For the brace treatment of adolescent idiopathic scoliosis (AIS), in-brace correction and brace-wear compliance are well-documented parameters associated with a greater chance of treatment success. However, the number of studies on the impact of sagittal and transverse correction on curve evolution in the context of bracing is limited. The objective of this work was to evaluate how immediate inbrace correction in the three anatomical planes is related to long-term curve evolution after two years of bracing. We performed a retrospective analysis on 94 AIS patients followed for a minimum of two years. We analyzed correlations between in-brace correction and two-year out-of-brace evolution for Cobb and apical axial rotations (ARs) in the medial thoracic and thoraco-lumbar/lumbar regions (MT & TL/L). We also studied the association between the braces’ kyphosing and lordosing effect and the evolution of thoracic kyphosis (TK) and lumbar lordosis (LL) after two years. Finally, we separated the patients into three groups based on their curve progression results after two years (corrected, stable and progressed) and compared the 3D in-brace corrections and compliance for each group. Coefficients were statistically significant for all correlations. They were weak for Cobb angles (MT: -0.242; TL/L: -0.275), low for ARs (MT: -0.423; TL/L: -0.417) and moderate for sagittal curves (TK: 0.549; LL: 0.482). In-brace coronal correction was significantly higher in corrected vs stable patients (p=0.004) while compliance was significantly higher in stable vs progressed patients (p=0.026). This study highlights the importance of initial in-brace correction in all three planes for successful treatment outcomes.
Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery
