Journal of Pediatric Orthopaedics - 2026-08-13 - Journal Article
A 14% Rate of Surgery in Modern Rigo Chêneau Bracing for Adolescent Idiopathic Scoliosis: In-Brace Correction and Brace Wear Contribute to Treatment Success.
Brown MW, Park AM, Elfilali MM, Gorman DC, Yu Y, Roye BD, Vitale MG
Topics
Key Takeaway
Rigo Chêneau orthosis in-brace correction ≥45% predicted treatment success with 88% success rate vs. 41% below that threshold (AUC=0.79), and 86% of patients avoided surgery at mean 3-year follow-up.
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Summary
This single-institution retrospective study evaluated whether in-brace correction (IBC) and objectively measured brace wear predicted treatment success in skeletally immature AIS patients (curves 20–40°) treated with Rigo Chêneau-style orthoses (RCSOs) using thermal wear-time sensors. Treatment success (≤5° change at final follow-up) was achieved in 72% of patients, with 86% avoiding surgery; mean IBC was 55% and mean wear time 11.7 h/day. On multivariable logistic regression, IBC was the sole independent predictor of success, with an IBC ≥45% threshold yielding an AUC of 0.79 and reducing surgical progression from 29% to 6%.
Key Limitation
The 50-patient cohort from a single center with a heterogeneous curve distribution and no control arm prevents direct comparison of RCSO efficacy against standard TLSO bracing.
Original Abstract
PURPOSE
Rigo Chêneau-style orthoses (RCSOs) have gained popularity for treating adolescent idiopathic scoliosis (AIS) due to their emphasis on 3-dimensional correction. However, previous studies lack objective measures of brace wear compliance and have not described in-brace correction (IBC) thresholds associated with treatment success. This study evaluated the relationship between IBC, brace wear, and treatment outcomes in AIS patients treated with RCSOs.
METHODS
A retrospective review at a single academic institution included skeletally immature patients aged 10 to 18 years with AIS and a major curve of 20 to 40 degrees, who underwent full-time RCSO treatment with thermal wear-time sensors. Patients were followed until skeletal maturity or progression to surgery. Treatment success was defined as a change of ≤5 degrees in the major curve at the latest follow-up. Multivariable logistic regression identified predictors of treatment success.
RESULTS
Fifty patients (45 females, 90%) were included, with 36 (72%) classified as Sanders stage 3 and a mean age at brace initiation of 12.4±1.2 years (range: 10.1 to 15.5). The mean baseline major curve was 31±5 degrees with an IBC of 55±20%. The mean brace wear was 11.7±3.6 hours per day. At a mean follow-up of 3.0±0.9 years (range: 1.1 to 5.3), 43 patients (86%) avoided surgery and 36 (72%) met criteria for treatment success, with a mean major curve of 32±12 degrees. Greater IBC (60% vs. 40%, P<0.001) and brace wear (12.4 vs. 10.0 h, P=0.034) were associated with treatment success in univariate analysis, with IBC remaining an independent predictor in multivariable analysis (P=0.013). An IBC ≥45% was associated with treatment success (AUC=0.79). Patients achieving ≥45% IBC (n=33) demonstrated significantly higher success rates (88% vs. 41%, P<0.001) and lower rates of progression to surgery (6% vs. 29%, P=0.037).
CONCLUSIONS
In this study, which included objective compliance data, 3-dimensional RCSO bracing in AIS was associated with high rates of treatment success. Greater IBC and brace wear were associated with improved outcomes, with IBC emerging as the primary independent predictor of success. An IBC of 45% was associated with improved outcomes and may represent a clinically meaningful target in modern 3-dimensional bracing.
LEVEL OF EVIDENCE
Level IV.