Evaluating brace holiday outcomes in idiopathic scoliosis

In idiopathic scoliosis, the psychological and social effects of bracing can be difficult, thus clinicians sometimes recommend a brace holiday when the curve drops below 25°. While the Scoliosis Research Society has reached a consensus on bracing indications and duration, there is little evidence regarding outcomes from taking a break from bracing prior to skeletal maturity. We hypothesized there would be no relationship between taking a brace holiday and final primary curve.

A retrospective cohort study at a single institution was performed for idiopathic scoliosis patients treated with a brace whose primary curve corrected to below 25° from 2016 to 2022. Objective bracing compliance I-button data was collected on patients aged 3 - 18 years old at the time of brace presentation. Patients with neuromuscular and syndromic etiologies of scoliosis and those ineligible for a brace holiday were excluded. Univariate analyses were performed as appropriate.

34 patients met inclusion criteria. Of these, 16 received a brace holiday (18 did not). At most recent follow up, primary curve size did not differ between those who received a brace holiday (23.1 ± 12.6°) and those who did not (21.7 ± 6.1°) (p = 0.772). Brace holidays lasted on average 17.8 ± 10.7 months, occurring at a mean age 10.6 ± 1.5 years in patients with a mean primary curve of 14.9 ± 3.6° at the beginning of the holiday. The mean age for patients who resumed bracing (n = 12) was 12.0 ± 0.9 years, at a mean primary curve of 29.3 ± 4.1°, with a most recent mean primary curve of 26.4 ± 12.4°.

This study demonstrates that select younger patients who take a brace holiday may not have clinically relevant differences in final primary curve magnitude compared to standard-of-care adolescents. This work offers evidence that can be valuable in the productive dialogue with families on the risks and benefits of a brace holiday.

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