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Association of success of brace treatment and various aspects of in-brace correction in patients with adolescent idiopathic scoliosis

  • Masayuki Sato
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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  • Masayuki Ohashi
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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  • Hideki Tashi
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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  • Tatsuo Makino
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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  • Yohei Shibuya
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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  • Toru Hirano
    Affiliations
    Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma City, Niigata Japan
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  • Kei Watanabe
    Correspondence
    Corresponding author. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510 Japan.
    Affiliations
    Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Published:November 10, 2022DOI:https://doi.org/10.1016/j.jos.2022.10.001

      Abstract

      Background

      Although skeletal maturity and brace wear time contribute to the success of brace treatment in adolescent idiopathic scoliosis (AIS), the extent of initial in-brace correction for ensuring successful outcomes remains unclear. We hypothesized that the degree of initial in-brace correction correlates with brace success in patients with AIS.

      Method

      The study included 135 AIS patients with a major Cobb angle of 20°–40° treated with a thoracic lumbosacral orthosis for at least one year and followed up for skeletal maturity. The subjects were divided into two groups: the skeletally immature group (group I, n = 72), who met the Bracing in Adolescent Idiopathic Scoliosis Trial study protocol at the start of brace treatment, and the skeletally mature group (group M, n = 63). Treatment success was defined as not needing surgical treatment and a major Cobb angle <40° at the end of brace treatment.

      Results

      In both groups, the mean major Cobb angles before treatment, while wearing the brace, and at the end of brace treatment were 30.6°/31.7°, 22.9°/24.2°, and 38.8°/33.9° (p < 0.05), respectively, and the treatment success rate was 56.9% and 77.8%, respectively (p < 0.05).
      Univariate regression analysis revealed the following risk factors: Risser grade 0 in group I, major Cobb angles before treatment, initial in-brace major Cobb angle, and in-brace correction rate in both groups. Cutoff values of in-brace major Cobb angle for treatment success calculated by ROC curve in groups I and M were 24° and 29°, respectively.

      Conclusions

      In-brace major scoliosis correction of <25° in patients with immature skeletal status and <30° in patients with mature skeletal structure should be aimed at to achieve significant brace treatment success.

      Keywords

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