Evaluation of Predictors and Outcomes of Bracing with Emphasis on the Immediate Effects of in-Brace Correction in Adolescent Idiopathic Scoliosis.

Background: Adolescent idiopathic scoliosis (AIS) is defined as a lateral curvature of the spine of unknown etiology with a Cobb angle of greater than 10 degrees with vertebral rotation. Bracing, specifically with a rigid thoracolumbosacral orthosis (TLSO), decreases the risk of curve progression to over 50 degrees, the threshold for surgical intervention. Some authors have suggested that 30-50% in-brace correction of the Cobb angles is required to prevent significant curve progression. The purpose of the study is to evaluate the current bracing protocol at the University of Iowa as a quality control exercise for the treatment team.

Methods: AIS patients (n = 61; 8 male, 53 female) who received a Rosenberger TLSO at the University of Iowa Department of Orthopaedics and Rehabilitation from 2016-2017 were included in the study. Inclusion criteria include presence of pre-brace and in-brace x-rays within 3 months of initiating brace treatment. Patients with other diagnoses were excluded. Radiographic indicators of brace effectiveness, such as the Cobb angle, were measured.

Results: The in-brace x-rays of 46 (76%) patients showed less than 30% correction. Minimal changes from the pre- to in-brace x-ray were observed in other radiographic measures.

Conclusions: Results indicate that if the 30-50% correction recommended by the literature is valid, then modifications to the process of measuring, fabricating or modifying our current TLSO's for AIS are warranted..