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

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.

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.

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.

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).

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.