• Users Online: 208
  • Print this page
  • Email this page

 Table of Contents  
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 151-159

Bracing in adolescent idiopathic scoliosis

1 Department of Orthopaedic Surgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 Department of Neurosciences, Park Clinic, Kolkata, West Bengal, India

Date of Submission18-Mar-2020
Date of Decision24-Apr-2020
Date of Acceptance07-Jun-2020
Date of Web Publication13-Jul-2020

Correspondence Address:
Dr. Kaustubh Ahuja
Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand.
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/isj.isj_21_20

Rights and Permissions

Bracing constitutes the most widely practiced treatment method for nonoperative management of adolescent idiopathic scoliosis (AIS). Brace treatment has undergone a large number of variations from the time of its inception, and it has led to a number of available options to choose from in present times. The evidence for bracing has also evolved tremendously in the last few years from single-center cohort studies to multicenter randomized controlled trials. For bracing to be successful, proper patient selection is an important prerequisite. A coordinated team effort from the patient, parents, family, the surgeon, and orthotist is also essential for ensuring compliance and treatment success. This article is a narrative review and focuses on the role of bracing in the management of AIS in terms of the brace history, types, indications, results, and drawbacks with relevant literature.

Keywords: Adolescent idiopathic scoliosis, bracing, conservative management

How to cite this article:
Garg B, Ahuja K, Basu S. Bracing in adolescent idiopathic scoliosis. Indian Spine J 2020;3:151-9

How to cite this URL:
Garg B, Ahuja K, Basu S. Bracing in adolescent idiopathic scoliosis. Indian Spine J [serial online] 2020 [cited 2023 Apr 1];3:151-9. Available from: https://www.isjonline.com/text.asp?2020/3/2/151/289648

  Introduction Top

The progression of deformity in adolescent idiopathic scoliosis (AIS) depends essentially on the size and pattern of deformity and age of the patient. The treatment strategies for these patients can be broadly divided into either operative or nonoperative. Among the various modalities of nonoperative management, bracing constitutes the most commonly used treatment method. Other nonoperative treatment strategies such as electrical stimulation, biofeedback, manipulation, physical therapy, and exercise are less widely practiced owing to the lack of substantial evidence in literature.

The main aim of brace treatment is the prevention of progression of the deformity to an extent that needs surgery. Several studies in the past have reviewed the use of bracing in AIS and concluded positive treatment outcomes with respect to curve progression, pain control, and patient satisfaction.[1],[2],[3],[4],[5],[6] Brace treatment has undergone a large number of variations from the time of its inception, and it has led to a number of available options to choose from in present times. Apart from the preference of the treating physician, level and size of the curve and anticipated compliance have a major bearing on the selection of the type of brace.

This article is a narrative review and focuses on the role of bracing in the management of AIS in terms of the brace history, types, indications, results, and drawbacks with relevant literature.

  Bracing History Top

The history of bracing dates back to 1924 when Lovett and Brewster[7] designed a plaster jacket split into cranial and caudal parts with a hinge centered over the convex side of the scoliotic curve. Risser[8] made a modification in this cast with a lighter material and it was called the localizer cast. Since then the art of bracing has seen a number of variations by various researchers, and the era was widely known as the “modern era” of bracing.[9] Milwaukee brace, which is the most commonly used brace today for curves with dorsal apex above D7, was introduced by Blount et al.[10] during this era in 1958. For curves with apex below D7, Watts et al.[11] introduced the low contact Boston brace in 1977. Further modifications were aimed at improving the brace compliance and efficacy.

  Types of Braces Top

  • Milwaukee Brace [Figure 1]—It is a type of cervico-thoracic-lumbar-sacral orthosis (CTLSO) consisting of a PVC pelvic section with one anterior metal upright connected to a neck ring with a throat mold superiorly and two posterior uprights connected to occipital pads or low-profile neck ring. It functions by the application of distracting forces to the mandible with lateral forces directed to the apex by straps and corrective pads. It is prescribed for a full-time wear; however, low compliance and the associated stigma limits its use.[12]

  • Wilmington brace—It is a type of thoraco-lumbar-sacral orthosis (TLSO) designed to improve patient compliance by the virtue of it being low profile and light weight as compared to the Milwaukee brace. The most common form is a customized underarm TLSO made from orthoplast. It opens from the front and is held closed by Velcro straps. Corrective molds are commonly incorporated into the plastic body jacket.[13] Like Milwaukee, this is also prescribed for full-time wear; however, curves less than 40° may benefit from brace compliance for 12–16 h a day.[14]

  • Boston brace [Figure 2]—It is also a TLSO-type brace, which uses both passive and active correction forces as opposed to Wilmington brace, which uses only passive correction forces.[15] Each brace is custom made from prefabricated polypropylene pelvic module with a soft foam polythene lining. Although it is suitable for almost all type of scoliosis, however, it is advisable to be fitted with Milwaukee brace superstructure for curves with apices above D7. It is also prescribed for full-time wear.

  • Dynamic SpineCor braceThe brace is designed to provide curve-specific corrective movement and is applied according to definitions contained in the SpineCor assistant software based on the principle of active biofeedback. The brace is prescribed for a full-time wear for a minimum of 18 months for neuromuscular integration.[16]

  • Charleston brace—This brace was developed to improve nighttime bracing. This brace is typically constructed from a mold with the deformity overcorrected by applying corrective forces at the apex of the curve in a supine patient.[17]

  • Providence brace—This brace uses an acrylic frame to apply direct corrective forces to the scoliotic curve. The frame is used to apply controlled lateral and rotational forces to correct or overcorrect the spinal deformity. It is custom made using computer-based design and manufacture. It is prescribed for nighttime wear only.[18]

  • Chêneau brace [Figure 3]—This brace is quite popular in certain European countries. It is based on the principle of detorsion and sagittal plane correction, resulting in the elongation of spine without excessive distraction forces. The Chêneau brace creates pressure on the convexity of the curve, and on the opposite side, there are wide expansion chambers in the frontal, sagittal, and horizontal planes, where the patient has to put his body mass through physiotherapy of deviation from pushes and respiratory kyphotic exercises for at least 1 h every day.[19]

  • Computer-assisted design (CAD) brace—A majority of the conventional braces use a preexisting fabricated symmetric module with modifications with respect to padding, trim lines, and areas of relief based on individual’s anthropometry and physical dimensions or indirectly using plaster cast of the patient’s trunk. However, there are certain limitations associated with this technique such as consideration of a complex three-dimensional (3D) deformity in only a two-dimensional plane and subjectivity in terms of physician or orthotist’s decision for trim lines, padding, and areas of relief. Although the braces have been effective in reducing or limiting the curves in the coronal plane, however, an important drawback recognized with the use of these braces was the reduction in the sagittal curvatures of the spine. With the increasing utilization of computer-assisted technology in scoliosis management, it is now possible to design a topographic virtual 3D model of a scoliotic trunk. Further, it allows the physicians or orthotists to identify the areas of corrective padding along with postfabrication assessment of 3D pressure dimensions for final customization and validation of the brace design. Although a prospective trial for the evaluation of the efficacy of this brace is ongoing, nevertheless the initial results with respect to the in-brace correction in these braces have been encouraging.[20],[21]
Figure 1: Milwaukee brace

Click here to view
Figure 2: Boston brace is typically useful if apex of the curve is at D7 or below

Click here to view
Figure 3: Chêneau brace aims at all three planes of correction including coronal, transverse, and sagittal

Click here to view

  Indications of Bracing Top

Bracing is typically indicated in patients with curves with Cobb’s angle ranging from 25° to 40°, and having substantial growth remaining, that is, from Risser’s grade 0 to 2. Curves less than 25° under observation, showing significant progression from 5° to 10° degrees over a period of 6 months, are also good candidates for bracing. Another relative indication includes patients with 20°–25° curve with pronounced skeletal immaturity (Risser, 0; Tanner, 1 or 2).[9] The biomechanical rationale behind these indications was recognized by the findings suggesting minimal requirement of forces to deform a scoliotic spine with Cobb’s angle over 25°. In contrast, vertebral loading is more symmetrical in curves less than 25°.[22],[23]

Bracing has no role in patients with curves over 45° or less than 25° without documented progression. It is also ineffective in skeletally mature patients.[24] Bracing is also contraindicated in patients with thoracic lordosis due to the lordotic effects of bracing on thoracic spine. In addition, obesity in adolescence is also an important factor leading to failure of bracing due to poor transmission of corrective forces due to cushioning effect of body fat and soft tissues. Obese patients also have a greater chance of curve progression when compared to nonobese patients.[15]

He et al.[25] studied the flexibility of spine in standing, supine, prone, sitting with lateral bending, and prone with lateral bending positions, and correlated it with initial correction after bracing. The initial correction of the deformity after bracing most closely correlated to the spinal flexibility in prone position [Figure 4]. It indirectly suggests that prone position can be an effective indicator of the initial effect of bracing in patients with AIS.[25]
Figure 4: Initial correction after orthotic treatment as evident from full length standing radiographs

Click here to view

  During Treatment Top

Accepting a brace for an adolescent can be a daunting task due to the associated stigma and discomfort associated. An ideal bracing protocol should accommodate the first 2–3 weeks for initial adjustment to the new brace. During this adjustment period, bracing period should be gradually increased over time. In addition, the brace should also be gradually tightened over the first 2 weeks to reach the desired level of snugness allowing the patient to “fit in” the brace. Once this initial period is tided over, an X-ray should be done after 4 weeks to assess the corrective forces and the degree of curve correction. A repeat X-ray study should be performed every 4–6 months without the brace to assess the progression of deformity if any. The brace should be removed for 12–24 h to assess the true size of the deformity. Some researchers, however, prefer repeat X-rays in the brace to monitor effectiveness of the brace in controlling the deformity. X-rays outside the brace should be done only if there is curve progression despite compliant bracing or at the end of the brace treatment to make a definitive decision.[26] Surgical treatment is warranted if there is a progression of 5° or more on subsequent radiographs done 6 months apart.

A number of researchers have tried to predict the progression of the curve on the basis of initial correction rate (ICR) and early Cobb’s angle reduction velocity (ARV) during brace treatment. Radiographs done at the beginning of the treatment and 6 months later can be used to calculate the ICR and ARV. Mao et al.[27] in their article have concluded ARV to be better than ICR for the prediction of curve progression during brace treatment. They found significantly high risk of progression in patients with initial ARV less than 10° per year.[27]

Brace compliance is an important concern during the treatment period. Most braces used in routine are prescribed for full-time wear except a few braces designed specifically for nighttime bracing. A number of studies have reviewed the effect of part-time and full-time bracing and concluded better results with longer hours of bracing per day resulting in improved outcomes. Patients are encouraged outdoor sports while continuing brace wear, if possible. A period of 2–3 h is permitted for bathing, swimming, and physical education. A recent meta-analysis reviewing the factors responsible for failure of brace treatment concluded poor compliance, lack of skeletal maturity, higher Cobb’s angle, poor in-brace correction, vertebral rotation, osteopenia, and thoracic curve type as risk factors for poor outcome following brace treatment.[28]

Wiley et al.[29] compared the results of noncompliant (less than 12 h a day), part-time (12–18 h a day), and full-time brace wearing (between 18 and 23 h a day), and reported an improvement in Cobb’s angle at final follow-up in full-time brace wearers as opposed to former two groups where Cobb’s angle deteriorated by 15° and 4° in noncompliant and part-time groups, respectively. The rate of surgery was also significantly higher (73%) in noncompliant group as opposed to full-time group (9%).[29] However, in smaller curves both part-time and full-time brace wear yielded comparable results.[30] Similarly, Allington and Bowen[14] found comparable results between part-time and full-time brace wear on using Wilmington brace for curves between 30° and 40° Cobb’s angle.

  Cessation of Treatment Top

Bracing should be continued till skeletal maturity has been attained and growth has stopped. This is indicated by no change in measured height when measured over 6 months apart, females with Risser 4 or males with Risser 5, 18–24 months post-menarchal, or skeletal maturity on bone age.[31] Once skeletal maturity is achieved, brace should be gradually weaned over time rather than sudden cessation of brace usage. Brace weaning is a process of gradually decreasing hours of bracing per day over a period of 2–3 months with monthly whole spine radiographs without the brace to check for residual curve and spinal stability. Deterioration of the residual curve at any stage of treatment may necessitate surgical management. A successful bracing is defined by the prevention of curve progression when measured on standing radiographs, cosmetic satisfaction to the patient, and avoidance of surgery [Figure 5].
Figure 5: Successful outcome after 5 years of treatment with a Milwaukee brace. (Above) Standing radiograph at the beginning (left), during (center), and at the cessation of treatment (right). (Below) Clinical photographs. Note: Although Boston brace has a higher acceptability and compliance curves below D7, however, both Milwaukee and Boston braces have comparable efficacy in these curves

Click here to view

  Complications Top

The major obstacle associated with bracing is compliance to bracing. Noncompliance can either be due to lesser hours of bracing per day or premature cessation of bracing altogether. Noncompliance to bracing is maximum with Milwaukee brace when compared to other braces. The causes can be multiple. Poor image or low self-esteem in school-going children or discomfort from chin and throat contact or pelvic and axillary part of the brace are the most common reasons.[26] Noncompliance may also be due to poor guidance and inadequate time taken for initial adjustment period. According to one study, only 38% males are compliant with brace treatment, and nearly 74% progressed 6° with half reaching surgical cut-off of 50°.[32] To ensure compliance, a number of objective measures such as temperature sensor loggers and pressure transducers have been introduced for physicians and parents.[33] Rahman et al.[35] in their article compared objective compliance with efficacy. Temperature sensor loggers fitted with Wilmington brace were used to ensure compliance. For patients in whom curve progression was more than 5°, orthotic compliance was 62% as opposed to 85% compliance in patients with nonprogression of their curves.[34]

The psychological impact of bracing on patients with AIS can not be understated. The emotional impact of bracing on these adolescents can play a major role in shaping their social interactions apart from the issues associated with noncompliance. The emotional impact due to bracing is particularly significant at the start of the therapy, and it tends to improve with the progression of the therapy. Maximum noncompliance and failure of the brace treatment in the initial part of the treatment can be partly attributed to its psychological impact at the beginning of the treatment.[35] Moreover, full-time bracing is also known to have a much sinister psychological impact on patients as compared to part-time bracing.[36] An organized team effort with inputs from the treating surgeon, orthotist, parents, psychologists, and patients is crucial to increase the overall acceptability of bracing.

Other complications associated with bracing include chest wall and rib deformation. This commonly ensues when bracing is done for cases with profound skeletal immaturity when the chest wall is plastic and the ribs are more prone to drooping on the side of convexity due to continuous application of corrective forces. This deformation along with compartmentalization due to orthosis may also lead to an initial worsening of vital capacity. However, both the deformation and vital capacity undergo correction when the brace use is discontinued. Permanent deformation is only seen in patients undergoing bracing for more than 5–6 years.[37],[38],[39],[40] Other minor problems encountered due to bracing include skin irritation, which is more common in warm areas or during summer months due to increased perspiration. Frequent changing of cotton undergarment may reduce the likelihood of skin irritation.

  Evidence on Bracing in AIS Top

There is overwhelming evidence supporting the use of various types of braces [Table 1]. Lonstein and Winter[5] analyzed the role of Milwaukee brace in 1020 patients, and they recommended the use of this brace in all patients with AIS under 25° Cobb’s angle and with a Risser sign of 0 without waiting for documentation of curve progression. Regarding Boston brace, Emans et al.[30] studied its effect on 295 patients for a mean period of 1.4 years and found AIS curves corrected or stayed unchanged in 93% of the patients, whereas only 11 patients needed surgery during the study period. In Europe, Negrini et al.[41] evaluated the effect of a new SPoRT (Symmetrical, Patient-oriented, Rigid, Three-dimensional, active) brace and compared it with the already famous Lyon brace. The authors found significantly better results with SPoRT brace when compared with Lyon brace, especially in curves with higher Cobb’s angles.[41]
Table 1: Available literature on various types of braces

Click here to view

A number of researchers have tried to study the effect of part-time bracing in the treatment of AIS. Allington and Bowen[14] studied the same with Wilmington brace in 188 patients. Although the progression of curves was seen in both the groups, however, the difference between the two groups was not statistically different.[14] In another prospective study, Price et al.[42] analyzed nighttime bracing only using Charleston brace in 191 curves. They found a meager failure rate of 17% in this cohort with Cobb’s angle progressing over 5° in 6 months. Thus, the authors recommended nighttime bracing with Charleston brace to be an effective method for the management of AIS.[42] Gepstein et al.[43] also found nighttime bracing for 8 h with Charleston brace equally effective to 18–22 h of TLSO bracing for AIS treatment. Another nighttime correction brace that has gained popularity among the surgeons of North America is the Providence brace. Yrjönen et al.[44] have found significantly better results with Providence nighttime brace as compared to Boston brace with respect to curve progression and failure rate. To improve the compliance, a number of flexible orthosis have also been designed for the management of AIS. Wong et al.[45] compared the rigid and flexible orthoses (SpineCor) in 43 patients. The authors found a high failure rate with SpineCor (32%) as compared to rigid orthoses (5%), and hence, did not recommend the flexible brace despite the initial enthusiasm.[45]

Despite the enormous available literature, a major criticism of bracing for AIS is the lack of a randomized and prospective study to review the efficacy of brace treatment. Sanders et al.[46] in their systematic review pointed out that a majority of studies in literature have supported the role of braces in achieving surrogate outcomes such as prevention of more than 6° progression; however, translation of these surrogate outcomes toward more patient-centric results such as the prevention of surgery cannot be proven with certainty. This lacuna in the literature was overcome by the BrAIST trial. BrAIST was started as a multicenter randomized prospective trial design. However, the recruitment was very slow owing to the preference for a particular treatment method, thus making informed randomization very difficult. This is the reason why a separate preference cohort had to be introduced in the trial, and thus it became an intention to treat trial. However, the trial had to be stopped early owing to the overwhelming efficacy of bracing. The rate of treatment success was 72% after bracing as compared to 48% after observation with a significant positive association between hours of brace wear and success of treatment. Subgroup analysis among the randomized patient group also yielded similar results. The authors concluded an important role of bracing in slowing the progression of high-risk curves and subsequently reducing the need for surgery.[17]

  Conclusion Top

An important prerequisite for success of brace treatment is appropriate patient selection and timely recognition of failure of brace treatment. In the Indian context, appropriate patient selection is a major problem because of the lack of awareness of AIS and the absence of school screening program. A coordinated team effort from the patient, parents, family, orthopedic surgeon, and orthotist is also essential for ensuring compliance and treatment success. New material for brace fabrication, especially to tide over hot and humid climates, and newer designs that promote compliance leave lots of scope for further research.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Fernandez-Feliberti R, Flynn J, Ramirez N, Trautmann M, Alegria M. Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis. J Pediatr Orthop 1995;15:176-81.  Back to cited text no. 1
Asher MA, Burton DC. Adolescent idiopathic scoliosis: Natural history and long term treatment effects. Scoliosis 2006;1:2.  Back to cited text no. 2
Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997;79:664-74.  Back to cited text no. 3
Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the brace study of the scoliosis research society. J Bone Joint Surg Am 1995;77:815-22.  Back to cited text no. 4
Lonstein JE, Winter RB. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients. J Bone Joint Surg Am 1994;76:1207-21.  Back to cited text no. 5
Olafsson Y, Saraste H, Söderlund V, Hoffsten M. Boston brace in the treatment of idiopathic scoliosis. J Pediatr Orthop 1995;15:524-7.  Back to cited text no. 6
Lovett RH, Brewster AH. The treatment of scoliosis by a different method from that usually employed. J Bone Joint Surg Am. 1924;6:847-57.  Back to cited text no. 7
Risser JC. The application of body casts for the correction of scoliosis. Instr Course Lect 1955;12:255-9.  Back to cited text no. 8
SRS Bracing Manual | Scoliosis Research Society. Available from: https://www.srs.org/professionals/online-education-and-resources/srs-bracing-manual. [Last accessed 2020 Feb 6].  Back to cited text no. 9
Blount WP, Schmidt AC, Keever ED, Leonard ET. The Milwaukee brace in the operative treatment of scoliosis. J Bone Joint Surg Am 1958;40-A:511-25.  Back to cited text no. 10
Watts HG, Hall JE, Stanish W. The Boston Brace system for the treatment of low thoracic and lumbar scoliosis by the use of a girdle without superstructure. Clin Orthop 1977;Jul-Aug(126):87-92.  Back to cited text no. 11
Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA. Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am 1996;78:557-67.  Back to cited text no. 12
Schiller JR, Thakur NA, Eberson CP. Brace management in adolescent idiopathic scoliosis. Clin Orthop Relat Res 2010;468:670-8.  Back to cited text no. 13
Allington NJ, Bowen JR. Adolescent idiopathic scoliosis: Treatment with the Wilmington brace. A comparison of full-time and part-time use. J Bone Joint Surg Am 1996;78:1056-62.  Back to cited text no. 14
O’Neill PJ, Karol LA, Shindle MK, Elerson EE, BrintzenhofeSzoc KM, Katz DE, et al. Decreased orthotic effectiveness in overweight patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am 2005;87:1069-74.  Back to cited text no. 15
Coillard C, Vachon V, Circo A, Beauséjour M, Shawafaty N, Rivard CH. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the Scoliosis Research Society for adolescent idiopathic scoliosis. Scoliosis 2007;2:S21.  Back to cited text no. 16
Weinstein SL, Dolan LA. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512-21.  Back to cited text no. 17
D’Amato CR, Griggs S, McCoy B. Nighttime bracing with the providence brace in adolescent girls with idiopathic scoliosis. Spine (Phila Pa 1976) 2001;26:2006-12.  Back to cited text no. 18
De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: Long-term results. Can it prevent surgery? Eur Spine J 2013;22(Suppl 6):815-22.  Back to cited text no. 19
Labelle H, Bellefleur C, Joncas J, Aubin CE, Cheriet F. Preliminary evaluation of a computer-assisted tool for the design and adjustment of braces in idiopathic scoliosis: A prospective and randomized study. Spine (Phila Pa 1976) 2007;32:835-43.  Back to cited text no. 20
Weiss HR, Kleban A. Development of CAD/CAM based brace models for the treatment of patients with scoliosis-classification based approach versus finite element modelling. Asian Spine J 2015;9:661-7.  Back to cited text no. 21
Hawes MC, O’brien JP. The transformation of spinal curvature into spinal deformity: Pathological processes and implications for treatment. Scoliosis 2006;1:3.  Back to cited text no. 22
Villemure I, Aubin CE, Dansereau J, Labelle H. Biomechanical simulations of the spine deformation process in adolescent idiopathic scoliosis from different pathogenesis hypotheses. Eur Spine J 2004;13:83-90.  Back to cited text no. 23
Carr WA, Moe JH, Winter RB, Lonstein JE. Treatment of idiopathic scoliosis in the Milwaukee brace. J Bone Joint Surg Am 1980;62:599-612.  Back to cited text no. 24
He C, To MK, Cheung JP, Cheung KM, Chan CK, Jiang WW, et al. An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS). PLoS One 2017;12:e0190141.  Back to cited text no. 25
Canavese F, Kaelin A. Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment. Indian J Orthop 2011;45:7-14.  Back to cited text no. 26
[PUBMED]  [Full text]  
Mao S, Shi B, Xu L, Wang Z, Hung ALH, Lam TP, et al. Initial Cobb angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis. Eur Spine J 2016;25:500-5.  Back to cited text no. 27
Hawary RE, Zaaroor-Regev D, Floman Y, Lonner BS, Alkhalife YI, Betz RR. Brace treatment in adolescent idiopathic scoliosis: Risk factors for failure—A literature review. Spine J 2019;19:1917-25.  Back to cited text no. 28
Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2000;25:2326-32.  Back to cited text no. 29
Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME. The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients. Spine (Phila Pa 1976) 1986;11:792-801.  Back to cited text no. 30
Shaughnessy WJ. Advances in scoliosis brace treatment for adolescent idiopathic scoliosis. Orthop Clin North Am 2007;38:469-75, v.  Back to cited text no. 31
Karol LA. Effectiveness of bracing in male patients with idiopathic scoliosis. Spine (Phila Pa 1976) 2001;26:2001-5.  Back to cited text no. 32
Nicholson GP, Ferguson-Pell MW, Smith K, Edgar M, Morley T. The objective measurement of spinal orthosis use for the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2003;28:2243-50; discussion 2250-1.  Back to cited text no. 33
Rahman T , Bowen JR, Takemitsu M, Scott C. The association between brace compliance and outcome for patients with idiopathic scoliosis. J Pediatr Orthop 2005;25:420-2.  Back to cited text no. 34
MacLean WE , Green NE, Pierre CB, Ray DC. Stress and coping with scoliosis: Psychological effects on adolescents and their families. J Pediatr Orthop 1989;9:257-61.  Back to cited text no. 35
Matsunaga S, Sakou T, Nozoe S. Psychological effects of brace therapy on patients with idiopathic scoliosis. J Orthop Sci 1997;2:391-5.  Back to cited text no. 36
Noonan KJ, Dolan LA, Jacobson WC, Weinstein SL. Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop 1997;17:712-7.  Back to cited text no. 37
Montazeri A, Mousavi SJ. Quality of life and low backpain. In: Preedy VR, Watson RR, editors. Handbook of Disease Burdens and Quality of Life Measures. New York: Springer; 2010. p. 3979-94.  Back to cited text no. 38
Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test. Spine (Phila Pa 1976) 2005;30:1610-5.  Back to cited text no. 39
Danielsson AJ, Nachemson AL. Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: A case-control study. Spine (Phila Pa 1976) 2001;26:1449-56.  Back to cited text no. 40
Negrini S, Marchini G, Tomaello L. The Sforzesco brace and sport concept (symmetric, patient-oriented, rigid, three-dimensional) versus the Lyon brace and 3-point systems for bracing idiopathic scoliosis. Stud Health Technol Inform 2006;123:245-9.  Back to cited text no. 41
Price CT, Scott DS, Reed FE Jr, Riddick MF. Nighttime bracing for adolescent idiopathic scoliosis with the Charleston bending brace. Preliminary report. Spine (Phila Pa 1976) 1990;15:1294-9.  Back to cited text no. 42
Gepstein R, Leitner Y, Zohar E, Angel I, Shabat S, Pekarsky I, et al. Effectiveness of the Charleston bending brace in the treatment of single-curve idiopathic scoliosis. J Pediatr Orthop 2002;22: 84-7.  Back to cited text no. 43
Yrjönen T, Ylikoski M, Schlenzka D, Kinnunen R, Poussa M. Effectiveness of the providence nighttime bracing in adolescent idiopathic scoliosis: A comparative study of 36 female patients. Eur Spine J 2006;15:1139-43.  Back to cited text no. 44
Wong MS, Cheng JC, Lam TP, Ng BK, Sin SW, Lee-Shum SL, et al. The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2008;33:1360-5.  Back to cited text no. 45
Sanders JO, Newton PO, Browne RH, Herring AJ. Bracing in adolescent idiopathic scoliosis, surrogate outcomes, and the number needed to treat. J Pediatr Orthop 2012;32(Suppl 2):S153-7.  Back to cited text no. 46


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Bracing History
Types of Braces
Indications of B...
During Treatment
Cessation of Tre...
Evidence on Brac...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded368    
    Comments [Add]    

Recommend this journal