• Leilei Xu, Xianfeng Yang, Yuwen Wang, Zhichong Wu, Chao Xia, Yong Qiu, and Zezhang Zhu.
• Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
• World Neurosurg. 2019 Jun 1; 126: e901-e906.

ObjectiveTo investigate effectiveness of brace treatment in patients with adolescent idiopathic scoliosis with curve between 40° and 45° and to determine predictive factors associated with bracing outcome.MethodsBracing was used to treat 90 patients with curve >40 degrees. Factors including Risser sign, age, sex, curve pattern, curve magnitude, and initial curve correction were compared between patients with curve improvement and patients with curve progression. Logistic regression analysis was used to determine the independent predictors of curve progression.ResultsCurve was improved in 34 (37.8%) patients and stabilized in 12 (13.3%) patients. Remarkable curve progression >50 degrees was observed in 44 (48.9%) patients. Intergroup comparison showed significant differences between the 2 groups in terms of age (12.3 ± 1.4 years vs. 13.2 ± 1.6 years, P = 0.01), initial curve correction (2.2% ± 5.4% vs. 19.7% ± 12.2%, P < 0.001), and curve pattern (P = 0.03). Logistic regression analysis showed that initial curve correction of <10% (odds ratio = 12.82, P < 0.001) and Risser grade of 0 (odds ratio = 1.46, P = 0.04) were significant indicators of curve progression.ConclusionsBracing may produce a favorable outcome in certain patients with curve between 40° and 45°. It should be cautiously used in this situation, as there was a higher probability of bracing failure. It is important to differentiate patients at high risk of curve progression at an early stage to avoid overtreatment.Copyright © 2019 Elsevier Inc. All rights reserved.

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