Does bracing for adolescent idiopathic scoliosis affect operative results?

Study design Retrospective comparative study. Objectives We hypothesize that preoperative bracing for idiopathic scoliosis results in increased stiffness, as measured by reduced correction on bending films, ultimately leading to decreased surgical correction. Summary of background data Bracing is the primary nonoperative treatment for immature AIS patients with mild to moderate curves. For patients who fail bracing and proceed to operative intervention, it is unknown whether their nonoperative treatment impacts their surgical results. Methods We conducted a single-center, retrospective, comparative study on 181 consecutive adolescent idiopathic scoliosis patients, aged 11–17 years, who underwent posterior spine fusion between 2011 and 2013. Patient flexibility was measured as percent change in the curve angle of the spine from standing to supine bend. Overall curve correction was calculated as the preoperative to postoperative change in standing coronal measure divided by the preoperative measurement and reported as a percentage. Results One hundred and twelve subjects (62%) underwent bracing prior to fusion. Braced patients had similar preoperative major Cobb angles than unbraced patients (56.5 vs 59.0, p = 0.07). Preoperatively, braced patients achieved less primary curve correction in bending films (33.6%) than unbraced patients (40.6%, p = 0.003). Postoperatively, Cobb angle correction was not different between the braced (75.7%) and unbraced group (77.2%) overall ( p = 0.41). There was no difference in blood loss ( p = 0.14) or surgical time ( p = 0.96) between braced and unbraced groups when adjusted for surgeon and number of levels fused. Conclusions While braced patients may demonstrate less preoperative flexibility, there is no evidence that braced patients experience decreased curve correction compared to unbraced patients. Bracing treatment did not impact operative results, as indicated by similar Cobb angle correction, estimated blood loss, and surgical time in both groups. Level of evidence III.