Conservative Scoliosis Treatment

Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the i...

Introduction L umbosacral transitional vertebra (LSTV) is the most common congenital anomaly of the lumbosacral spine, with a reported prevalence between 16% and 36% in the general population. (1) LSTV may manifest either as a sacral assimilation of the L5 vertebra (sacralisation) or lumbar assimilation of the S1 segment (lumbarisation). Most of these anomalies may either go undetected or be discovered fortuitously. (2) However, an isolated and minor LSTV may disrupt normal spine biomechanics and anatomy. A unilateral LSTV will slow growth on that side of the spine and cause the growing spine to curve and rotate. Recent studies have correlated the presence of LSTV with low back pain. Symptoms can originate from the anomalous articulation itself, the contralateral facet joint, instability and early degeneration of the level cephalad to the transitional vertebrae, and nerve root compression from hypertrophy of the transverse process. (3) Clinical symptoms associated with each of the above processes are treated differently. Our case examples demonstrate the potential association between LSTV and adolescent scoliosis, which was previously overlooked. We present the following two cases in accordance with the CARE Guidelines. Abstract: Lumbosacral transitional vertebrae (LSTVs) are the most common congenital anomaly of the lumbosacral spine that presents either as L5 sacralisation or S1 lumbarisation. Although most of the LSTVs are of minor clinical importance, these anomalies may contribute to disruptions in biomechanics and alterations in spinal and paraspinal structures. Here, we present two cases of adolescent idiopathic scoliosis to illustrate some overlooked effects of a unilateral LSTV on spinal deformity. Cure correction was not attained in both cases. While a unilateral LSTV was on a different side of their lumbosacral spine, it is incidentally noticed that the direction of the curve was convex on the contralateral side of the LSTV. Most likely, unilateral LSTVs on certain occasions could cause the growing spine to curve and rotate. The aim of this report is to demonstrate an overlooked association between minor anomalies and the growing spines, which may be important to tailor an appropriate treatment plan.

Measure of  various aspects of scoliosis is important in every step of patient care. Here is illustrated this concept from a practical point of view, and applied to each moment of the clinical activity with the scoliotic patients: first visit,  radiographic evaluation, risk of progression estimation, compliance evaluation, treatment efficacy and finally stress of the patient because of brace treatment.

This scoping review has been in the making for a very long time. Research of the conservative therapeutic possibilities for children with early onset and adolescent idiopathic scoliosis are readily available. Articles and studies about the treatment possibilities for children with neuromuscular scoliosis (NMS) are sadly lacking and during the most recent search it became apparent that another approach was needed. One of the difficulties was that the neuromuscular scoliosis is present in so many different disorders. What could be the perfect treatment option for one disorder might not be so for the other.

Background
The immediate first results of the new Lyon brace: ARTbrace demonstrates an in-brace correction of the Cobb angle of 70% for the first 225 cohort of patients treated since May 2013. This correction is 40% higher than the former Lyon brace or historical Lyon brace. It is also higher than any studies which have been published to date in the literature including retrospective studies. These results can be explained by numerous innovations such as:
- Segmental moulding with correction of the sagittal plane
- Biomechanical helicoidally detorsion
- High rigidity asymmetric polycarbonate…
Despite numerous publications which highlight a correlation between the immediate in-brace correction and the final result of the treatment, there is no consensus on this criterion. So it was crucial to see if the in-brace results are decreasing over time, are being consistent or are continuing to improve during treatment.
Design
Prospective case series of 148 scoliosis with short time results after 1 year compared with a historical retrospective case series of 100 scoliosis. Consecutive cases are recruited in both groups. Randomization was not possible due to the administrative impossibility to perform plaster casts after May 2013.. OCEMB level 2 [1]
Material and Methods
All thoracic, thoracolumbar and double major scoliosis justifying a conservative orthopaedic treatment were included. Patients suffering from lumbar scoliosis Lenke 5 continue to be treated by GTB short brace.
The first group consists of the first 148 patients reviewed one year after the brace fitting and the second group of the last 100 patients treated with plaster cast and the historical Lyon brace also controlled 1 year after brace fitting. All treatment parameters like indications, physiotherapy, full or part-time bracing are identical.
Data were transcribed immediately with Excel 2013 and processed by the statistical package SPSS v20.
Results
An independent-samples t-test was conducted to compare Cobb angles before brace, in-brace at 6 months and at 1 year.
There was not a significant difference in the scores of thoracic Cobb angles before brace for the control group with an old Lyon brace (M=31.14, SD=9.62) and the ARTbrace group (M=29.76, SD=8.75); t(183)=1.015, p = 0.311
There was not a significant difference in the scores of Lumbar Cobb angles before brace for the control group with the old Lyon brace (M=26.69, SD=7.72) and the ARTbrace group (M=27.86, SD=7.54); t(143)=0.905, p = 0.367
There was a significant difference in the scores for thoracic and lumbar curves: in brace, at 6 months and at 1 year.
Thoracic in-brace: t(182)=4.254, p=0.00
Lumbar in-brace: t(144)=3.993, p=0.00
Thoracic at 6 months: t(182)=2.284, p=0.023
Lumbar at 6 months: t(144)=2.131, p=0.035
Thoracic at 1 year: t(182)=3.205, p=0.02
Lumbar at 1 year: t(134)=2.463, p=0.015
The radiological percentage improvement without a brace after 6 months is: 40%, which is equivalent to the best statistics of immediate in-brace results. At 1 year the percentage is even 35.5%.
But especially when compared with the former Lyon treatment, the immediate in-brace differential is 43% (ART vs Old Lyon brace). This differential keeps on improving: 55% at 6 months and 79% at 1 year.
Conclusion
The brace correction effect is confirmed and further improved at 6 months and this improvement continues after one year.
It seems that the in-brace reduction can be considered as a criterion of the final result of the conservative treatment.

Bu çalışmanın amacı, 18. Yüzyılda başlayan yeni bir insanlık durumunun anlaşılma ve yorumlanma biçimi 2olarak muhafazakârlığın teorik çerçevesini ortaya koymak; günümüze kadar birçok siyasi, sosyo-politik vaka ve olaya betimleyici ve kronolojik bir kimlik kazandırıcı etkisinin izini sürmek, sosyal- dini bağlamda bireysel bir tutumu tasvir edecek kadar anlam genişlemesine uğramış biçimini açıklamak ve son olarak, sosyal bilimler literatürünün yeni dalga unsuru olarak kurucu ve yapılandırıcı durumu hakkında bilgi vermektir.

Introduction The new dynamic asymmetric brace Scoliosis Treatment Crass Cheneau® is made of special hypoallergenic polypropylene, 2.5 to 3 mm. of thickness, semi-transparent when applied on the patient's body. Laser scanner technique or the use of plaster tape at lordosis position are required to estimate the size of the patient's body. Its way of construction with negative pressure, the least thickness and almost zero weight offers perfect fit on the user's body, making it bearable, invisible, effective but foremost directly corrective for all three dimensions of spinal deformation.

This study was devised to develop a simple computerised method for measuring and quantifying the magnitude of spinal curvatures. A digitally scanned anteroposterior radiographic image was used. The vertebral column was defined as a line that can be subdivided into a number of segments, rather than into the exact number of vertebrae. The technique developed allows an observer to measure the spinal curvature with a high resolution and accuracy. One important advantage of the technique is that the assessor does not need to be skilled or experienced in measurement of a spinal curvature.

There are a number of different non-operative
interventions which aim to control moderate
adolescent idiopathic scoliosis (AIS) from
progression. Clinicians may find difficulties in
the selection of appropriate interventions for
AIS. A comprehensive literature review was
carried out to study all contemporary nonoperative
interventions, it was noted that rigid
spinal orthoses apparently give more curve
control; however, it would compromise the
patient's quality of life via those inevitable
factors - physical constraint, poor acceptance
and psychological disturbance. There is a trend
to develop more effective, acceptable and userfriendly
interventions. Under such an aspiration,
the theories and clinical evidence of different
interventions should be developed along the
clinical pathway of early intervention with
reliable indicators/predictors, patient's active
participation, dynamic control mechanism,
holistic psychological and psychosocial
considerations, and effective and long-lasting
outcome.

Background Successful brace treatment entails good control of scoliosis with avoidance of surgery. However, achieving curve regression may be an even better radiological result than prevention of curve progression for patients with adolescent idiopathic scoliosis. Vertebral remodeling may occur with well-fitted braces. Better in-brace curve correction may influence the likelihood of vertebral remodeling and the chance of curve regression. Only a few reports have evaluated curve regression with brace treatment, and the factors associated with these events are unknown. Questions/purposes (1) What changes in curvature are observed with brace treatment for adolescent idiopathic scoliosis? (2) What factors are associated with curve im-provement? (3) What factors are associated with curve de-terioration? (4) Is curve regression associated with improvements in patient-reported objective outcome scores? Methods Between September 2008 and December 2013, 666 patients with adolescent idiopathic scoliosis underwent underarm brace treatment and were followed until skeletal maturity at 18 years old. Among these patients, 80 were excluded because of early discontinuation of brace treatment (n = 66) and loss to follow-up (n = 14). Hence, 586 patients were included in this study, with a mean brace-wear duration of 3.8 6 1.5 years and post-weaning follow-up duration of 2.0 6 1.1 years. The mean age at baseline was 12.6 6 1.2 years. Most patients were female (87%, 507 of 586) and up to 53% (267 of 507) of females were post-menarche. Bracing outcomes were based on changes in the Cobb angle measured out of brace. These included curve regression, as indicated by at least a 5°reduction in the Cobb angle, curve progression, as indicated by at least a 5°increase in the Cobb angle, and unchanged, as indicated by a change in the Cobb angle of less than 5°. We studied the pre-brace and supine Cobb angles, curve flexibility (pre-brace Cobb angle-su-pine Cobb angle / pre-brace Cobb angle x 100%), correction rate (pre-brace Cobb angle-in-brace Cobb angle / pre-brace Cobb angle x 100%), location of apical vertebrae, apical ratio (convex vertebral height/concave vertebral height), change in the major curve Cobb angle, and apical ratio post-bracing. The refined 22-item Scoliosis Research Society questionnaire was used for patient-reported outcomes and Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Will manipulating skin influence trunk rotation as measured by scoliometer? Immediate results of applying Elastic Therapeutic Tape on spinal rotation: experimental study of twins with Adolescent Idiopathic Scoliosis.
Introduction: The human body needs skin moving normally to function properly. Research by Richard RL and colleagues identified functional cutaneous areas in the body. They found that the amount of skin involved in joint movement extends far beyond the immediate proximity of the local joint creases. Recent research by prof. T Fukui has shown the physiological movement path of skin in the whole human body. Should skin movement or the lack thereof be a matter of concern in the treatment of scoliosis patients? Can we influence rotational movement of the spine by manipulating the skin with tape?
Method:  Four different tape applications were trialled in two sessions with the assistance of two thirteen year old twin girls with IAS. Parents and girls consented after explanation of experimental study goals and method. They were familiar with Elastic Therapeutic Taping and its possibilities in sports as they both play basketball. Participants were assessed with scoliometer at a number of vertebral levels before applying the tapes and directly after applying. Tapes were then removed. Two application were trialled per session.
Conclusion: The last tape applied in the lumbar area resulted in influencing spinal rotation in both participants measured by scoliometer. This experiment shows that we can influence rotation of the spine just by applying a small piece of elastic tape therapeutically taking Fukui research and his Skin Rules into account.
Discussion: The ‘extra’ skin making flexion and extension of trunk possible is located in the lower trunk region. Interestingly skin movement during rotation trunk changes direction at the spine. This experimental research shows that we can influence skin and rotation in the spine just by applying manual stretch or tapes. More research into this phenomena could be of importance.

Study Design. Prospective cross-sectional study. Objective. To determine the health-related quality of life (HRQoL) of adolescent idiopathic scoliosis (AIS) patients undergoing bracing, previously braced and observation only. Summary of Background Data. HRQoL is an important treatment outcome measure for AIS. A poor HRQoL may also negatively influence the success of bracing by reducing the likelihood of good brace compliance. Yet, the HRQoL thresholds for patients undergoing observation only, brace treatment or previous brace treatment is not well understood. Methods. Chinese AIS patients with refined Scoliosis Research Society 22-item (SRS-22r) Questionnaire and 5-level EQ-5D (EQ-5D-5L) Questionnaire scores were consecutively recruited for this cross-sectional study. Patients were grouped based on their treatment modality (observation only, bracing, previously braced, and postoperatively). Coronal and sagittal Cobb angles, degree of apical vertebral rotation, and curve type were studied. Spearman correlation test, independent t test, and one-way analysis of variance (ANOVA) with Tukey Post-hoc test were performed for statistical analysis. Results. A total of 652 AIS patients with mean age of 14.8 AE 1.9 years and mean Cobb angle of 18.68 AE 10.08 was studied. The respective mean SRS-22r total scores for bracing, observation, and previously braced groups were 4.20, 4.54, and 4.42, and mean EQ-5D-5L scores were 0.87, 0.95, and 0.92. The total and domain scores were correlated with coronal Cobb angles (P < 0.001) while only EQ-5D-5L correlated with sagittal Cobb angles (P < 0.001). Curves greater than 408 had worse HRQoL (P < 0.001). Currently braced patients had significantly worse HRQoL than those under observation, as indicated by lower EQ-5D-5L (0.08) and SRS-22r (0.35) scores (P < 0.001 to P < 0.05). Previously braced patients had better HRQoL than currently braced patients, with 0.05 higher EQ-5D-5L score (P < 0.001), and 0.23 higher SRS-22r score (P < 0.001). However, currently braced patients were more satisfied with treatment (1.94 difference; P < 0.001) than previously braced. There were no gross differences between patients previously braced and undergoing observation only. Conclusion. The negative impact of bracing on HRQoL is only transient as previously braced patients have superior HRQoL. It appears as though the EQ-5D-5L scores are more sensitive to changes in the sagittal profile as compared with SRS-22r. Our study highlights the differences in HRQoL between patients only being observed, undergoing bracing or previous brace treatment and the importance of monitoring HRQoL throughout follow-up. Further longitudinal studies may help determine the timing and threshold of HRQoL changes during the entire duration of bracing as well as after brace weaning.

Abstract
Introduction: Scoliosis is a three-dimensional deformative abnormality of the spine, defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane. Based on the age of presentation, scoliosis is further categorized as infantile, juvenile or adolescent idiopathic. Adolescent idiopathic scoliosis (AIS) has the highest prevalence of the three categories. This type of scoliosis is present at age ten and lasts till the end of growth. Its prevalence is dependent on the curvature of the spine and gender of the patient. Objective: The purpose of this review is to evaluate the role of physiotherapy in reducing curve progression and pain, postponing or avoiding invasive treatment and improve the quality of life in adolescents with AIS. Methodology: The study is a Systematic Review, meta-analytic type, consisting of 5 studies (RCT) of the last ten years, which focus on the impact of physiotherapy in AIS. Studies include 210 patients evaluated and treated by physiotherapist, divided into 2 groups: experimental and control group. The measurement and rehabilitation includes Cobb angle, pain and quality of life. Data was extracted from medical websites and scientific journals. The evaluation was realized with the PEDro scale, which shows the validity of each study. Results: The literature used in the study claimed that physiotherapist in AIS reduces pain and Cobb angle and improve QoL (p<0.05). The 5 studies had an average PEDro score of 5.6/10. Conclusions: Evidence suggests that physiotherapy is good at reducing the Cobb angle, pain and improving the quality of life in patients with AIS. Scientific research on this topic is limited, so it is suggested to increase research, especially now that AIS incidence is higher.

Aims
The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes.
Patients and Methods
This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic
parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable
logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores.
Results
Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores.
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.

Background: Concern exists regarding the potential for chiropractic treatment to cause adverse effects in individuals with scoliosis. The aim of this paper is to present the self-reported responses of 189 scoliosis patients over 3198 unique visits, collected over one calendar year from nine chiropractic clinics, regarding how they felt and the side effects they experienced immediately after chiropractic treatment. Methods: Thirty six private chiropractic clinics specializing in the treatment of scoliosis were asked to participate in a prospective study regarding the side-effects of the chiropractic treatment of scoliosis; 9 agreed to participate. A response form was provided to each scoliosis patient at the end of their clinic visit, and consisted of two questions: "How do you feel after your treatment today?" and "Did you experience any side-effects as a result of your treatment today?" Results: One hundred eighty nine informed consent forms were collected and 3198 response forms were collected, suggesting an average of 17 visits per patient. Patients reported feeling worse post-treatment after 5.0 % of the visits. The incidence of side-effects was 29.7 %. Muscle soreness accounted for 35.2 % of all side effects. 99.9 % of all side effects were classified as mild. Six moderate side-effects (sprains/strains) were reported out of 3,198 visits. There were no reported cases of severe side effects. Conclusion: Mild side effects were common, although the frequency was slightly lower than the average for chiropractic interventions. The rate of moderate side effects reported was one per 533 visits involving the care of 189 scoliosis patients surveyed from 9 chiropractic offices over a timeframe of one calendar year. No serious adverse events occurred that required medical attention, hospital stays, or surgical intervention. Based upon this preliminary data, side effects reported by scoliosis patients immediately after chiropractic treatment appear to be relatively common but generally benign.

Abstract:
Introduction: Disc space variation, neural mobility and their relation to sciatica symptoms in degenerative disc disease is still a challenging area to work, Sciatica is a common diagnosis causing the pain, weakness, numbness or tingling in the leg, with compromise in quality of life, functional activity. , lifetime incidence of sciatica varying from 13% to 40%, annual incidence ranges from 1% to 6 % in India.
Objective:  1. To find the effectiveness of traction on disc space of L4-L5 and L5-S1 regions.  2. Neurodynamics on neural mobility, mechano sensitivity 3. Combined effects of traction and Neurodynamics and their correlation with functional outcome, pain and ADLs in patients with sciatica due to degenerative disc disease. 
Materials and Methods: 42 subjects with sciatica due to degenerative disc disease were included and 35 completed study, with age >25 years, both sexes. Group1 (G1): control, Group2 (G2) received neurodynamics treatment, Group 3 (G3) received lumbar traction, Group 4 (G4) received both neurodynamics and lumbar traction. Efficacy of treatment of experimental groups (G2,3,4) was assessed  on 1st  day and at the end of 2 week with 1. Magnetic resonance imaging (MRI) for disc parameters, 2. pain by VAS, 3. Range of motion by goniometer and 4. functional rating scales sciatica bothersomeness index, maineseattle back questionaaire and Hopkins symptom checklist-25.  The data subjected to statistical analysis using descriptive and inferential statistics.
Results: Combined group (G4) showed better outcome in all parameters than neurodynamics (G2) or traction alone (G3). Traction alone Group (G3), combined group (G4) have got similar changes in MRI disc parameters better than neurodynamics alone group (G2).
Discussion: Findings suggests that 2 weeks treatment showed variable improvements in all groups on MRI of L4-L5 and L5-S1, functional outcome, pain and ADL activities. Effectiveness of lumbar traction is evident in group 3 and 4, effectiveness of Neurodynamics is evident in group 2, only in group 4 all parameters improved this can be attributed to combined effect.
Conclusion: Neurodynamics may be effective on reducing the mechanosensitivity of nerve and traction may be useful for decompression of segment. In order to address pain, function and ADL activities combination of traction and Neurodynamics showed better results than traction or Neurodynamics alone in this study.
Key words: Neurodynamics, Lumbar traction, Sciatica, Degenerative disc disease.

Effectiveness of orthotic treatment for scoliosis depends on how much time and how well the orthosis is worn. Questionnaires and clinical judgment are subjective methods to wear compliance. Even though using a temperature sensor can objectively record how long the orthosis has been used, it may not be able to answer the orthosis effectiveness without knowing the wear tightness. Custom made thoracolumbosacral orthoses (TLSO) were instrumented with low power wireless data acquisition systems to measure the time and loads imposed by the pressure pad during daily activities. Force measurements were recorded at 1 sample/min and the system was able to record data up to 4 months without patient-involvement. Ten subjects (9F, 1M), age between 9 and 13.5 years, average 11.6 ± 1.3 years, who prescribed a new TLSO and full-time brace wear were took part in this study over 4.4 ± 1.0 months. Longterm logging of loads within a spinal orthosis is a reliable method to measure compliance objectively. The monthly quantity of brace wear ranged from 33% to 82%, average 60.0 ± 4.3%. The monthly average loads imposed by the pressure pads varied from 39% to 78% relative to the reference level, average 64.3 ± 4.6%. There was a statistically significant decrease in force, but increase in wear time over the period after the brace fitting session. This information may help to better understand the effectiveness of bracing and to predict the brace treatment outcomes.

Correspondence should be sent to J. P. Y. Cheung; email: cheungjp@ hku. hk The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. Methods This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radio-graph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cutoff for curve progression was analyzed with receiver operating characteristic curve. Results A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. Conclusion Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254-260.