A Long-Debated Question, Now Answered
For decades, scoliosis bracing was prescribed widely but questioned scientifically. That changed in 2013 when the BrAIST trial was published in the New England Journal of Medicine — the first randomised controlled trial to show that bracing significantly reduces the progression of adolescent scoliosis curves to the surgical threshold.
Bracing, when worn 13+ hours a day, achieves a 90–93% success rate in stopping curve progression — the evidence is no longer debatable.
What the BrAIST Trial Showed
The trial enrolled patients aged 10–15 with Risser grades 0–2 and Cobb angles between 20–40°. Results:
- Success (curve not progressing to ≥50°) was achieved in 72% of the brace group versus 48% in the observation group.
- The effect was strongly dose-dependent: patients wearing the brace 13+ hours a day had a 90–93% success rate.
- The trial was stopped early because the brace benefit was so clear it would have been unethical to continue the control arm.
Bracing, when worn correctly, is a genuinely effective treatment — not a placebo or a delay tactic.
Who Benefits Most From Bracing?
- Adolescents with curves between 25–45°
- Children who are still growing (Risser grade 0–2, pre- or early-menarchal in girls)
- Thoracic and thoracolumbar curves (lumbar curves are harder to control but still respond)
- Patients with a motivated family and realistic compliance expectations
Bracing is unlikely to reverse a curve — its goal is prevention of progression. A 35° curve held at 35° at skeletal maturity is a success if it would otherwise have reached 55°.
Types of Brace
- TLSO (Thoracolumbosacral Orthosis): The Boston brace and its variants — rigid plastic braces from under the arms to the hips. Standard for most AIS curves.
- Rigo-Chêneau: A 3D corrective brace that actively guides the spine toward correction rather than just containing it. Requires a highly skilled orthotist.
- Charleston Nighttime Brace: Designed for lumbar and thoracolumbar curves; worn only during sleep. Not suitable for thoracic curves.
- Providence Brace: Another nighttime option with similar indications to Charleston.
At Central Ortho & Spine, we fit primarily Rigo-Chêneau and Boston-style braces, selected based on curve pattern and which design achieves the best in-brace correction (measured by X-ray at fitting).
Compliance: The Critical Variable
The brace only works if worn. Adolescents commonly report wearing the brace 16 hours a day when compliance monitoring shows actual wear of 8–10 hours. This is not dishonesty — it is the reality of teenage life, body image anxiety, and physical discomfort.
Modern braces include heat-sensor compliance monitors that log wear time automatically. At our centre, we review compliance data at every visit and contact families proactively if wear time drops significantly before the next X-ray cycle.
When Bracing Is Not Enough
If a curve progresses to 45–50° despite adequate brace wear, surgery should be discussed. If a child presents for the first time with a curve already above 45°, bracing is unlikely to be curative. In these cases, early surgical planning is in the child's best interest.
Getting Fitted in Istanbul
International families visiting Central Ortho & Spine can have a brace fitted during the same trip. Our on-site orthotist uses 3D surface scanning technology for a precise fit, and we communicate in-brace correction X-ray findings directly to the family before they return home. Follow-up adjustments can often be managed through partnerships with local orthotists in the family's home country.