The Effect of Bracing on Large Curves of 40° to 55° in Adolescents with Idiopathic Scoliosis who Have Avoided Surgery

Background: In clinical setting, despite the recommendation of surgery for Cobb angle of > 40°, some AIS patients avoid the spinal fusion and insisted on the use of a brace. However, the effectiveness of bracing for patients with Cobb angle of > 40° is controversial. This study was aimed to evaluate the effect of bracing on curves of 40° to 55° in adolescents with idiopathic scoliosis (AIS).Methods: In this retrospective comparative study, Clinical cases of 60 AIS with initial Cobb angle between 40° to 55° who had undergone bracing were reviewed. The prescription of the physician for these patients on the first visit had been surgery, but strongly rejected by the patients. The inclusion criteria were Risser sign 0-2 at initiation of bracing, age above 10 years, and no previous treatment. The curve magnitude was recorded at the initiation of bracing, weaning, discontinuance of bracing and minimum two years after discontinuance of bracing.Results: Seven males and fifty-three females with an initial Cobb angle of 44.93° ± 4.86° were included in this study. The curve progressed in 57% of patients, stabilized in 25% and improved in 18%. In the progression group (34 patients), 31 patients had undergone surgery. In the non-progression group (26 patients), the Cobb angle was significantly different between the initiation of bracing and weaning time, discontinuance of brace and final follow-up (p < 0.05).Conclusion: The failure rate of bracing for AIS patients with Cobb angle between 40°-55° was 57%. Although the success rate of bracing for these patients was lower than those with moderate curves, but these results can help the physicians to take appropriate decision about those patients with larger curves who refused surgery. Further studies are needed to establish the prognostic factors in effectiveness of bracing for AIS patients with curves of > 40 degrees.