Journal of Pediatric Orthopaedics - 2026-07-01 - Journal Article; Comparative Study
A Comparative Analysis of Patients With Adolescent Idiopathic Scoliosis Treated With Rigo Cheneau, Boston-style, and Providence Braces: A Preliminary Report.
Davis L, Bridges A, Hantak J, Harris H, Stroeva SE, Braykov N, Jahan A, Fletcher ND
Topics
Key Takeaway
Risser 0 AIS patients braced with a Boston TLSO had a 5.6-fold higher risk of requiring surgery compared to those treated with Rigo-Cheneau or Providence nighttime braces (P=0.04).
Summary Depth
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Summary
This single-center retrospective study compared brace success rates across three orthoses in AIS patients aged 10–18 with curves 20–45° and Risser 0–2 at initiation. Overall, 44% progressed >5° and 19% required surgery; among Risser 0 patients specifically, 55% of Boston brace patients progressed to surgery versus 11% RC and 10% PNB (P=0.03). Multivariate regression identified Risser 0 status with Boston bracing as conferring a 5.6-fold higher surgical risk and 2.8-fold higher progression risk compared to RC or PNB.
Key Limitation
Non-randomized brace assignment at a single center means unmeasured confounders—including curve flexibility, compliance, and provider selection bias—cannot be excluded as drivers of the observed surgical rate differences.
Original Abstract
BACKGROUND
Numerous brace choices exist for the management of adolescent idiopathic scoliosis (AIS); however, there is sparse literature comparing brace efficacy. Much of current bracing practice likely reflects institutional preferences rather than comparative data.
METHODS
A review of patients age 10 to 18 with AIS of 20 to 45 degrees who were Risser 0 to 2 at initiation of brace treatment treated at a single center was performed. Patients were included if they had completed brace treatment and had either a minimum of 6 month out of brace follow-up or had undergone surgery. Brace success was defined as curve progression ≤5 degrees without the need for surgery. Patients were treated with a Providence nighttime brace (PNB), Boston TLSO (BB), or Rigo-Cheneau (RC) custom brace.
RESULTS
Patients treated with 32 PNB, 30 BB, and 37 RC braces met all inclusion criteria. 88% were female, with an average age at brace initiation of 12.0 years. Sixty-two percent of females were premenarchal at the onset of bracing and 66% were Risser 0. Thoracic, thoracolumbar, and lumbar curves averaged 27±7 degrees, 29±6 degrees, and 26±6 degrees at initiation. Thoracic in-brace curve correction was 46±34% compared with thoracolumbar curves (73±36%). Forty-four patients (44%) progressed >5 degrees and 19 patients (19%) progressed to surgery. Twenty-seven percent of patients treated with a BB progressed to surgery compared with 13% of RC and 13% of PNB patients ( P =0.2). Among Risser 0 patients, 55% of BB patients progressed to surgery compared with 11% of RC and 10% of PNB patients ( P =0.03). Multivariate regression analysis found that skeletally immature (R0) patients treated with a BB had a 5.6-fold higher risk of surgery than RC or PNB patients ( P =0.04) and a 2.8-fold higher risk of curve progression ( P =0.09); however, this difference was not seen in Risser 1 or 2 patients.
CONCLUSIONS
Skeletally immature patients (Risser 0) treated with a BB were nearly 6x more likely to require surgery when compared with those treated with a RC or PNB. Patients who were Risser 1 or 2 were successfully treated in any of the 3 braces.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.