Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention.
Over 16 hours/day of brace wear linked to successful curve correction in scoliosis.
Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention.
Surgery is typically recommended for patients with severe adolescent idiopathic scoliosis (adolescent idiopathic scoliosis); however, some patients explicitly refuse due to concerns about surgical risks and other factors.
This single-center retrospective cohort study included patients with severe adolescent idiopathic scoliosis (Cobb angle >40°) who met surgical indications but refused surgery during the study period (January 2021 to April 2025).
The overall correction rate was 18.0% ± 14.0%, with 56.1% of patients achieving a Cobb angle below 40°, and 39.0% showing improvement greater than 10°.
Multivariate analysis revealed that daily brace-wearing time was an independent predictor of correction rate (each additional hour increased the correction rate by 1.88%, P = 0.003).
The four core domains of the SRS-22r quality-of-life questionnaire (function/activity, pain, self-image, and mental health) demonstrated significant improvement, and treatment satisfaction was high at final follow-up.
Patient motivation showed a strong positive correlation with wearing time ( r = 0.654).
For patients with severe adolescent idiopathic scoliosis who refused surgery, conservative bracing achieved satisfactory short-to-mid-term outcomes with a favorable safety profile within a shared decision-making framework.
Actual daily wearing time demonstrated the strongest independent association with radiographic outcomes among measured variables, while patients' intrinsic motivation showed a strong correlation with compliance, suggesting a potential indirect pathway to improved outcomes.