due to cosmetic concerns.
CONCLUSIONS: Providence nighttime braces are an effective treatment for adolescent idiopathic scoliosis patients. This study reports a success rate of 89%, and the results are comparable to full-time treatment with the Boston brace. In-brace correction is crucial in part-time bracing, and we recommend at least 70% curve correction, if part-time bracing should be considered. These slides can be retrieved under Electronic Supplementary Material.

In-brace correction (IBC) plays an important role in curve progression of patients with adolescent idiopathic scoliosis (AIS) under brace treatment. We evaluated the coronal deformity angular ratio (C-DAR) as a potential predictor of IBC. Based on our experience, we postulated that a high C-DAR may result in low IBC. This relationship had not been previously studied.
To evaluate the relationship of C-DAR and IBC in patients with AIS.
A retrospective study.
A total of 119 patients with AIS treated with a Gensingen brace in our scoliosis center from July 2015 to October 2017 were included.
In-brace correction.
Data were collected before and upon brace placement. Correlation analyses between study variables and IBC were performed. A linear regression model was established on the basis of C-DAR.
At brace fitting, the average age was 12.62±1.16 (range, 10-15) years and mean major curve Cobb angle was 32.14±4.66° (range, 25-40°). Mean IBC was 59.62%±22.03% (range, 16.2-100%). IBC had significant correlation with C-DAR (r=-0.69; 95% confidence interval, -0.77 to -0.61; p<.001). IBC was not significantly correlated with age, sex, height, weight, BMI, menstrual status, or Risser sign. A simple linear regression model established that in-brace correction=115.4-10.7×C-DAR.
C-DAR has strong negative correlation with IBC and may estimate the expected IBC. The usage of C-DAR may obviate the need for flexibility radiographs, such as supine or supine lateral bending radiographs.

OBJECTIVE: To identify the factors affecting in-brace correction in patients with adolescent idiopathic scoliosis (AIS).
METHODS: We performed a retrospective analysis of patients with AIS receiving Gensingen brace treatment in our scoliosis center from July 2015 to October 2017 was performed. The selection of patients was in accordance with the Scoliosis Research Society inclusion criteria for a bracing study. Some radiographic and clinical parameters, including the Cobb angle, rib-vertebra angle difference, coronal and sagittal balance, lumbar-pelvic relationship (LPR), Risser sign, curve type, age, gender, height, weight, body mass index, and menstrual status were collected. The correlation and difference analyses were performed to identify the factors influencing in-brace correction.
RESULTS: A cohort of 112 patients with AIS (94 girls and 18 boys) were included in the present study. The mean in-brace correction was 59.29% ± 22.33% (range, 16.22%-100.00%). In-brace correction showed a significantly negative correlation with the major curve Cobb angle, minor curve Cobb angle, total curve Cobb angle, and LPR (P < 0.05 for all). Sagittal and coronal imbalance could reduce the curve correction (P < 0.001 and P = 0.008, respectively). The remaining parameters were not related to in-brace correction.
CONCLUSIONS: In-brace correction in the present study was 59.29% ± 22.33% (range, 16.22%-100.00%). Some factors, including the Cobb angle, sagittal and coronal balance, and LPR, have an effect on in-brace correction. The results from the present study can provide some useful information for brace design and fabrication.

BACKGROUND: Physiotherapeutic Scoliosis-Specific Exercises (PSSE) and bracing have been found to be effective in the stabilization of curves in patients with Adolescent Idiopathic Scoliosis (AIS). Yet, the difference among the many PSSEs and braces has not been studied. The present review attempts to investigate the role of curve correction in the outcome of treatment for PSSEs and braces.
METHODS: A PubMed manual search has been conducted for studies on the role of correction in the effectiveness of PSSE and bracing. For the PSSEs, the key words used were \"adolescent idiopathic scoliosis, correction, physiotherapy, physical therapy, exercise, and rehabilitation.\" For bracing, the key words used were \"adolescent idiopathic scoliosis, correction and brace\". Only papers that were published from 2001-2017 were included and reviewed, as there were very few relevant papers dating earlier than 2001.
RESULTS: The search found no studies on the role of correction on the effectiveness of different PSSEs. The effectiveness of different PSSEs might or might not be related to the magnitude of curve correction during the exercises. However, many studies showed a relationship between the magnitude of in-brace correction and the outcome of the brace treatment.
CONCLUSIONS: The role of correction on the effectiveness of PSSE has not been studied. In-brace correction, however, has been found to be associated with the outcome of brace treatment. An in-brace correction of < 10% was associated with an increased rate of failure of brace treatment, whereas an in-brace correction of >40-50% was associated with an increased rate of brace treatment success (i.e. stabilization or improvement of curves). Thus, in the treatment of AIS, patients should be advised to use highly corrective braces, in conjunction with PSSE since exercises have been found to help stabilize the curves during weaning of the brace. Presently, no specific PSSE can be recommended.
CONCLUSIONS: Braces of high in-brace correction should be used in conjunction with PSSEs in the treatment of AIS. No specific PSSE can be recommended as comparison studies of the effectiveness of different PSSEs are not found at the time of this study.