Bracing for Adolescent Idiopathic Scoliosis in Practice Today

Background: The use of orthoses in adolescent idiopathic scoliosis has a long history. The purpose of this article is to summarize the current practice of bracing in the treatment of adolescent idiopathic scoliosis. Methods: The literature from the past 25 years was reviewed for primary papers that contained accepted inclusion criteria for bracing, meta-analyses, and summaries of existing opinion. Recent literature was also reviewed for current bracing practices. Results: The highest level of existing evidence comes from a prospective center-randomized study by Nachemson et al, which showed that bracing was effective for single curves of 25 to 35 degrees in female patients with a starting Risser score of 0 to 2. Two other studies with meta-analyses came to opposite conclusions because of variations in the examined investigations. Although there are few studies that compare different types of treatment, most show an improved outcome versus historical controls. The yearly number of peer-reviewed papers on the topic has increased markedly over this time. Two prospective randomized multicenter trials are underway. Reviews suggest that most orthopaedic specialists recommend bracing but that they differ on expected results. There is also a proliferation of interest in bracing by nonorthopaedists, with more varied indications. There are many types of full-time and part-time braces, and their designs and indications are described. Conclusions: Brace treatment for adolescent idiopathic scoliosis continues to be frequently used, and the number of brace types has increased. Predicting progressive curves and refining indications requires additional investigation.