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

## TL;DR

A six-month out-of-brace X-ray is the best early indicator of long-term success in treating adolescent scoliosis with braces.

## Contribution

The study identifies the six-month out-of-brace radiographic evaluation as the most reliable predictor of brace treatment success in adolescent idiopathic scoliosis.

## Key findings

- The six-month out-of-brace Cobb angle is the strongest predictor of treatment success.
- Lumbar and single-curve patterns show more stable correction than thoracic or multiple-curve deformities.
- Initial in-brace correction is less predictive than the six-month out-of-brace evaluation.

## Abstract

What are the main findings?
The six-month out-of-brace radiographic evaluation is the most reliable predictor of long-term brace treatment success in adolescents with idiopathic scoliosis.Lumbar and single-curve patterns show significantly better and more stable correction compared to thoracic or multiple-curve deformities.

The six-month out-of-brace radiographic evaluation is the most reliable predictor of long-term brace treatment success in adolescents with idiopathic scoliosis.

Lumbar and single-curve patterns show significantly better and more stable correction compared to thoracic or multiple-curve deformities.

What are the implications of the main findings?
Clinical follow-up in AIS should focus on dynamic, time-dependent assessment rather than relying solely on initial in-brace correction.The six-month out-of-brace spine radiograph should be considered as an integral part of the standard clinical protocol for brace treatment evaluation to ensure more accurate assessment of treatment outcomes.Patients with thoracic or complex curve patterns require intensified monitoring and individualized treatment protocols to optimize outcomes.

Clinical follow-up in AIS should focus on dynamic, time-dependent assessment rather than relying solely on initial in-brace correction.

The six-month out-of-brace spine radiograph should be considered as an integral part of the standard clinical protocol for brace treatment evaluation to ensure more accurate assessment of treatment outcomes.

Patients with thoracic or complex curve patterns require intensified monitoring and individualized treatment protocols to optimize outcomes.

Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions: 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.