Infantile Idiopathic Scoliosis: Outcomes of Brace Treatment until Skeletal Maturity or Spinal Fusion

Document Type : RESEARCH PAPER


1 Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: Serial casting under general anesthesia, which is considered as a gold standard of treatment for patients
with infantile idiopathic scoliosis (IIS), can lead to significant negative neurodevelopmental effects. Therefore, the
appropriateness of this type of treatment is controversial. Brace treatment is one alternative method of treatment for IIS
patients. However, long-term studies have not yet verified its effectiveness. Thus, the present study aimed to evaluate
the effectiveness of brace treatment in patients with IIS until skeletal maturity or spinal fusion.
Methods: The medical records of all IIS patients with the referral age of 0-3 years who received brace treatment from
June 1986 to November 2013 were reviewed. Those patients with pre-brace Cobb angle > 20° were included and
followed up to skeletal maturity or the time of spinal fusion. The Cobb angle was recorded at the time of diagnosis
before the initiation of bracing, weaning time, brace discontinuation, and final follow-up. In addition, the maximum inbrace
curve correction was measured.
Results: Out of 87 patients with IIS, a total of 29 cases (19 males and 10 females) with the average curve magnitude
of 35.62° at the time of diagnosis were included in the study. The average best in-brace correction was 57.32% for
successfully treated patients and 36.97% for progression/surgery patients. Based on the results, brace treatment failed
for a total of 20 patients (69%), with a scoliosis curvature progress ≥ 45°. Of these patients, 12 cases (60%) reached
spinal fusion. Finally, four patients (13%) in the surgery-treated group underwent surgery before the age of 10.
Conclusion: The results revealed that bracing was successful for more than two-thirds of patients with IIS curves,
preventing surgery before the age of 10.
Level of evidence: IV


1. James JI. Idiopathic scoliosis; the prognosis, diagnosis,
and operative indications related to curve patterns
and the age at onset. J Bone Joint Surg Br. 1954; 36-
2. Scott JC, Morgan TH. The natural history and prognosis
of infantile idiopathic scoliosis. J Bone Joint Surg Br.
1955; 37-b(3):400-13.
3. Ceballos T, Ferrer-Torrelles M, Castillo F, Fernandez-
Paredes E. Prognosis in infantile idiopathic scoliosis. J
Bone Joint Surg Am. 1980; 62(6):863-75.
4. Thompson SK, Bentley G. Prognosis in infantile
idiopathic scoliosis. J Bone Joint Surg Br. 1980; 62-
5. Tis JE, Karlin LI, Akbarnia BA, Blakemore LC,
Thompson GH, McCarthy RE, et al. Early onset
scoliosis: modern treatment and results. J Pediatr
Orthop. 2012; 32(7):647-57.
6. Mehta MH. Growth as a corrective force in the early
treatment of progressive infantile scoliosis. J Bone
Joint Surg Br. 2005; 87(9):1237-47.
7. FDA review results in new warnings about using
general anesthetics and sedation drugs in young
children and pregnant women. The U.S. Food and Drug
Administration (FDA): 2016 [updated 2017 April 27;
cited 2016 December 14]. Available from: https://
8. Andropoulos DB, Greene MF. Anesthesia and
developing brains: implications of the FDA warning.
N Engl J Med. 2017; 376(10):905-7.
9. Derderian CA, Szmuk P, Derderian CK. Behind the
Black Box: The evidence for the U.S. food and drug
administration warning about the risk of general
anesthesia in children younger than 3 years. Plast
Reconstr Surg. 2017; 140(4):787-92.
10. Hu D, Flick RP, Zaccariello MJ, Colligan RC, Katusic SK,
Schroeder DR, et al. Association between exposure
of young children to procedures requiring general
anesthesia and learning and behavioral outcomes in a
population-based birth cohort. Anesthesiology. 2017;
11. Smith JR, Samdani AF, Pahys J, Ranade A, Asghar J,
Cahill P, et al. The role of bracing, casting, and vertical
expandable prosthetic titanium rib for the treatment
of infantile idiopathic scoliosis: a single-institution
experience with 31 consecutive patients. J Neurosurg 
Spine. 2009; 11(1):3-8.
12. Thometz J, Liu XC. Serial CAD/CAM Bracing: An
alternative to serial casting for early onset scoliosis. J
Pediatr Orthop. 2019; 39(3):e185-e9.
13. Welborn MC, D’Astous J, Bratton S, Heflin J. Infantile
idiopathic scoliosis: factors affecting EDF casting
success. Spine Deform. 2018; 6(5):614-20.
14. Jarvis J, Garbedian S, Swamy G. Juvenile idiopathic
scoliosis: the effectiveness of part-time bracing. Spine
(Phila Pa 1976). 2008; 33(10):1074-8.
15. Richards BS, Bernstein RM, D’Amato CR, Thompson
GH. Standardization of criteria for adolescent
idiopathic scoliosis brace studies: SRS Committee on
bracing and nonoperative management. Spine (Phila
Pa 1976). 2005; 30(18):2068-75.
16. Iorio J, Orlando G, Diefenbach C, Gaughan JP, Samdani
AF, Pahys JM, et al. Serial casting for infantile
idiopathic scoliosis: radiographic outcomes and
factors associated with response to treatment. J
Pediatr Orthop. 2017; 37(5):311-6.
17. Sanders JO, D’Astous J, Fitzgerald M, Khoury
JG, Kishan S, Sturm PF. Derotational casting for
progressive infantile scoliosis. J Pediatr Orthop. 2009;
18. van den Bogaart M, van Royen BJ, Haanstra TM, de
Kleuver M, Faraj SSA. Predictive factors for brace
treatment outcome in adolescent idiopathic scoliosis:
a best-evidence synthesis. Eur Spine J. 2019; 28(3):
19. Rahimi S, Kiaghadi A, Fallahian N. Effective factors on
brace compliance in idiopathic scoliosis: a literature
review. Disabil Rehabil Assist Technol. 2019:1-7. doi:
10.1080/17483107.2019.1629117. [Epub ahead of
20. Hawary RE, Zaaroor-Regev D, Floman Y, Lonner BS,
Alkhalife YI, Betz RR. Brace treatment in ais: risk
factors for failure - a literature review. Spine J. 2019
21. Lavelle J. An assessment of brace compliance in
adolescent idiopathic scoliosis using a new brace
timer. J Bone Joint Surg Br. 1996;78(Supp):162.
Volume 8, Issue 6
November and December 2020
Pages 696-702
  • Receive Date: 27 January 2020
  • Revise Date: 09 March 2020
  • Accept Date: 27 March 2020
  • First Publish Date: 01 November 2020