Predictive factors for brace treatment outcome in adolescent idiopathic scoliosis: a best-evidence synthesis

  • Manon van den Bogaart
  • Barend J. van RoyenEmail author
  • Tsjitske M. Haanstra
  • Marinus de Kleuver
  • Sayf S. A. Faraj
Review Article



To evaluate predictive factors for brace treatment outcome in adolescent idiopathic scoliosis (AIS) by a systematic review of the literature.


Eligible studies evaluating one or more predictive factors for brace treatment outcome were included following a systematic search in PubMed and EMBASE on October 23, 2017. Inclusion criteria were: (1) subjects diagnosed with AIS, (2) age ≤ 18 years, (3) treated with a thoraco-lumbo-sacral orthosis (TLSO), and (4) evaluated one or more predictive factors of treatment outcome (failure and/or success). The methodological quality of included studies was independently assessed by two authors. Pooling was not possible due to heterogeneity in statistical analysis. Predictive factors were presented according to a best-evidence synthesis.


The literature search identified 26 studies that met the inclusion criteria, and multiple types of TLSO braces were identified (Boston, Wilmington, Chêneau, Osaka Medical College, Dresdner Scoliosis Orthosis and SPoRT). A total of 19 radiographic and 8 clinical predictive factors were reported. Strong evidence was found that lack of initial in-brace correction is associated with treatment failure. Moderate evidence suggests that brace wear time is associated with failure and success, whereas initial curve magnitude and curve type are not.


The results of this review suggest that lack of initial in-brace correction is strongly associated with brace treatment failure. Future studies on the threshold for minimal immediate in-brace correction, as a potential indication for brace treatment, are recommended.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adolescent idiopathic scoliosis Brace Treatment Outcome Predictive 


Compliance with ethical standards

Conflict of interest


Supplementary material

586_2018_5870_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)
586_2018_5870_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 13 kb)
586_2018_5870_MOESM3_ESM.docx (24 kb)
Supplementary material 3 (DOCX 24 kb)
586_2018_5870_MOESM4_ESM.docx (18 kb)
Supplementary material 4 (DOCX 18 kb)


  1. 1.
    Trobisch P, Suess O, Schwab F (2010) Idiopathic scoliosis. Dtsch Arztebl Int 107:875–883. Google Scholar
  2. 2.
    Horne JP, Flannery R, Usman S (2014) Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Phys 89:193–198Google Scholar
  3. 3.
    Chalmers E, Westover L, Jacob J et al (2015) Predicting success or failure of brace treatment for adolescents with idiopathic scoliosis. Med Biol Eng Comput 53:1001–1009. CrossRefGoogle Scholar
  4. 4.
    Weinstein SL, Dolan LA, Wright JG, Dobbs MB (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369:1512–1521. CrossRefGoogle Scholar
  5. 5.
    Zaina F, De Mauroy JC, Grivas T et al (2014) Bracing for scoliosis in 2014: state of the art. Eur J Phys Rehabil Med 50:93–110Google Scholar
  6. 6.
    Negrini S, Minozzi S, Bettany-Saltikov J et al (2010) Braces for idiopathic scoliosis in adolescents. In: Negrini S (ed) Cochrane database of systematic reviews. Wiley, ChichesterGoogle Scholar
  7. 7.
    Italiano A (2011) Prognostic or predictive? It’s time to get back to definitions! J Clin Oncol 29:4718CrossRefGoogle Scholar
  8. 8.
    Sun W, Zhou J, Sun M et al (2017) Low body mass index can be predictive of bracing failure in patients with adolescent idiopathic scoliosis: a retrospective study. Eur Spine J 26:1665–1669. CrossRefGoogle Scholar
  9. 9.
    Donzelli S, Zaina F, Martinez G et al (2017) Adolescents with idiopathic scoliosis and their parents have a positive attitude towards the thermobrace monitor: results from a survey. Scoliosis Spinal Disord 12:1–8. CrossRefGoogle Scholar
  10. 10.
    Zhang Y, Yang Y, Dang X et al (2014) Factors relating to curve progression in female patients with adolescent idiopathic scoliosis treated with a brace. Eur Spine J 24:244–248. CrossRefGoogle Scholar
  11. 11.
    Sun X, Wu T, Liu Z et al (2013) Osteopenia predicts curve progression of adolescent idiopathic scoliosis in girls treated with brace treatment. J Pediatr Orthop 33:366–371. CrossRefGoogle Scholar
  12. 12.
    Karol LA, Virostek D, Felton K et al (2016) The effect of the risser stage on bracing outcome in adolescent idiopathic scoliosis. J Bone Jt Surg 98:1253–1259. CrossRefGoogle Scholar
  13. 13.
    Katz DE, Durrani AA (2001) Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine 26:2354–2361. CrossRefGoogle Scholar
  14. 14.
    Negrini S, Aulisa AG, Aulisa L et al (2012) 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 7:3. CrossRefGoogle Scholar
  15. 15.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. CrossRefGoogle Scholar
  16. 16.
    Hayden JA, Côté P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144:427–437. CrossRefGoogle Scholar
  17. 17.
    Faraj SSA, Holewijn RM, van Hooff ML et al (2016) De novo degenerative lumbar scoliosis: a systematic review of prognostic factors for curve progression. Eur Spine J 25:2347–2358. CrossRefGoogle Scholar
  18. 18.
    Bastick A, Runhaar J, Belo J, Bierma-Zeinstra S (2015) Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies. Arthritis Res Ther 17:1–13. CrossRefGoogle Scholar
  19. 19.
    Lievense AM, Bierma-Zeinstra SMA, Verhagen AP et al (2002) Prognostic factors of progress of hip osteoarthritis: a systematic review. Arthritis Rheum 47:556–562. CrossRefGoogle Scholar
  20. 20.
    Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363Google Scholar
  21. 21.
    Castro FP (2003) Adolescent idiopathic scoliosis, bracing, and the Hueter–Volkmann principle. Spine J 3:180–185. CrossRefGoogle Scholar
  22. 22.
    Goodbody CM, Asztalos IB, Sankar WN, Flynn JM (2016) It’s not just the big kids: both high and low BMI impact bracing success for adolescent idiopathic scoliosis. J Child Orthop 10:395–404. CrossRefGoogle Scholar
  23. 23.
    Xu L, Qin X, Qiu Y, Zhu Z (2015) Initial correction rate can be predictive of the outcome of brace treatment in patients with adolescent idiopathic scoliosis. J Spinal Disord Tech. Google Scholar
  24. 24.
    Karol LA, Virostek D, Felton K, Wheeler L (2016) Effect of compliance counseling on brace use and success in patients with adolescent idiopathic scoliosis. J Bone Jt Surg 98:9–14. CrossRefGoogle Scholar
  25. 25.
    Lou EHM, Hill DL, Raso JV et al (2016) How quantity and quality of brace wear affect the brace treatment outcomes for AIS. Eur Spine J 25:495–499. CrossRefGoogle Scholar
  26. 26.
    Ryan PM, Puttler EG, Stotler WM, Ferguson RL (2007) Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis. J Pediatr Orthop 27:671–676. CrossRefGoogle Scholar
  27. 27.
    Zaina F, Donzelli S, Negrini S (2017) Overweight is not predictive of bracing failure in adolescent idiopathic scoliosis: results from a retrospective cohort study. Eur Spine J 26:1670–1675. CrossRefGoogle Scholar
  28. 28.
    Kuroki H, Inomata N, Hamanaka H et al (2015) Predictive factors of Osaka Medical College (OMC) brace treatment in patients with adolescent idiopathic scoliosis. Scoliosis. Google Scholar
  29. 29.
    Emans JB, Kaelin A, Bancel P et al (1986) The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients. Spine 11:792–801. CrossRefGoogle Scholar
  30. 30.
    Hanks GA, Zimmer B, Nogi J (1988) TLSO treatment of idiopathic scoliosis. An analysis of the Wilmington jacket. Spine 13:626–629CrossRefGoogle Scholar
  31. 31.
    Ylikoski M, Peltonen J, Poussa M (1989) Biological factors and predictability of bracing in adolescent idiopathic scoliosis. J Pediatr Orthop 9:680–683CrossRefGoogle Scholar
  32. 32.
    Rahman T, Bowen JR, Takemitsu M, Scott C (2005) The association between brace compliance and outcome for patients with idiopathic scoliosis. J Pediatr Orthop 25:420–422. CrossRefGoogle Scholar
  33. 33.
    Castelein RM, Veraart B (1992) Idiopathic scoliosis: prognostic value of the profile. Eur Spine J 1:167–169. CrossRefGoogle Scholar
  34. 34.
    Landauer F, Wimmer C, Behensky H (2003) Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Dev Neurorehabil 6:201–207. Google Scholar
  35. 35.
    Lou E, Raso JV, Hill DL et al (2004) Correlation between quantity and quality of orthosis wear and treatment outcomes in adolescent idiopathic scoliosis. Prosthet Orthot Int 28:49–54. Google Scholar
  36. 36.
    O’Neill PJ, Karol LA, Shindle MK et al (2005) Decreased orthotic effectiveness in overweight patients with adolescent idiopathic scoliosis. J Bone Jt Surg Am 87:1069–1074. CrossRefGoogle Scholar
  37. 37.
    Lou E, Hill D, Raso J et al (2006) Prediction of brace treatment outcomes by monitoring brace usage. Stud Health Technol Inf 123:239–244. Google Scholar
  38. 38.
    Ovadia D, Eylon S, Mashiah A et al (2012) Factors associated with the success of the Rigo System Chêneau brace in treating mild to moderate adolescent idiopathic scoliosis. J Child Orthop. Google Scholar
  39. 39.
    Shi B, Guo J, Mao S et al (2016) Curve progression in adolescent idiopathic scoliosis with a minimum of 2 years’ follow-up after completed brace weaning with reference to the SRS standardized criteria. Spine Deform 4:200–205. CrossRefGoogle Scholar
  40. 40.
    Thompson RM, Hubbard EW, Jo C-H et al (2017) Brace success is related to curve type in patients with adolescent idiopathic scoliosis. J Bone Jt Surg 99:923–928. CrossRefGoogle Scholar
  41. 41.
    Seifert J, Selle A, Flieger C, Günther KP (2009) Die Compliance als Prognosefaktor bei der konservativen Behandlung idiopathischer Skoliosen. Orthopade 38:151–158. CrossRefGoogle Scholar
  42. 42.
    Bullmann V, Halm HF, Lerner T et al (2004) Prospective evaluation of braces as treatment in idiopathic scoliosis. Zeitschrift für Orthopädie und ihre Grenzgebiete. Google Scholar
  43. 43.
    Nachemson AL, Peterson LE, Bradford DS et al (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 Jt Surg Ser A 77(6):815–822. CrossRefGoogle Scholar
  44. 44.
    He C, To MKT, Cheung JPY et al (2017) An effective assessment method of spinal flexibility to predict the initial in-orthosis correction on the patients with adolescent idiopathic scoliosis (AIS). PLoS ONE 12:e0190141. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryAmsterdam University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of OrthopedicsRadboud University Medical CenterNijmegenThe Netherlands

Personalised recommendations