Bracing Outcomes and Risk of Curve Progression in Adolescents with Idiopathic Scoliosis and Autism Spectrum Disorder

Whether the sensory and behavioral traits of autism spectrum disorder (ASD) affect bracing outcomes in adolescent idiopathic scoliosis (AIS) remains unclear. This study evaluated the impact of ASD on bracing success, curve progression, and patient-reported outcomes in patients with AIS.

This retrospective study included patients 10 to 18 years of age who were treated for AIS with bracing between 2011 and 2024. A total of 58 patients with ASD were matched in a 1:2 ratio to 116 controls with use of nearest-neighbor matching based on BrAIST-Calc predicted probabilities. Exclusions included non-idiopathic scoliosis, early-onset scoliosis, kyphoscoliosis, a Risser stage of >2, pre-treatment curves of <25° or >40°, and inadequate follow-up. Progression to the surgical threshold was defined as a major curve of ≥45°. Firth logistic regression was used to model the association between ASD and progression to the surgical threshold, adjusting for residual imbalances.

The matched cohort (n = 174; 51% male; 40% White, 25% Hispanic, 21% Black, 10% Asian, and 5% not specified) demonstrated balanced propensity scores (SMD = 0.006). Compared with patients without ASD, those with ASD had higher rates of progression to the surgical threshold (40% versus 20%; p = 0.005), a curve progression of ≥6° (60% versus 38%; p = 0.005), noncompliance (36% versus 22%; p = 0.04), brace-related issues (22% versus 8%; p = 0.006), and surgery being recommended or performed (33% versus 13%; p = 0.002). In the multivariable analysis, ASD (odds ratio [OR], 3.12 [95% confidence interval (CI), 1.32 to 7.35]; p = 0.009), noncompliance (OR, 4.00 [95% CI, 1.65 to 9.71]; p = 0.002), and a greater initial curve magnitude (OR per degree, 1.26 [95% CI, 1.15 to 1.38]; p < 0.001) significantly increased the odds of progression to the surgical threshold. Within the ASD group, Scoliosis Research Society-22 revised (SRS-22r) self-image, management, and total scores improved significantly over time. No significant between-group differences in change scores were observed.

Adolescents with ASD were >3 times more likely to progress to the surgical threshold and had higher rates of noncompliance, brace-related issues, and surgery being recommended or performed. ASD may represent a risk factor for bracing failure, potentially related to sensory or behavioral intolerance. Nonetheless, 60% of patients with ASD avoided progression to the surgical threshold, and within-group improvements in SRS-22r scores were observed. These findings support bracing as a viable treatment option for patients with ASD, although it is likely best paired with individualized care and closer follow-up. Future studies should aim to improve brace tolerance and adherence in this population.

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.