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Multicenter Study
. 2025 Aug 1;50(15):1035-1041.
doi: 10.1097/BRS.0000000000005175. Epub 2024 Oct 8.

The Effect of Night-time Versus Full-time Bracing on the Sagittal Profile in Adolescent Idiopathic Scoliosis : A Propensity Score-matched Study

Martin Heegaard  1 , Lærke Ragborg  1   2 , Amy L McIntosh  2 , Megan E Johnson  2 , Martin Gehrchen  1 , Daniel J Sucato  2 , Benny Dahl  1 , Søren Ohrt-Nissen  1
Affiliations
Multicenter Study

The Effect of Night-time Versus Full-time Bracing on the Sagittal Profile in Adolescent Idiopathic Scoliosis : A Propensity Score-matched Study

Martin Heegaard et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective multicenter cohort study.

Objective: To investigate the impact of night-time bracing (NTB) and full-time bracing (FTB) on the sagittal profile in patients with adolescent idiopathic scoliosis (AIS).

Background: Recent studies have shown that FTB in patients with AIS may induce hypokyphosis. Whether this effect differs between NTB and FTB is unknown.

Materials and methods: We included skeletally immature patients with AIS with main curves ranging from 20° to 45° treated with either NTB or FTB. The 2 cohorts were propensity-score matched on Risser stage, age, major curve size, and kyphosis at brace initiation. Coronal and sagittal radiographic parameters were gathered at the initiation and completion of brace treatment.

Results: Two hundred fifty-seven patients were eligible for inclusion. The matched cohorts included 62 patients in each group. During bracing, the thoracic kyphosis increased from 31 ± 11° to 35 ± 13° in the NTB group compared with a decrease from 30 ± 12° to 28 ± 13° in the FTB group ( P = 0.011). Of the total, 8% were hypokyphotic (<20°) after bracing in the NTB group compared with 24% in the FTB group ( P = 0.015). Pelvic incidence, sacral slope, and pelvic tilt were not significantly different between the groups. In the coronal plane, curve progression >50° was seen in 50% of the NTB group and 31% in FTB ( P = 0.028).

Conclusion: We saw a small increase in thoracic kyphosis in the NTB group versus a small decrease in the FTB group. After bracing, 8% in the NTB group versus 24% in the FTB group showed substantial hypokyphosis. The impact of minor changes in thoracic kyphosis remains uncertain; however, a 3-fold difference in the occurrence of hypokyphosis is notable and merits further attention.

Keywords: adolescent idiopathic scoliosis; flatback deformity; full-time brace; hypokyphosis; hypokyphotic; night-time brace; progression; sagittal plane; sagittal profile; thoracic kyphosis.

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Conflict of interest statement

M.G.: Institutional grants from Cerapedics, institutional grants from Globus Medical, Stryker (consultancy). B.D.: Stryker (consultancy), supported by The Alfred Benzon Foundation. D.J.S.: Globus Medical (royalties). M.E.J.: Globus Medical (consultancy), Orthopediatrics (consultancy). A.L.M.: Globus Medical (consultancy). The remaining authors report no conflicts of interest.

References

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    1. Ohrt-Nissen S, Lastikka M, Andersen TB, et al. Conservative treatment of main thoracic adolescent idiopathic scoliosis: full-time or nighttime bracing? J Orthop Surg. 2019;27:230949901986001.
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    1. Courvoisier A, Drevelle X, Vialle R, et al. 3D analysis of brace treatment in idiopathic scoliosis. Eur Spine J. 2013;22:2449–55.

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