European Spine Journal

, Volume 22, Issue 2, pp 268–273 | Cite as

Does brace treatment impact upon the flexibility and the correctability of idiopathic scoliosis in adolescents?

  • Xu Sun
  • Wen-jun Liu
  • Lei-lei Xu
  • Qi Ding
  • Sai-hu Mao
  • Bang-ping Qian
  • Ze-zhang Zhu
  • Yong QiuEmail author
Chinese Section



Brace treatment has served as a vital non-surgical procedure for immature adolescent idiopathic scoliosis (AIS) patients with a mild or moderate curve. For the patients who fail in bracing and resort to surgery, it is unclear whether prior full-time brace treatment significantly influences outcomes. This study aims to investigate whether prior brace treatment has a negative impact upon the flexibility and correctability of the main curve in patients with AIS.


The participants were collected from female AIS patients who underwent posterior correction surgery with pedicle screw instrumentation from August 2006 to December 2010, with or without prior brace treatment. Patients included in Group A had prior brace treatment over a 1-year period, and underwent surgery within 6 months after cessation of bracing; those in Group B received no prior treatment and were randomly selected from our database. Curve flexibility pre-surgery and curve correctability post-surgery were computed and compared between both groups and subgroups according to the curve location.


Each group consisted of 35 patients. Age, curve magnitude and location were comparable between the two groups. Before surgery, patients in Group A had a slightly lower curve flexibility than those in Group B (52 vs. 60 %, P = 0.036). After surgery, satisfactory correction results were observed in both groups, but the average post-operative main curve magnitude of patients in Group B was 4° less than that of Group A (10° vs. 14°, P = 0.010). The curve correctability in Group B was significantly higher than that in Group A (80 vs. 74 %, P = 0.002). No matter what curve pattern the patient had, having a prior history of brace treatment resulted in a trend of lower flexibility and correctability of their scoliosis.


Good surgical correction can be achieved in AIS patients who have been unsuccessful with prior brace treatment. However, a history of prior brace treatment leads to a trend of lowering the curve flexibility, and in turn, negatively impacts upon the curve correctability.


Adolescent idiopathic scoliosis Bracing Surgery Flexibility Correction 



A grant research support from Stryker Spine is acknowledged, which may indirectly relate to the subject of this study.

Conflict of interest



  1. 1.
    Allington NJ, Bowen JR (1996) Adolescent idiopathic scoliosis: treatment with the Wilmington brace. A comparison of full-time and part-time use. J Bone Joint Surg Am 78:1056–1062PubMedGoogle Scholar
  2. 2.
    Asher MA, Burton DC (2006) Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 1:2PubMedCrossRefGoogle Scholar
  3. 3.
    Aubin CE, Labelle H, Chevrefils C, Desroches G, Clin J, Eng AB (2008) Preoperative planning simulator for spinal deformity surgeries. Spine (Phila Pa 1976) 33:2143–2152CrossRefGoogle Scholar
  4. 4.
    Bunge EM, Habbema JD, de Koning HJ (2010) A randomised controlled trial on the effectiveness of bracing patients with idiopathic scoliosis: failure to include patients and lessons to be learnt. Eur Spine J 19(5):747–753PubMedCrossRefGoogle Scholar
  5. 5.
    Cheung WY, Lenke LG, Luk KD (2010) Prediction of scoliosis correction with thoracic segmental pedicle screw constructs using fulcrum bending radiographs. Spine (Phila Pa 1976) 35:557–561CrossRefGoogle Scholar
  6. 6.
    Clamp JA, Andrews JR, Grevitt MP (2008) A study of the radiologic predictors of curve flexibility in adolescent idiopathic scoliosis. J Spinal Disord Tech 21:213–215PubMedCrossRefGoogle Scholar
  7. 7.
    Deviren V, Berven S, Kleinstueck F, Antinnes J, Smith JA, Hu SS (2002) Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis. Spine (Phila Pa 1976) 27:2346–2349CrossRefGoogle Scholar
  8. 8.
    Diab M, Sharkey M, Emans J, Lenke L, Oswald T, Sucato D, Spinal Deformity Study Group (2010) Preoperative bracing affects postoperative outcome of posterior spine fusion with instrumentation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1876–1879CrossRefGoogle Scholar
  9. 9.
    Dolan LA, Weinstein SL (2007) Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976) 32(19 Suppl):S91-S100Google Scholar
  10. 10.
    Fernandez-Feliberti R, Flynn J, Ramirez N, Trautmann M, Alegria M (1995) Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis. J Pediatr Orthop 15:176–181PubMedGoogle Scholar
  11. 11.
    Hamzaoglu A, Talu U, Tezer M, Mirzanli C, Domanic U, Goksan SB (2005) Assessment of curve flexibility in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 30:1637–1642CrossRefGoogle Scholar
  12. 12.
    King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 65:1302–1313PubMedGoogle Scholar
  13. 13.
    Klepps SJ, Lenke LG, Bridwell KH, Bassett GS, Whorton J (2001) Prospective comparison of flexibility radiographs in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 26:E74–E79CrossRefGoogle Scholar
  14. 14.
    Lange JE, Steen H, Brox JI (2009) Long-term results after Boston brace treatment in adolescent idiopathic scoliosis. Scoliosis 4:17PubMedCrossRefGoogle Scholar
  15. 15.
    Li J, Dumonski ML, Samartzis D, Hong J, He S, Zhu X, Wang C, Vaccaro AR, Albert TJ, Li M (2011) Coronal deformity correction in adolescent idiopathic scoliosis patients using the fulcrum-bending radiograph: a prospective comparative analysis of the proximal thoracic, main thoracic, and thoracolumbar/lumbar curves. Eur Spine J 20:105–111PubMedCrossRefGoogle Scholar
  16. 16.
    Liu RW, Teng AL, Armstrong DG, Poe-Kochert C, Son-Hing JP, Thompson GH (2010) Comparison of supine bending, push-prone, and traction under general anesthesia radiographs in predicting curve flexibility and postoperative correction in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:416–422CrossRefGoogle Scholar
  17. 17.
    Lonstein JE, Winter RB (1994) The Milwaukee brace for the treatment of adolescent idiopathic scoliosis: a review of one thousand and twenty patients. J Bone Joint Surg Am 76:1207–1221PubMedGoogle Scholar
  18. 18.
    Muller C, Fuchs K, Winter C, Rosenbaum D, Schmidt C, Bullmann V, Schulte TL (2011) Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment. Eur Spine J 20(7):1127–1136PubMedCrossRefGoogle Scholar
  19. 19.
    Nachemson AL, Peterson LE (1995) 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 77:815–821PubMedGoogle Scholar
  20. 20.
    Noonan KJ, Dolan LA, Jacobson WC, Weinstein SL (1997) Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop 17:712–717PubMedGoogle Scholar
  21. 21.
    Qiu G, Qiu Y, Zhu Z, Liu Z, Song Y, Hai Y, Luo Z, Liu Z, Zhang H, Lv G, Wang Y, Zhang J, Shen J, Sun X (2011) Re-evaluation of reliability and validity of simplified Chinese version of SRS-22 patient questionnaire: a multicenter study of 333 cases. Spine (Phila Pa 1976) 36:E545–E550CrossRefGoogle Scholar
  22. 22.
    Qiu Y, Sun X, Cheng JC, Zhu F, Li W, Zhu Z, Wang B, Yu Y (2008) Bone mineral accrual in initially osteopenic and non-osteopenic adolescents with idiopathic scoliosis during bracing treatment. Spine (Phila Pa 1976) 33:1682–1689CrossRefGoogle Scholar
  23. 23.
    Richards BS, Bernstein RM, D’Amato CR, Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS committee on bracing and nonoperative management. Spine (Phila Pa 1976) 30:2068–2075CrossRefGoogle Scholar
  24. 24.
    Spoonamore MJ, Dolan LA, Weinstein SL (2004) Use of the Rosenberger brace in the treatment of progressive adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:1458–1464CrossRefGoogle Scholar
  25. 25.
    Trivedi JM, Thomson JD (2001) Results of Charleston bracing in skeletally immature patients with idiopathic scoliosis. J Pediatr Orthop 21:277–280PubMedGoogle Scholar
  26. 26.
    Vaughan JJ, Winter RB, Lonstein JE (1996) Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 21:2469–2473CrossRefGoogle Scholar
  27. 27.
    Wang C, Zhao Y, He S, Zhu X, Zhao Y, Chen Z, Gu S, Xie Y, Li M (2009) Effect of preoperative brace treatment on quality of life in adolescents with idiopathic scoliosis following corrective surgery. Orthopedics 32(8). = 41920. doi: 10.3928/01477447-20090624-10. PubMed PMID: 19708629Google Scholar
  28. 28.
    Weigert KP, Nygaard LM, Christensen FB, Hansen ES, Bünger C (2006) Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24. Eur Spine J 15:1108–1117PubMedCrossRefGoogle Scholar
  29. 29.
    Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537PubMedCrossRefGoogle Scholar
  30. 30.
    Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV (2000) Effectiveness of the Boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 25:2326–2332CrossRefGoogle Scholar
  31. 31.
    Xu L, Qiu X, Sun X, Mao S, Liu Z, Qiao J, Qiu Y (2011) Potential genetic markers predicting the outcome of brace treatment in patients with adolescent idiopathic scoliosis. Eur Spine J 20:1757–1764PubMedCrossRefGoogle Scholar
  32. 32.
    Yrjönen T, Ylikoski M, Schlenzka D, Kinnunen R, Poussa M (2006) Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients. Eur Spine J 15:1139–1143PubMedCrossRefGoogle Scholar
  33. 33.
    Yrjönen T, Ylikoski M, Schlenzka D, Poussa M (2007) Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace. Eur Spine J 16:393–397PubMedCrossRefGoogle Scholar
  34. 34.
    Zaborowska-Sapeta K, Kowalski IM, Kotwicki T, Protasiewicz-Fałdowska H, Kiebzak W (2011) Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity. Scoliosis 25 6(1):2CrossRefGoogle Scholar
  35. 35.
    Zheng X, Sun X, Qian B, Wu T, Mao S, Zhu Z, Wang B, Qiu Y (2012) Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis. Eur Spine J 21:1157–1164PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Xu Sun
    • 1
  • Wen-jun Liu
    • 2
  • Lei-lei Xu
    • 1
  • Qi Ding
    • 1
  • Sai-hu Mao
    • 1
  • Bang-ping Qian
    • 1
  • Ze-zhang Zhu
    • 1
  • Yong Qiu
    • 1
    Email author
  1. 1.Department of Spine SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina
  2. 2.Department of Spine SurgeryShengli Oilfield Central HospitalDongyingChina

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