Below is a curated list of links of published scientific evidentiary studies that specifically supports Schroth Physiotherapy for early-detected mild curves in children with AIS and as an adjunct therapy to Orthotic Bracing. Schroth (from John Hopkins Health) is one methodology of Physiotherapeutic Scoliosis-Specific Exercises PSSE developed in Europe, aimed just for Scoliosis patients. It is not yet widely accepted or practiced in the US, Canada or England. However, Schroth is the most researched and widely used PSSE methodology in Europe where other types exist and recently being practiced in China. And gaining popularity in Canada but access is restricted due to a shortage of certified Schroth Physiotherapists and the financial cost which can be a barrier to parents and patients of limited means. The Schroth method is not part of the academic curriculum taught to physiotherapy students in Canadian universities and there is a shortage of certified Physiotherapists across Canada. As SOSORT recommends, based on evidentiary-studies, The Canadian Scoliosis Screening Coalition advocates that Schroth physiotherapy be added to the standard of care for young children diagnosed with AIS with mild curves and to be added as an adjunct treatment to orthotic bracing for adolescents and recognized by the Canadian Physiotherapy Association. And Canada's Universal health care and funding extended to include Schroth Physiotherapy and Orthotic braces as growth-dependent medical necessary Paediatric treatments and devices, as some prescription drugs were recently in Bill C-64, the Pharma Care Act, and direct provincial health ministries to cover the costs.

1. Jiménez-Jiménez AB, Gámez-Centeno E, Muñoz-Paz J, Muñoz-Alcaraz MN, Mayordomo-Riera FJ. z, The Effects of the Schroth Method on the Cobb Angle, Angle of Trunk Rotation, Pulmonary Function, and Health-Related Quality of Life in Adolescent Idiopathic Scoliosis: A Narrative Review. Healthcare. 2025; 13(20):2631. https://doi.org/10.3390/healthcare13202631 "... 13 studies were included in our review. The results showed that the Schroth method proved effective in reducing the Cobb angle and ATR, particularly in patients with mild curves and in early stages of skeletal growth. Improvements were also observed in health-related quality of life and aesthetic perception, and to a lesser extent, in pulmonary function. ... Conclusions: The Schroth method could be an effective treatment associated with orthopedic treatment, yielding satisfactory results. Its implementation requires structured programs, professional supervision, and strategies to enhance therapeutic adherence..."
2. Zhang X, Lv J, Li X, Lin B, Huang Y, Lin Y, Hu M, Liao B. Immediate Effects of the Schroth Method on Spinal Curvature and Paravertebral Muscle Activation in Adolescent Idiopathic Scoliosis. Orthop Surg. 2025 Jul;17(7):2150-2158. doi: 10.1111/os.70096. Epub 2025 Jun 9. PMID: 40491181; PMCID: PMC12214401."...Conclusion: While Schroth exercises effectively reduced thoracic curvature and improved T8 muscle symmetry, caution is warranted during "50 × Pezziball" and sail exercises due to increased PT compensation and lumbar/T2 muscle imbalances. Muscle cylinder exercises may mitigate adverse lumbar effects."
3. Mohamed N, Acharya V, Schreiber S, Parent EC, Westover L. Effect of adding Schroth physiotherapeutic scoliosis specific exercises to standard care in adolescents with idiopathic scoliosis on posture assessed using surface topography: A secondary analysis of a Randomized Controlled Trial (RCT). PLoS One. 2024 Apr 30;19(4):e0302577. doi: 10.1371/journal.pone.0302577. PMID: 38687741; PMCID: PMC11060560. "...In this randomized controlled clinical trial (RCT), the objective was to determine the effect of the 6-month Schroth exercise intervention added to standard care compared to standard care used alone on asymmetry measures in AIS using ST analysis. ...Conclusion: Schroth Exercise treatment added to standard care (observation or bracing) reduced asymmetry measurements in AIS. As expected, a greater effect was observed for participants who followed the prescribed exercise treatment per protocol..."
4. Tombak K, Yüksel İ, Ozsoy U, Yıldırım Y, Karaşin S. A Comparison of the Effects of Supervised versus Home Schroth Exercise Programs with Adolescent Idiopathic Scoliosis. Children (Basel). 2024 Mar 17;11(3):354. doi: 10.3390/children11030354. PMID: 38539389; PMCID: PMC10969552."... 37 patients were randomly assigned to either the Supervised (n = 19) or Home-Based Schroth Exercise Group (n = 18) and completed the study. Both groups were treated for seven days a week over twelve weeks... In our investigation, both Schroth therapy procedures applied to AIS patients had successful outcomes for most of the examined parameters. However, there are few physiotherapists with Schroth training. Patients with AIS have restricted access to this therapy due to several factors...we can conclude that the supervised Schroth exercise program has a more remarkable impact on improving morphometric and cosmetic effects of AIS than the home exercise program. The home exercise program can be an alternative treatment if corrected by a physiotherapist at specific intervals..."
5. Kyrkousis A, Iakovidis P, Chatziprodromidou IP, Lytras D, Kasimis K, Apostolou T, Koutras G.Effects of a Long-Term Supervised Schroth Exercise Program on the Severity of Scoliosis and Quality of Life in Individuals with Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial Study Medicina. 2024; 60(10):1637. https://doi.org/10.3390/medicina60101637 "...Our study evaluated the impact of a long-term supervised Schroth exercise program on individuals with AIS who wear a brace. The results demonstrated that implementing a 12-month supervised Schroth exercise program is feasible and can lead to statistically and clinically significant improvements in both the severity of scoliosis and the quality of life for individuals with AIS. The study found a statistically significant improvement in the Cobb angle after completing the Schroth exercise program with the improvement exceeding the minimum detectable clinical difference of 5°. Additionally, a significant improvement in the ATR maximum was observed after the program, which was sustained 6 months post-intervention. Finally, the Schroth program had a significant impact on the SRS-22 score, which also remained improved 6 months after the intervention...
6. Chen C, Xu J, Li H. Effects of Schroth 3D Exercise on Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Children (Basel). 2024 Jul 1;11(7):806. doi: 10.3390/children11070806. PMID: 39062255; PMCID: PMC11275065. "...Spinal deformity impacts not only physiological function but also self-esteem and mental health...Clinical treatment should prioritize patients’ self-image and psychological well-being...Schroth exercise therapy shows notable benefits in treating idiopathic scoliosis by improving curvature and vertebral rotation angles, quality of life, and lumbar extensor strength compared to traditional treatments..."
7. ***Karavidas N, Iakovidis P, Chatziprodromidou I, Lytras D, Kasimis K, Kyrkousis A, Apostolou T,
   Physiotherapeutic Scoliosis-Specific Exercises (PSSE-Schroth) can reduce the risk for progression during early growth in curves below 25 degrees: prospective control study. Eur 3 Phys Rehabil Med. 2024 Apr,60(2):331-339. doi: 10.23736/S1973-9087.24.08177-2. Epub 2024 Mar 19. PMID: 38502554; PMCID: PMC11112511."...Our inclusion criteria were Cobb angle 15°-25°, Risser 0-2 and angle trunk rotation (ATR) >5°, measured by scoliometer...RESULTS For PSSE - Schroth group, 103 patients (63.2%) remained stable, 39 (23.9%) improved and 21 (12.9%) worsened. The success rate (87.1%) was significantly higher compared to Control group (P=0.002), where 15 subjects (25.9%) were stable and 43 (74.1%) worsened. Similarly, 16 patients (9.8%) from PSSE - Schroth group finally needed a brace, while 39 (67.2%) from control group (P=0.01)....PSSE-Schroth exercises can effectively treat AIS patients at early growth, significantly reducing the risk of progression and brace wearing. Only 12.9% of our sample had progression >5° and 9.8% required brace treatment... Our approach improved trunk rotation, self-perception, and quality of life..."
8. Jiping Chen, Tianwen Xu, Jianfan Zhou, Bing Han, Qingxu Wu, Wei Jin, Xianliang ZhangThe Superiority of Schroth Exercise Combined Brace Treatment for Mild-to-Moderate Adolescent Idiopathic Scoliosis: A Systematic Review and Network Meta-Analysis World NeuroSurg 2024 Jun:186:184-196.e9. doi: 10.1016/j.wneu.2024.03.103. Epub 2024 Mar 24. PMID: 3853147, "...the most optimal programs were those that included (1) at least 10 weeks of approximately 60-minute Schroth exercise sessions twice a week and (2) wearing the brace for 23 hours every day throughout the treatment period...."
9. Kyra Stein, Fabian Holzgreve, Fee Keil, Panagiotis Diaremes, David A Groneberg, Eileen M Wanke, Omar Zabar, Daniela Ohlendorf Improvement of pulmonary function parameters in female patients with adolescent idiopathic scoliosis by Schroth rehabilitative therapy Heliyon. 2024 Jul 17;10(15):e34758. doi: 10.1016/j.heliyon.2024.e34758

10. Ceballos-Laita L, Carrasco-Uribarren A, Cabanillas-Barea S, Pérez-Guillén S, Pardos-Aguilella P, Jiménez Del Barrio S. The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2023 Apr;59(2):228-236. doi: 10.23736/S1973-9087.23.07654-2. Epub 2023 Jan 24. PMID: 36692412; PMCID: PMC10170402. The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method consists of three-dimensional correction of the specific curve pattern of the patient using a combination of sensorimotor, postural, and corrective breathing exercises....PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, and Web of Science databases were searched. Studies were included if they were randomized controlled trials that compared the effects of the Schroth method in isolation to conservative interventions or no intervention. The quality of the studies was assessed with the PEDro Scale, and the risk of bias with the Cochrane Collaboration tool. Two independent assessors extracted data through a standardized form.
11. Zapata KA, McIntosh AL, Jo CH, Virostek D. The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression J Pediatr Orthop. 2023 Jul 1;43(6):368-372. doi: 10.1097/BPO.0000000000002391. Epub 2023 Mar 16. PMID: 36922003."...The PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P<0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P<0.01). ..In this prospective series of patients in nighttime Providence braces, the addition of Schroth-based physical therapy reduced curve progression after 1 year and at skeletal maturity. These findings can educate motivated families interested in PSSE. “ Level of Evidence: II
12. Dimitrijević V, Šćepanović T, Jevtić N, Rašković B, Milankov V, Milosević Z, Ninković SS, Chockalingam N, Obradović B, Drid P. Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Dec 13;19(24):16730. doi: 10.3390/ijerph192416730. PMID: 36554613; PMCID: PMC9779560. "Abstract: This study aimed to critically evaluate the effect size of Schroth’s method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: “Schroth exercise”, “idiopathic scoliosis”, “Cobb angle”, “angle of trunk rotation”, and “quality of life”. Only articles written in English that met the following criteria were included in our study...Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis."
13. Larni Y, Mohsenifar H, Ghandhari H, Salehi R. The effectiveness of Schroth exercises added to the brace on the postural control of adolescents with idiopathic scoliosis: Case series. Ann Med Surg (Lond). 2022 Nov 13;84:104893. doi: 10.1016/j.amsu.2022.104893. PMID: 36536721; PMCID: PMC9758328. "...It is a case series study on twenty-three AIS patients. They were treated using the Schroth method and brace for three months, with the first five sessions lasting two weeks and subsequently one session per week....Conclusion: Schroth method and brace improved the postural control and trunk rotation of AIS patients."
14. Dimitrijević V, Viduka D, Šćepanović T, Maksimović N, Giustino V, Bianco A, Drid P. Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. Eur Spine J. 2022 Dec;31(12):3500-3511. doi: 10.1007/s00586-022-07407-4. Epub 2022 Oct 14. PMID: 36229615. "...Conclusion The current systematic review and meta-analysis indicates that both Schroth method and core stabilization exercises have a positive effect in subjects with idiopathic scoliosis. Subgroup analysis showed that the Schroth method had a larger effect size than the core stabilization exercises....
15. Seleviciene V, Cesnaviciute A, Strukcinskiene B, Marcinowicz L, Strazdiene N, Genowska A.Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice Int J Environ Res Public Health. 2022 Jul 28;19(15):9240. doi: 10.3390/ijerph19159240. PMID: 35954620; PMCID: PMC9368145."...Bracing has traditionally been the mainstay of treatment, but growing evidence suggests that PSSE physiotherapy allows effective management of idiopathic adolescent scoliosis... existing evidence indicates that PSSE physiotherapy helps to stabilize spinal deformity and improve patients' quality of life. Among the abovementioned methodologies, Schroth is the most widely studied and has been proven to be effective. However, both SEAS and BSPTS effectively stabilize and even reduce the Cobb angle of scoliosis. Data supporting the validity of other methodologies are very limited. Only the Schroth method significantly reduces the angle of trunk rotation, while both SEAS and Schroth methods greatly improve the quality of life indicators..."
16. Gao A, Li JY, Shao R, Wu TX, Wang YQ, Liu XG, Yu M. Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients. Chin Med J (Engl). 2021 Oct 13;134(21):2589-2596. doi: 10.1097/CM9.0000000000001799. PMID: 34653079; PMCID: PMC8577664., "..Figure 3. A 15-year-old girl with Risser 3 performed Schroth exercises. (A) Pre-treatment Cobb angle was 34.1° on X-ray; (B) after 1-year Schroth exercise, Cobb angle decreased to 28.5° on X-ray; and (C) after 28-month Schroth exercise, Cobb angle was 28.3°...For AIS patients with a Risser 3–5 and a Cobb angle 20°–40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS..."
17. Fang MQ, Huang XL, Wang W, Li YA, Xiang GH, Yan GK, Ke CR, Mao CH, Wu ZY, Pan TL, Zhu RB, Xiao J, Yi XH, The efficacy of Schroth exercises combined with the Chêneau brace for the treatment of adolescent idiopathic scoliosis: a retrospective controlled study. Disabil Rehabil. 2022 Sep;44(18):5060-5068. doi: 10.1080/09638288.2021.1922521. Epub 2021 May 13. PMID: 33984249. "...Conclusions: Compared to bracing alone, the Schroth exercises plus bracing had a better effect on coronal balance. Schroth exercises improve flatback deformity caused by bracing and positively influence the HRQoL in AIS patients ..."
18. Kocaman H, Bek N, Kaya MH, Büyükturan B, Yetiş M, Büyükturan Ö. The effectiveness of two different exercise approaches in adolescent idiopathic scoliosis: A single-blind, randomized-controlled trial. PLoS One. 2021 Apr 15;16(4):e0249492. doi: 10.1371/journal.pone.0249492. PMID: 33857180; PMCID: PMC8049223. "...28 subjects with adolescent idiopathic scoliosis with a mild curve magnitude (10°–26°) were randomly divided into two groups: the Schroth group (n = 14) and the core group (n = 14). The patients in the Schroth group were treated with supervised Schroth exercises, and the patients in the core group were treated with supervised core stabilization exercises...Results It was found that patients in the Schroth group showed greater improvement in Cobb angles, thoracic trunk rotation angle, cosmetic trunk deformity, spinal mobility, and quality of life than those in the core group (p<0.05), except for in lumbar trunk rotation angle. Peripheral muscle strength improvement was greater in the core group than in the Schroth group (p<0.05)... Conclusion Schroth exercises are more effective than core stabilization exercises in the correction of scoliosis and related problems in mild adolescent idiopathic scoliosis, and core stabilization exercises are more effective than Schroth exercises in the improvement of peripheral muscle strength."
19. Fan Y, To MKT, Yeung EHK, Wu J, He R, Xu Z, Zhang R, Li G, Cheung KMC, Cheung JPY. Does curve pattern impact on the effects of physiotherapeutic scoliosis specific exercises on Cobb angles of participants with adolescent idiopathic scoliosis: A prospective clinical trial with two years follow-up. PLoS One. 2021 Jan 25;16(1):e0245829. doi: 10.1371/journal.pone.0245829. PMID: 33493172; PMCID: PMC7833215."Current clinical evidence suggests that a well-planned physiotherapeutic scoliosis specific exercise (PSSE) program is effective for scoliosis regression....this study investigated the long-term therapeutic effects of Schroth exercises on major thoracic and major lumbar curves, respectively...In this study, no curve progression was observed in either group, suggesting that a well-planned PSSE program can prevent scoliosis deterioration regardless of curve patterns..."
20. Sanja Schreiber, Eric C Parent, Doug L Hill, Douglas M Hedden, Marc J Moreau, Sarah C Southon Patients with adolescent idiopathic scoliosis perceive positive improvements regardless of change in the Cobb angle – Results from a randomized controlled trial comparing a 6-month Schroth intervention added to standard care and standard care alone. SOSORT 2018 Award winner"...Conclusion Participants undergoing Schroth treatment added to the standard of care or standard care alone over 6 months perceived a positive change in the state of their backs even if the Cobb angle did not improve beyond the accepted threshold of 5°. The perceived improvement in the overall back status appears to be due to improvements in outcomes other than the two-dimensional Cobb angle. This study warrants investigating further outcomes that might be more relevant in determining what the patients with AIS perceive as important to monitor during the conservative treatment."
21. Schreiber S, Parent EC, Hill DL, Hedden DM, Moreau MJ, Southon SC. Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? - results from a randomized controlled trial - "SOSORT 2017 Award Winner". Scoliosis Spinal Disord. 2017 Nov 14;12:26. doi: 10.1186/s13013-017-0137-8. PMID: 29164179; PMCID: PMC5684768. "... The short term of Schroth PSSE intervention added to standard care provided a large benefit as compared to standard care alone..."
22. Kwan KYH, Cheng ACS, Koh HY, Chiu AYY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study-SOSORT Award 2017 Winner. Scoliosis Spinal Disord. 2017 Oct 16;12:32. doi: 10.1186/s13013-017-0139-6. PMID: 29051921; PMCID: PMC5641990."...Conclusions: This is the first study to investigate the effects of Schroth exercises during bracing in patients with a high risk of curve progression. The findings from this preliminary study suggest that Schroth exercises during bracing can further improve the Cobb angle compared with bracing alone and compliance is associated with greater benefit..."
23. Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC. Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS One. 2016 Dec 29;11(12):e0168746. doi: 10.1371/journal.pone.0168746. PMID: 28033399; PMCID: PMC5198985."...The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies... The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis...PSSE have not yet been widely accepted in North America. However, the international Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)...developed 'guidelines' that recommend PSSE used alone and as an add-on to bracing for patients with curves <45° to 1) prevent further curve progression at puberty, 2) to prevent or treat respiratory dysfunction, 3) to prevent or treat spinal pain syndromes, 4) to improve aesthetics via postural correction, and 5) reduce the need for surgery... Differences between the North American and European guidelines may be due to cost, culture, social standards or, possibly differing appraisals of the quality of research involving exercises...In conclusion...six-months of Schroth PSSE added to standard of care improved curve severity in adolescents with idiopathic scoliosis compared to standard of care...."
24. Borysov M, Mogiliantseva T. Z Rehabilitation of Adolescents with Scoliosis During Growth - Preliminary Results Using a Novel Standardized Approach in Russia. (Methodology). Curr Pediatr Rev. 2016;12(1):31-5. doi: 10.2174/1573396312666151117120746. PMID: 26573163."...Results: After an out-patient Schroth Best Practice® program ATR was reduced significantly from 9.58 degrees to 7.47 degrees in thoracic and from 8.9 to 6.6 degrees in lumbar. An average in-brace correction of 59% was achieved in CADCAM braces...The deformity of the trunk can be reduced significantly after out-patient rehabilitation according to Schroth Best Practice® standards...In-brace correction comparable with published results on CAD-CAM bracing can be achieved in braces according to Gensingen® standards after appropriate training...."
25. Kim G, HwangBo PN. Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis. J Phys Ther Sci. 2016 Mar;28(3):1012-5. doi: 10.1589/jpts.28.1012. Epub 2016 Mar 31. PMID: 27134403; PMCID: PMC4842415. "...Both Schroth and Pilates exercises were effective in changing the Cobb angle and weight distribution of scoliosis patients; however, the intergroup comparison showed that the Schroth exercise was more effective than the Pilates exercise...."
26. Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: "SOSORT 2015 Award Winner". Scoliosis. 2015 Sep 18;10:24. doi: 10.1186/s13013-015-0048-5. PMID: 26413145; PMCID: PMC4582716. "In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS....Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME..."

1. Boucher J, Lebel A, Nguyen DN, Jacques S, Charest J, Shidler S, Chebaro C, Huang CH, Adulovic N, Carberry JImprovement After Hardware Removal in Post-Fusion Adult AIS: A Unique 35-Year Case Study Using Schroth-Based Physiotherapy and Bracing. Healthcare. 2026; 14(1):43. https://doi.org/10.3390/healthcare14010043 "... this is the first documented case showing the restoration of sagittal alignment, respiratory function, and quality of life following complete implant removal in an adult scoliosis patient treated exclusively with physiotherapeutic scoliosis-specific exercises (PSSE) and individualized bracing. This report also addresses a patient subgroup not represented in the current SOSORT or SRS guidelines and illustrates the potential role of non-surgical management in selected adults after hardware removal...." Note, this well-documented case study deserves to be read by Health Ministers and health professionals as adult scoliosis patients, disproportionately female, is a long-standing medically neglected patient group in Canada.

   The author is the subject and in her own words, "The article describes an atypical and complex pathway: late detection of scoliosis during adolescence, in the context of the cessation of school-based scoliosis screening in Canada at that time; progressive deformity; spinal surgery at age 24; a subsequent postoperative infection, leading to hardware removal two years later; and a rapid structural deterioration, with the later development of significant thoracic kyphosis. When my curves once again reached surgical thresholds, I chose—rather than pursuing further surgery—to explore a conservative approach using Schroth-based physiotherapeutic scoliosis-specific exercises and bracing.

   The outcomes achieved with this non-surgical management were particularly meaningful from both a postural and functional perspective and highlight important considerations related to delayed detection and access to conservative care in complex adult scoliosis."

Below is a curated list of links to published evidentiary studies (a small fraction of total publications) on Orthotic bracing. Orthotic bracing has been the cornerstone of conservative non-operative treatment of AIS for decades and an established standard of care protocol for moderate curves. The purpose of bracing is to prevent curves from progressing to a surgical threshold in children with scoliosis. During puberty children with AIS are at highest risk of rapid growth spurts with severe curve progression occuring. Early treatment (hence Early-Detection and Early Diagnosis) is ideal for optimal bracing success, when children are just beginning puberty or before puberty and their spines are flexible and the Scoliosis curves are mild, compliance is also a documented key requirement. Typically the treatment plan stretches over the growth period of adolescence until skeletal maturity is reached or when the child stops growing. Often, the child has to be fitted, multiple times (equivalent to buying new shoes as their feet grow) with new custom, specially fitted orthotic braces. Radiagraphs are taken to monitor progress.

Adding Physiotherapeutic Scoliosis-Specific Exercises PSSE and PSSE Schroth to the standard of care for AIS patients and as adjunct treatment to bracing, has been documented (see sections above) to lead to better outcomes. A concerning issue to the Canadian Scoliosis Screening Coalition is the cost of orthotic braces which are at least 3K each, and the funding disparities that vary across Canada¹. In British Columbia and the Maritime provinces there is no government funding at all for braces creating socioeconomic barriers to access of conservative care for children from low-income families. These are necessary growth-dependent medical devices for children diagnosed with scoliosis, a serious "real" medical condition. The CSSC is advocating that universal funding be provided for braces as well as Physiotherapeutic Scoliosis-Specific Exercises PSSE as surgeries are fully funded in Canada for severe scoliosis. And advocatng for National guidelines for bracing and PSSE across Canada. Note, it must be recognized that bracing is challenging for children and poses psycho-social problems especially for teenagers and support and counselling should be offered.

1. Lebel A, Kline M, Boucher J, Carberry J, Adulovic N, Dermott JA. Bracing and non-surgical management of scoliosis in Canada: Early detection, access inequities, and the need for interdisciplinary reform. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 2, No. 9. https://doi.org/10.33137/cpoj.v8i2.46590 "Abstract: Bracing remains the cornerstone of non-surgical management for adolescent idiopathic scoliosis (AIS) with an aim to minimize the risk of progression and to avoid spine surgery. ...While all surgical costs associated with spinal fusion are publicly funded, custom scoliosis braces are not always eligible for reimbursement, leaving families to pay $3,000–$6,000 CAD or more out-of-pocket. This disparity puts families at risk of not being able to afford non-surgical care, even though it may prevent the need for surgery, which ultimately is more costly at a system level...Government funding for scoliosis bracing is highly variable across Canada and is contingent on prescriptions from recognized professionals, generally a physician or nurse practitioner, fabricated by an approved provider. Quebec has the most comprehensive public funding, at two braces per growth period31supporting day–night bracing strategies. In Manitoba the cost of a scoliosis brace is covered under the Manitoba Health Prosthetic and Orthotic Program.32Ontario residents are eligible for 75% coverage through the Assistive Devices Program (ADP)33with a new brace allowed to accommodate growth, approximately once a year. Alberta employs a structured, cost-share system through the Alberta Aids to Daily Living (AADL) program, providing two braces every two years for pediatric patients with a modest family contribution that is tiered by family taxable income.34British Columbia, the Atlantic provinces and the territories offer no standardized provincial funding, leaving families reliant on private insurance or out-of-pocket payment. In most provinces, families that have qualified for social assistance, do have the cost of the brace covered. Indigenous children, regardless of geographic location can access Non-Insured Health Benefits for full coverage of the cost of orthotic device..There is no uniformity to the prescription of bracing and PSSE across the country. These discrepancies highlight the absence of national standardization and illustrate how geographically dependent clinical philosophies can substantially influence prioritization of non-surgical scoliosis care. There is a need for national guidelines and equitable funding frameworks to ensure that youth with scoliosis receive timely and appropriate orthotic management... "
2. Truong, Walter H. MD*,†; Bauer, Jennifer M. MD, MS‡; Murphy, Joshua S. MD, MS§; Roye, Benjamin D. MD, MPH∥; Morgan, Sara J. PhD*,†. Provider Perspectives on Use of Nighttime and Full-time Bracing to Treat Adolescent Idiopathic Scoliosis. Journal of Pediatric Orthopaedics 45(10):p e938-e943, November/December 2025. | DOI: 10.1097/BPO.0000000000003056 "Background: For patients with adolescent idiopathic scoliosis (AIS), full-time scoliosis braces are effective in preventing curve progression but are a source of stress for patients and families. Nighttime hypercorrective braces have minimal impact on daily life, but there is little evidence to guide prescription. It is not known how providers with expertise in scoliosis incorporate nighttime bracing into their routine clinical practice. The aim of this study is to assess provider perspectives and recommendations regarding the use of nighttime and full-time scoliosis bracing for patients with AIS.... Conclusion: Most providers preferred to prescribe full-time over nighttime braces. Providers were more willing to recommend a nighttime brace for patients with lumbar/thoracolumbar curves and those who were at lower risk for curve progression (ie, more skeletally mature and smaller curve magnitudes)..."
   Level of Evidence: Expert opinion.
3. Bonsignore-Opp, L., Givens, R.R., Malka, M.S. et al. Three-dimensional Rigo Cheneau-style brace for adolescent idiopathic scoliosis: higher in-brace correction and lower rates of curve progression. Spine Deform (2025). https://doi.org/10.1007/s43390-025-01153-5"... The purpose of this study is to compare curve progression and need for surgery between patients treated with Rigo Cheneau-style orthoses (RCSO) that focus on three-dimensional correction and traditional thoracolumbar-sacral orthoses (TLSO)....Forty-three percent of patients treated with TLSO experienced curve progression of more than 10° compared to only 13% of patients treated with RCSO (p = 0.001). ... Conclusions Patients treated with RCSO have a higher in-brace curve correction and lower odds of curve progression compared to patients treated with TLSO."
4. Cheung PWH, Canavese F, Wong JSH, Luk KDK, Cheung JPY. The Use of Proximal Femur Maturity Index in Guiding Brace Weaning for Adolescent Idiopathic Scoliosis. JB JS Open Access. 2025 Nov 12;10(4):e25.00191. doi: 10.2106/JBJS.OA.25.00191. PMID: 41210905; PMCID: PMC12594310.
5. Fazeli Veisari S, Bidari S, Barati K, Atlasi R, Komeili A. Wearable Devices in Scoliosis Treatment: A Scoping Review of Innovations and Challenges. Bioengineering (Basel). 2025 Jun 25;12(7):696. doi: 10.3390/bioengineering12070696. PMID: 40722388; PMCID: PMC12292784. "...literature shows that the use of wearable devices can enhance scoliosis treatment by improving the efficiency of braces and enabling remote monitoring in rehabilitation programs. However, more research is needed to evaluate user compliance, long-term effectiveness, and the need for personalized interventions. Future advancements in artificial intelligence, microsensor technology, and data analytics may enhance the efficacy of these devices, which can lead to more personalized and accessible scoliosis treatment...."
6. Hou, Hao MD; Guo, Dong MD; Liu, Haonan MD; Luo, Yanzhong MD; Yao, Ziming PhD; Feng, Lei MD; Cao, Jun PhD; Gao, Rongxuan MD; Zhang, Xuejun MD. The Evolution of Curve Patterns in Adolescent Idiopathic Scoliosis During Chêneau Brace Treatment. Spine 50(6):p 368-374, March 15, 2025. | DOI: 10.1097/BRS.0000000000005059 "...Conclusions. Bracing outcomes were more favorable in patients with main lumbar curves than those with main thoracic curves. However, no significant differences were found in patients with double-curve patterns. Thoracic curves exhibited a higher progression risk compared with thoracolumbar/lumbar curves within the same curve pattern. During bracing, a tendency for primary curves to shift proximally was noted." Level of Evidence. Level III.
7. Peiro-Garcia, Alejandro MD, MBAa,b; Garcia, Rocio G. MSca,b; Martin-Gorgojo, Victor MDc; Vilalta-Vidal, Inmaculada MDa,b; Gonzalez-Gonzalez, Luis PhDb; Martin-Moreno, Jose M. MD, PhD, DrPHd,e; Silvestre-Muñoz, Antonio MD, PhDd,f. Impact on Quality of Life of Full-time and Night-time Braces in Adolescent Idiopathic Scoliosis: A Randomized Clinical Trial. Spine 50(4):p 231-237, February 15, 2025. | DOI: 10.1097/BRS.0000000000005228 "...Conclusions. According to our results, both braces are equally effective in avoiding the progression of the deformity and need for surgery. However, FT brace has a higher impact on self-image and pain compared with NT brace."
8. Trofimchuk V, Atepileva A, Karibzhanova D, Kriklivyy A, Danilenko S. Conservative treatment of adolescent idiopathic scoliosis: the effectiveness of rigid bracing. J Orthop Surg Res. 2025 May 16;20(1):464. doi: 10.1186/s13018-025-05743-x. PMID: 40380287; PMCID: PMC12083098. "...Conclusions: ...The use of the Chêneau brace in combination with SEAS gymnastics has been shown to reduce the risk of spinal curvature progression in individuals with AIS."
9. Hori Y, Kaymaz B, da Silva LCA, Rogers KJ, Yorgova PK, Gabos PG, Shah SA. Differences in spine growth potential for Sanders maturation stages 7A and 7B have implications for treatment of idiopathic scoliosis. Spine Deform. 2024 May;12(3):621-628. doi: 10.1007/s43390-024-00829-8. Epub 2024 Feb 19. PMID: 38372941; PMCID: PMC11068661."...Conclusion: This study revealed that patients staged SMS 7A exhibited more spine and total body growth and a greater incidence of substantial curve progression than those at 7B. These findings imply that delaying brace discontinuation until reaching 7B could be beneficial, particularly for those with larger curves." Level of evidence: Level III (Case-control study).
10. Guy, A., Coulombe, M., Labelle, H. et al. Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model. Sci Rep 14, 3300 (2024). https://doi.org/10.1038/s41598-024-53586-z
11. Lim KBL, Mak HKW, Abdul Rahaman SH, Ong LL, Ooi SYJ, Lee NKL. A pilot study on the "ScoliBrace" in the treatment of adolescent idiopathic scoliosis. Eur J Orthop Surg Traumatol. 2024 May;34(4):1803-1809. doi: 10.1007/s00590-024-03845-6. Epub 2024 Feb 28. PMID: 38416233. "...Conclusion: Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. Using "ScoliBrace" as a non-surgical treatment, maintained curves below surgical threshold and showed curve reduction, improving patient satisfaction with management.". Note: ScoliBrace is a 3-D printed brace that is quite costly at average 5k+.
12. Asada, Tomoyuki MD, PhDa,b,c; Kotani, Toshiaki MD, PhDa; Sakuma, Tsuyoshi MD, PhDa; Iijima, Yasushi MD, PhDa; Sakashita, Kotaro MDb; Ogata, Yosuke MDb; Akazawa, Tsutomu MD, PhDd; Minami, Shohei MD, PhDa; Ohtori, Seiji MD, PhDe; Koda, Masao MD, PhDb; Yamazaki, Masashi MD, PhDb. Factors Influencing Optimal Bracing Compliance in Adolescent Idiopathic Scoliosis: A Single-center Prospective Cohort Study. Spine 49(24):p 1708-1715, December 15, 2024. | DOI: 10.1097/BRS.0000000000004997 "...Conclusions. Optimal bracing compliance in AIS is significantly influenced by prebracing satisfaction and brace compliance at earlier time points. These findings highlight the need to address psychological factors and early compliance in AIS bracing treatment. SRS-22r can be useful to identify the need for psychological support."
13. Coulombe, Maxence BEnga,b; Guy, Aymeric PhDb,c; Joncas, Julie BNb; Manitiu, Anton DECa,b; Poirier, Philippe DECa,b; Barchi, Soraya BScb; Chémaly, Olivier MDa,b; Brassard, Félix MDa,b; Parent, Stefan MD, PhDa,b; Labelle, Hubert MDa,b; Aubin, Carl-Éric PhD, ScD, PEnga,b,c.
    Immediate Correction of Idiopathic Scoliosis With Nighttime Braces Created by a Fully Automated Generative Design Algorithm A Randomized Controlled Crossover TrialSpine 49(23):p 1615-1620, December 1, 2024. | DOI: 10.1097/BRS.0000000000005138 "...Methods. Fifty-eight skeletally immature patients diagnosed with IS, aged between 10 and 16 years were recruited. All patients received both a nighttime brace automatically generated by the algorithm (test) and a Providence-type brace designed by an expert orthotist (control). Radiographs were taken for each patient with both braces in a randomized crossover approach to evaluate immediate in-brace correction....Conclusion. The fully automated generative brace design algorithm proves to be clinically relevant, allowing for immediate in-brace correction equivalent to that of braces designed by expert orthotists. Patient 2 years follow-up will continue. This method’s integration could help design and rationalize the design of braces for the treatment of IS." Level of Evidence. Level 2
14. Delbrück H, Karl I, Hildebrand F, Hertwig MK, Pishnamaz M. Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society's criteria: 5-year observational study from a German orthopaedic university hospital. Eur J Med Res. 2024 Oct 29;29(1):521. doi: 10.1186/s40001-024-02112-y. PMID: 39468711; PMCID: PMC11520584. "...we were able to prove the Cobb angle at initial presentation and at brace initiation, the Risser sign, the Nash and Moe degree, the age at first curve notation and at brace initiation, the in-brace correction, the age at menarche, and the curve pattern as predictive variables for outcome in our patients...brace therapy for patients with AIS is definitely justified even outside the previously established criteria for a high risk of progression (above 10 years of age, Risser 0–2, curves 25°–40°) and may even lead to curve improvements. Furthermore, research in bracing outside these criteria should not be overlooked..."
15. Swaby L, Cui M, Cole A. Discontinuation of brace treatment in adolescent idiopathic scoliosis (AIS): a scoping review. Spine Deform. 2024 Sep;12(5):1217-1228. doi: 10.1007/s43390-024-00882-3. Epub 2024 May 1. PMID: 38693334; PMCID: PMC11343946."...Brace treatment for adolescent idiopathic scoliosis (AIS) is usually prescribed for 20–40° curves in patients with growth potential. The aim is to reduce the risk of curve progression during growth and to avoid the curve reaching a surgical threshold. Having as small a curve as possible at skeletal maturity will reduce the risk of curve progression during adult life. While evidence exists for brace treatment in AIS, there is disagreement on how and when to discontinue bracing. The purpose of this review was to investigate what criteria have been reported for initiating brace cessation and published weaning protocols and to look at estimates of the number of patients that may progress > 5 degrees after the end of growth....Conclusion: Curve progression after bracing cessation is a negative outcome for patients who have tolerated bracing for several years, especially if surgery is required. The literature shows that when to start brace cessation and weaning protocols vary. Approximately 34% of patients progressed by more than 5 degrees at 2-4 years after brace cessation or weaning. Larger curves seem more likely to progress. More research is needed to evaluate the risk factors for curve progression after brace treatment, defining the best time to stop bracing based on the lowest risk of curve progression ..."
16. Fields MW, Rymond CC, Malka MS, Givens RR, Simhon ME, Matsumoto H, Marciano GF, Boby AZ, Roye BD, Vitale MG Improvement in axial rotation with bracing reduces the risk of curve progression in patients with adolescent idiopathic scoliosis. Spine Deform. 2024 Sep;12(5):1345-1353. doi: 10.1007/s43390-024-00888-x. Epub 2024 May 2. PMID: 38698106. Level of evidence: Retrospective study; Level III. "...Purpose: New evidence highlights the significance of 3D in-brace correction for Adolescent Idiopathic Scoliosis (AIS) patients. This study explores how axial parameters relate to treatment failure in braced AIS patients... Methods: AIS patients (Sanders 1-5) undergoing Rigo-Chêneau bracing at a single institution were included...Results: 75 patients (81% female) were included. Mean age at bracing initiation was 12.8 ± 1.3 years and patients had a pre-brace major curve of 31.0° ± 6.5°. 25 patients (76% female) experienced curve progression > 5°, and 18/25 required surgical intervention. The treatment failure group had larger in-brace AVR than the success group (5.8° ± 4.1° vs. 9.9° ± 7.6°, p = 0.003), but also larger initial coronal curve measures..."
17. Lim KBL, Mak HKW, Abdul Rahaman SH, Ong LL, Ooi SYJ, Lee NKL. A pilot study on the "ScoliBrace" in the treatment of adolescent idiopathic scoliosis. Eur J Orthop Surg Traumatol. 2024 May;34(4):1803-1809. doi: 10.1007/s00590-024-03845-6. Epub 2024 Feb 28. PMID: 38416233. "...Results A total of 30 female AIS patients with mean age 11.85 ± 0.68 years, predominantly Risser 0 (70%), and median Cobb angle 29° were recruited; 21 patients were included for the final analysis. Results showed significant difference in Cobb angle between T0 and T5-2 (median = 22.5° vs. 28.5°, p = 0.0082). 57.14% had reduction in Cobb angle by ≥ 5° at skeletal maturity...Conclusion Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. .."
18. Nan X, Kuru Çolak T, Akçay B, Xie H, Zhao L, Borysov M.Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study. JMIR Rehabil Assist Technol. 2024 Jan 10;11:e50299. doi: 10.2196/50299. PMID: 38198197; PMCID: PMC10809064."...The Gensingen brace is a further developed Chêneau brace derivative with individual design, which can be adapted through computer-aided design......The results of this study suggest that above-average correction effects with full-time brace application lead to significant improvements of the Cobb angle upon completion of brace treatment..."
19. Zapata KA, Virostek D, Davis K, Johnson ME, Jo CH, Owen M, Sucato DJ. Early brace treatment for idiopathic scoliosis may change the paradigm to improve curves. Spine Deform. 2023 Nov;11(6):1381-1388. doi: 10.1007/s43390-023-00726-6. Epub 2023 Jul 10. PMID: 37428431. “...Conclusion: Early brace treatment (Cobb < 25° and open TRC) may not only reduce curve progression and the need for surgical treatment but may also result in curve improvement, thus challenging the paradigm that the goal of bracing is merely to stop curve progression..."
20. Di Maria F, Testa G, Carnazza M, Testaì M, Pavone V. Longer Brace Duration Is Associated with Lower Stress Levels and Better Quality of Life in Adolescents with Idiopathic Scoliosis. Children (Basel). 2023 Jun 28;10(7):1120. doi: 10.3390/children10071120. PMID: 37508617; PMCID: PMC10378022."...In conclusion, among AIS patients, increased psychological stress and poor QoL induced by brace wearing are particularly evident during the early bracing period...The results of this study indicate that AIS patients in the initial stages of conservative scoliosis treatment are more susceptible to the negative effects of brace wearing. Hence, early intervention strategies, including the provision of psychological support, are advisable..."
21. Aymeric Guy, Carl-Éric Aubin, Finite element simulation of growth modulation during brace treatment of adolescent idiopathic scoliosis Journal of Orthopaedic Research, First published: 15 March 2023.Volume 41, Issue9 September 2023 Pages 2065-2074, doi: https://doi.org/10.1002/jor.25553
22. Kawasaki S, Cheung PWH, Shigematsu H, Tanaka M, Suga Y, Yamamoto Y, Tanaka Y, Cheung JPY. Alternate In-Brace and Out-of-Brace Radiographs Are Recommended to Assess Brace Fitting and Curve Progression With Adolescent Idiopathic Scoliosis Follow-Up. Global Spine J. 2023 Jun;13(5):1332-1341. doi: 10.1177/21925682211032559. Epub 2021 Jul 15. PMID: 34263679; PMCID: PMC10416593."Conclusions: Patients may develop curve progression despite good correction on in-brace radiographs. Those with higher flexibility and suboptimal brace fitting are at-risk. In-brace and out-of-brace radiographs should be taken alternately for brace treatment follow-up...."
23. Pepke W, Morani W, Schiltenwolf M, Bruckner T, Renkawitz T, Hemmer S, Akbar M. Outcome of Conservative Therapy of Adolescent Idiopathic Scoliosis (AIS) with Chêneau-Brace. J Clin Med. 2023 Mar 26;12(7):2507. doi: 10.3390/jcm12072507. PMID: 37048593; PMCID: PMC10095099."...The results of this study implicate that C-brace therapy can be effective in the prevention of curve progression during a growth spurt. However, our results reveal the high efficacy variability due to factors such as primary Cobb angle magnitude, skeletal maturity, and in-brace Cobb angle correction at the begin of C-brace therapy. The study results might shed some light on AIS patients’ treatment in context of bracing and might be beneficial for treating physicians."
24. Johnson, M.A., Gohel, S., Flynn, J.M. et al. “Will I Need a Brace?”: likelihood of curve progression to bracing range in adolescent idiopathic scoliosis. Spine Deform 10, 537–542 (2022). https://doi.org/10.1007/s43390-021-00457-6
25. Provost M, Beauséjour M, Ishimo MC, Joncas J, Labelle H, Le May S. Development of a model of interprofessional support interventions to enhance brace adherence in adolescents with idiopathic scoliosis: a qualitative study. BMC Musculoskelet Disord. 2022 Apr 30;23(1):406. doi: 10.1186/s12891-022-05359-w. PMID: 35490213; PMCID: PMC9055765. “...Because of its negative biopsychosocial impact on adolescent patients' quality of life, brace adherence is a common problem... The purpose of this paper is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with scoliosis....patients who benefited from interprofessional care management with effective collaboration between stakeholders (orthopedist, orthotist and physiotherapist) tended to be more compliant than patients treated through regular care.”
26. Asada T, Kotani T, Sakuma T, Iijima Y, Nakayama K, Inage K, Shiga Y, Akazawa T, Minami S, Ohtori S, Koda M, Yamazaki M. Impact of Brace-Related Stress on Brace Compliance in Adolescent Idiopathic Scoliosis: A Single-Center Comparative Study Using Objective Compliance Measurement and Brace-Related Stress. Spine Surg Relat Res. 2023 Mar 13;7(4):377-384. doi: 10.22603/ssrr.2022-0246. PMID: 37636154; PMCID: PMC10447194.
27. Aulisa AG, Toniolo RM, Falciglia F, Giordano M, Aulisa L. Long-term results after brace treatment with Progressive Action Short Brace in adolescent idiopathic scoliosis. Eur J Phys Rehabil Med. 2021 Jun;57(3):406-413. doi: 10.23736/S1973-9087.20.06129-8. Epub 2020 Sep 29. PMID: 32990686. z "...At 10 years follow-up after bracing, scoliotic curves had not deteriorated beyond their original curve size"
28. Wang H, Tetteroo D, Arts JJC, Markopoulos P, Ito K. Quality of life of adolescent idiopathic scoliosis patients under brace treatment: a brief communication of literature review. Qual Life Res. 2021 Mar;30(3):703-711. doi: 10.1007/s11136 020-02671-7. Epub 2020 Oct 24. PMID: 33098493; PMCID: PMC7952337. “Our review indicates that scoliotic adolescents treated with bracing suffer in their quality of life most from psychological burdens. To improve these patients’ life quality, more attention should be focussed on supporting their mental health.”
29. Kwan, Kenny Yat Hong BMBCh, FRCSEd, FHKCOS, FHKAM; Cheung, Amy Ka Po BA, MA; Koh, Hui Yu BSc, MPhil; Cheung, Kenneth Man Chee MBBS, MD, FRCS, FHKCOS, FHKAM. Brace Effectiveness Is Related to 3-Dimensional Plane Parameters in Patients with Adolescent Idiopathic Scoliosis. The Journal of Bone and Joint Surgery 103(1):p 37-43, January 6, 2021. | DOI: 10.2106/JBJS.20.00267 Level of Evidence: Prognostic Level II
30. Cheung PWH, Cheung JPY. Does the Use of Sanders Staging and Distal Radius and Ulna Classification Avoid Mismatches in Growth Assessment with Risser Staging Alone? Clin Orthop Relat Res. 2021 Nov 1;479(11):2516-2530. doi: 10.1097/CORR.0000000000001817. PMID: 34036944; PMCID: PMC8509998.
31. Dolan, Lori A. PhDa; Donzelli, Sabrina MDb; Zaina, Fabio MDb; Weinstein, Stuart L. MDa; Negrini, Stefano MDb,c,d. Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace: Comparative Effectiveness Analysis of BrAIST and ISICO Cohorts. SPINE 45(17):p 1193-1199, September 1, 2020. | DOI: 10.1097/BRS.0000000000003506
32. Cheung JPY, Cheung PWH, Yeng WC, Chan LCK, Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis? Clin Orthop Relat Res. 2020 Feb;478(2):334-345. doi: 10.1097/CORR.0000000000000989. PMID: 31688210; PMCID: PMC7438132.Level of Evidence: Level III, therapeutic study. "...The parameters associated with curve progression were younger age (pre-menarche and younger chronological age) and increased apical ratio. ...another factor associated with curve progression is increased vertebral wedging as seen by an increased apical ratio...Vertebral wedging and increased rotational deformity have been suggested to be risk factors of curve progression [30]. These are early prognostic factors for poor bracing outcomes....This study has shown that 17% of patients may experience curve regression with satisfactory duration of brace-wear. The possible improvement in the Cobb angle should be disclosed to patients before and during bracing. Positive reinforcement may encourage patients and their families to be more compliant with bracing protocols. This perceived effect, along with the influence of using better skeletal maturity parameters than Risser staging for initiating bracing, and using more objective compliance data should be verified in future prospective studies. Physicians should also advocate that braces should be made with the curve reduced as much as possible; often the molded brace can achieve similar correction to that predicted with pre-bracing supine radiographs. A well-fitting brace provides the best chance of a positive outcome and the potential of vertebral remodeling to a more normal spine."
33. Ron El Hawary, Daphna Zaaroor-Regev, Yizhar Floman, Baron S. Lonner, Yasser Ibrahim Alkhalife, Randal R. Betz, Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review, The Spine Journal,Volume 19, Issue 12, 2019, Pages 1917-1925, ISSN 1529-9430,"...This data demonstrates that 60% to 70% of the patients referred to bracing are Risser 0 and 30% to 70% of this group will not wear the brace enough to ensure treatment efficacy. Furthermore, Risser 0 patients who reach the accelerated growth phase with a curve ≥40° are at 70% to 100% risk of curve progression to the fusion surgical threshold despite proper brace wear. Skeletally immature patients with relatively large magnitude scoliosis who are noncompliant are at a higher risk of failing brace treatment..."
34. Zapata, K.A., Sucato, D.J., Lee, M.C. et al. Skeletally Immature Patients With Adolescent Idiopathic Scoliosis Curves 15°–24° Are at High Risk for Progression. Spine Deform 7, 870–874 (2019). https://doi.org/10.1016/j.jspd.2019.02.012
35. Cheung JPY, Chong CHW, Cheung PWH. Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity: the role of sagittal spinopelvic parameters. Bone Joint J. 2019 Nov;101-B(11):1370-1378. doi: 10.1302/0301-620X.101B11.BJJ-2019-0515.R1. PMID: 31674249. "...This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. ...Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life...."
36. Minsk MK, Venuti KD, Daumit GL, Sponseller PD. Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study. Scoliosis Spinal Disord. 2017 Mar 20;12:7. doi: 10.1186/s13013-017-0117-z. PMID: 28331904; PMCID: PMC5357818. "...In this large retrospective review of an academic outpatient scoliosis practice, patients treated with RCOs were substantially less likely to progress to spinal surgery than those treated with Boston-style TLSOs. Patients treated with RCOs also had smaller mean change and smaller percent increase in major curves from treatment initiation through follow-up. Future studies should examine differences in outcomes by brace type in other settings and in larger samples, and they should investigate the impact of the rotational dimension of correction with RCOs. Clinicians may consider increasing use of RCOs for AIS."
37. Zhu Z, Xu L, Jiang L, Sun X, Qiao J, Qian BP, Mao S, Qiu Y. Is Brace Treatment Appropriate for Adolescent Idiopathic Scoliosis Patients Refusing Surgery With Cobb Angle Between 40 and 50 Degrees. Clin Spine Surg. 2017 Mar;30(2):85-89. doi: 10.1097/BSD.0b013e3182a1de29. PMID: 28207617. "...Conclusions: The effectiveness of brace treatment significantly decreases when applied to patients with curve magnitude between 40 and 50 degrees. Although a majority of these patients will inevitably undergo a surgical intervention, and thus wearing a brace may not be the best alternative to surgical intervention; there are patients who will stabilize with the brace until skeletal maturity thus warranting this option for those patients refusing surgical intervention with curves between 40 and 50 degrees."
38. Karol LA, Virostek D, Felton K, Jo C, Butler L. The Effect of the Risser Stage on Bracing Outcome in Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2016 Aug 3;98(15):1253-9. doi: 10.2106/JBJS.15.01313. PMID: 27489315. ...Risser stage-0 patients should be prescribed a minimum of 18 hours of brace wear. Bracing should be initiated for curves of <30° in patients at Risser stage 0, especially those with open triradiate cartilage...."
39. Negrini S, Minozzi S, Bettany-Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Zaina F. Braces for Idiopathic Scoliosis in Adolescents. Spine (Phila Pa 1976). 2016 Dec 1;41(23):1813-1825. doi: 10.1097/BRS.0000000000001887. PMID: 27584672. (Review of brace studies)"...Background Idiopathic scoliosis is a three‐dimensional deformity of the spine. The most common form is diagnosed in adolescence. While adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased..."
40. Schwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016 Feb;41(4):311-9. doi: 10.1097/BRS.0000000000001210. PMID: 26555827; PMCID: PMC4736292.
41. Gutman G, Benoit M, Joncas J, Beauséjour M, Barchi S, Labelle H, Parent S, Mac-Thiong JM. The effectiveness of the SpineCor brace for the conservative treatment of adolescent idiopathic scoliosis. Comparison with the Boston brace. Spine J. 2016 May;16(5):626-31. doi: 10.1016/j.spinee.2016.01.020. Epub 2016 Jan 22. PMID: 26809149."...Conclusions: The SC brace did not prevent curve progression as effectively as the Bb. Although it has the potential benefit of increasing mobility during brace wear, the SC brace was associated with increased curve progression in comparison with the Bb. There is also a trend for increased risk of requiring surgery when the SC brace is worn."
42. Karol LA, Virostek D, Felton K, Wheeler L. Effect of Compliance Counseling on Brace Use and Success in Patients with Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2016 Jan 6;98(1):9-14. doi: 10.2106/JBJS.O.00359. PMID: 26738898.
43. Guo J, Lam TP, Wong MS, Ng BK, Lee KM, Liu KL, Hung LH, Lau AH, Sin SW, Kwok WK, Yu FW, Qiu Y, Cheng JC. A prospective randomized controlled study on the treatment outcome of SpineCor brace versus rigid brace for adolescent idiopathic scoliosis with follow-up according to the SRS standardized criteria. Eur Spine J. 2014 Dec;23(12):2650-7. doi: 10.1007/s00586-013-3146-1. Epub 2013 Dec 31. PMID: 24378629. "...Conclusions: Curve progression rate was found to be significantly higher in the SpineCor group when compared with the rigid brace group. Changing to rigid bracing could control further curve progression for majority of patients who previously failed with SpineCor bracing...."
44. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013 Oct 17;369(16):1512-21. doi: 10.1056/NEJMoa1307337. Epub 2013 Sep 19. PMID: 24047455; PMCID: PMC3913566."...the rate of treatment success was 72% after bracing,...bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. Longer hours of brace wear were associated with greater benefit."
    Note: critical BRAIST study.
45. Clin J, Aubin CÉ, Sangole A, Labelle H, Parent S. Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010 Aug 15;35(18):1706-13. doi: 10.1097/BRS.0b013e3181cb46f6. PMID: 21330954. "Abstract in brief: The present study found a correlation between in-brace correction of coronal curves and bending moments acting on the apical vertebrae that could be interpreted as a correlation between immediate in-brace correction and long-term treatment outcome."
46. Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010 Jun;92(6):1343-52. doi: 10.2106/JBJS.I.01142. PMID: 20516309.
47. Gammon SR, Mehlman CT, Chan W, Heifetz J, Durrett G, Wall EJ. A comparison of thoracolumbosacral orthoses and SpineCor treatment of adolescent idiopathic scoliosis patients using the Scoliosis Research Society standardized criteria. J Pediatr Orthop. 2010 Sep;30(6):531-8. doi: 10.1097/BPO.0b013e3181e4f761. PMID: 20733415."...No significant difference (P=0.75) was found using the more strict outcome measure (< or =5-degree curve progression) as the success rates were 60% (21/35) for TLSO and 53% (17/32) for SpineCor. Similarly, no significant difference (P=0.62) was found using the more liberal outcome measure (never reached 45 degrees) as the success rates were 80% (28/35) for TLSO and 72% (23/32) for SpineCor. Conclusions: We were unable to identify any significant differences in brace treatment outcomes when comparing TLSO and SpineCor treated patients. "
48. 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 Sep 15;30(18):2068-75; discussion 2076-7. doi: 10.1097/01.brs.0000178819.90239.d0. PMID: 16166897. "...Conclusions: Optimal inclusion criteria for future adolescent idiopathic scoliosis brace studies consist of: age is 10 years or older when brace is prescribed, Risser 0-2, primary curve angles 25 degrees -40 degrees , no prior treatment, and, if female, either premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness should include: (1) the percentage of patients who have < or =5 degrees curve progression and the percentage of patients who have > or =6 degrees progression at maturity, (2) the percentage of patients with curves exceeding 45 degrees at maturity and the percentage who have had surgery recommended/undertaken, and (3) 2-year follow-up beyond maturity to determine the percentage of patients who subsequently undergo surgery..."

Refer also to Links to Publications (including research) on Curve Progression in AIS.