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“Will I Need a Brace?”: likelihood of curve progression to bracing range in adolescent idiopathic scoliosis



Bracing treatment for adolescent idiopathic scoliosis (AIS) is typically initiated in skeletally immature patients with primary curves greater than 25°. The goal of this study was to develop a model predicting a patient’s likelihood of progressing to bracing treatment.


All patients with AIS presenting to a large pediatric spine center with a primary curve below 25° and skeletally immature (Sanders stage 1–6) were included. A patient was considered to have progressed into the bracing range if their primary curve reached a 25° threshold prior to skeletal maturity. Binary logistic regression analysis was performed to predict the likelihood of curve progression into bracing range.


A total of 180 patients (71% female) were included in this study with an average presenting age of 13.2 ± 1.4 years. At presentation, 31 (17%) were pre-peak height velocity, 62 (34%) were at their peak height velocity, and 87 (48%) were in the late adolescent growth stage. The high-risk patient group was defined as Sanders 1–2 and curve size > 10 and < 25° or Sanders 3–6 and curve size > 20 but < 25°. Those in the high-risk group demonstrated an over 5 times higher risk of progression to bracing range when accounting for age, sex, and curve location (OR: 5.168, 95% CI: 2.212–12.071, p < 0.001).


Patient’s curve magnitude and skeletal maturity can be used to predict their likelihood of curve progression to greater than 25° and thus require bracing treatment. Orthopaedic providers can consider earlier treatment interventions or stricter follow-up adherence for patients at high risk for progression.

Level of evidence

3—retrospective cohort study.

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  1. Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7(1):3–9

    Article  PubMed  Google Scholar 

  2. Kamtsiuris P, Atzpodien K, Ellert U et al (2007) Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):686–700

    CAS  Article  PubMed  Google Scholar 

  3. Suh SW, Modi HN, Yang JH et al (2011) Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(7):1087–1094

    Article  Google Scholar 

  4. Nery LS, Halpern R, Nery PC et al (2010) Prevalence of scoliosis among school students in a town in southern Brazil. Sao Paulo Med J=Rev Paul Med 128(2):69–73

    Article  Google Scholar 

  5. Daruwalla JS, Balasubramaniam P, Chay SO et al (1985) Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren. J Bone Joint Surg Br 67(2):182–184

    CAS  Article  PubMed  Google Scholar 

  6. Wong HK, Hui JH, Rajan U et al (2005) Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine 30(10):1188–1196

    Article  PubMed  Google Scholar 

  7. Cilli K, Tezeren G, Taş T et al (2009) School screening for scoliosis in Sivas, Turkey. Acta Orthop Traumatol Turc 43(5):426–430

    Article  PubMed  Google Scholar 

  8. Soucacos PN, Soucacos PK, Zacharis KC et al (1997) School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am Vol 79(10):1498–1503

    CAS  Article  Google Scholar 

  9. Negrini S, Minozzi S, Bettany-Saltikov J et al (2016) Braces for idiopathic scoliosis in adolescents. Spine 41(23):1813–1825

    Article  PubMed  Google Scholar 

  10. Weinstein SL, Dolan LA, Wright JG et al (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16):1512–1521

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 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 Vol 77(6):815–822

    CAS  Article  Google Scholar 

  12. Cheung KM, Cheng EY, Chan SC et al (2007) Outcome assessment of bracing in adolescent idiopathic scoliosis by the use of the SRS-22 questionnaire. Int Orthop 31(4):507–511

    Article  PubMed  Google Scholar 

  13. Cheung PWH, Wong CKH, Cheung JPY (2019) An insight into the health-related quality of life of adolescent idiopathic scoliosis patients who are braced, observed, and previously braced. Spine 44(10):E596-e605

    Article  PubMed  Google Scholar 

  14. Climent JM, Sánchez J (1999) Impact of the type of brace on the quality of life of adolescents with spine deformities. Spine 24(18):1903–1908

    CAS  Article  PubMed  Google Scholar 

  15. Noonan KJ, Dolan LA, Jacobson WC et al (1997) Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop 17(6):712–717

    CAS  PubMed  Google Scholar 

  16. Ugwonali OF, Lomas G, Choe JC et al (2004) Effect of bracing on the quality of life of adolescents with idiopathic scoliosis. Spine J: Off J North Am Spine Soc 4(3):254–260

    Article  Google Scholar 

  17. Vasiliadis E, Grivas TB, Savvidou O et al (2006) The influence of brace on quality of life of adolescents with idiopathic scoliosis. Stud Health Technol Inform 123:352–356

    PubMed  Google Scholar 

  18. Wang H, Tetteroo D, Arts JJC et al (2021) Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review. Qual Life Res: Int J Qual Life Asp Treat Care And Rehabil 30(3):703–711

    Article  Google Scholar 

  19. Flynn D (2007) Biopsychosocial aspects of idiopathic scoliosis.

  20. Hines T, Roland S, Nguyen D et al (2015) School scoliosis screenings: family experiences and potential anxiety after orthopaedic referral. Spine 40(21):E1135–E1143

    Article  PubMed  Google Scholar 

  21. Wang H, Li T, Yuan W et al (2019) Mental health of patients with adolescent idiopathic scoliosis and their parents in China: a cross-sectional survey. BMC Psychiatry 19(1):147

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schwieger T, Campo S, Steuber KR et al (2016) An exploration of information exchange by adolescents and parents participating in adolescent idiopathic scoliosis online support groups. Scoliosis Spinal disord 11:22

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kuroki H (2018) Brace treatment for adolescent idiopathic scoliosis. J Clin Med 7(6):136

    Article  PubMed Central  Google Scholar 

  24. Sanders JO, Khoury JG, Kishan S et al (2008) Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence. J Bone Joint Surg Am 90(3):540–553

    Article  PubMed  Google Scholar 

  25. Sitoula P, Verma K, Holmes L Jr et al (2015) Prediction of curve progression in idiopathic scoliosis: validation of the sanders skeletal maturity staging system. Spine 40(13):1006–1013

    Article  PubMed  Google Scholar 

  26. Richards BS, Bernstein RM, D’Amato CR et al (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine 30(18):2068–2075 (discussion 76–7)

    Article  PubMed  Google Scholar 

  27. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    CAS  Article  PubMed  Google Scholar 

  28. Nault ML, Beauséjour M, Roy-Beaudry M et al (2020) A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit. Spine 45(9):605–611

    Article  PubMed  Google Scholar 

  29. Wiemann JM, Shah SA, Price CT (2014) Nighttime bracing versus observation for early adolescent idiopathic scoliosis. J Pediatr Orthop 34(6):603–606

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hosmer DW Jr, Lemeshow S, Sturdivant RX (2013) Applied logistic regression. Hoboken, New Jersey

    Book  Google Scholar 

  31. García-Giménez JL, Rubio-Belmar PA, Peiró-Chova L et al (2018) Circulating miRNAs as diagnostic biomarkers for adolescent idiopathic scoliosis. Sci Rep 8(1):2646

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ogura Y, Matsumoto M, Ikegawa S et al (2018) Epigenetics for curve progression of adolescent idiopathic scoliosis. EBioMedicine 37:36–37

    Article  PubMed  PubMed Central  Google Scholar 

  33. Zhang J, Cheuk KY, Xu L et al (2020) A validated composite model to predict risk of curve progression in adolescent idiopathic scoliosis. EClinicalMedicine. 18:100236

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cheung JPY, Cheung PWH, Luk KD (2019) When should we wean bracing for adolescent idiopathic scoliosis? Clin Orthop Relat Res 477(9):2145–2157

    Article  PubMed  PubMed Central  Google Scholar 

  35. Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am Vol 72(3):328–333

    CAS  Article  Google Scholar 

  36. Geijer H, Beckman K, Jonsson B et al (2001) Digital radiography of scoliosis with a scanning method: initial evaluation. Radiology 218(2):402–410

    CAS  Article  PubMed  Google Scholar 

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Authors and Affiliations



Conception or design of work: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Acquisition, analysis, or interpretation of data for the work: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Drafting of work or revising it critically for important intellectual content: MAJ, SG, JMF, JBA, PJC, JJW, and KDB. Final approval of version to be published: MAJ, SG, JMF, JBA, PJC, JJW, and KDB.

Corresponding author

Correspondence to Keith D. Baldwin.

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All authors have no relevant financial or non-financial interests to disclose.

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This study was conducted with IRB approval.

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Johnson, M.A., Gohel, S., Flynn, J.M. et al. “Will I Need a Brace?”: likelihood of curve progression to bracing range in adolescent idiopathic scoliosis. Spine Deform 10, 537–542 (2022).

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  • Adolescent idiopathic scoliosis
  • Progression
  • Bracing
  • Skeletal maturity
  • Risk
  • Outcomes