Work

Toward a Dynamic Follow-Up Protocol in Adolescent Idiopathic Scoliosis: Six-Month Out-of-Brace Evaluation as the Key Predictor of Treatment Success

Year: 2025

Type: article

Abstract: Background: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that requires effective conservative management to prevent progression and reduce surgical risk. Although bracing is effective, predictors of long-term outcomes and the prognostic value of short-term results remain insufficiently defined. Objective: This study aimed to identify clinical and radiological determinants of final treatment success in AIS patients treated with the Chêneau modified brace (CMB), with special emphasis on short-term predictors. Methods: A prospective longitudinal cohort study was conducted at the Institute for Physical Medicine, Rehabilitation, and Orthopaedic Surgery “Dr. Miroslav Zotović”, Banja Luka (2018–2024). Fifty AIS patients (mean age 13.5 ± 1.4 years; 80% female) with Cobb angles between 20 and 45° and Risser sign 0–3 were analyzed. Cobb angles were measured at four timepoints: baseline, 4 weeks (in-brace), 6 months (out-of-brace), and final follow-up (48.3 ± 9.4 months). Statistical analyses included repeated-measures ANOVA, Pearson correlation, and multivariate regression. Results: The mean Cobb angle improved significantly from 28.7° ± 7.1° to 22.1° ± 10.5° (p < 0.001). The six-month out-of-brace Cobb angle was the strongest predictor of treatment success (OR = 0.726, p = 0.001), surpassing initial in-brace correction. Lumbar curves demonstrated the most stable correction (28.1° → 20.5°, p < 0.001), while thoracic curves showed partial loss of improvement (30.5° → 26.9°, p = 0.373). Single-curve and non-compensatory deformities achieved greater correction than complex or double curves (p = 0.014). Conclusions: The six-month out-of-brace radiograph represents a key prognostic milestone in AIS management. Incorporating this dynamic assessment into routine follow-up may enhance individualized treatment planning and long-term outcomes.

Source: Children

DOI: 10.3390/children13010010