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Purpose Standard treatment for skeletally immature adolescents with moderate Adolescent Idiopathic Scoliosis (AIS) is a full-time spinal orthosis. However, adherence to full-time wear (≥ 18 h/day) is often challenging for these patients. Nighttime bracing is an alternative option that may improve patient adherence and/or satisfaction. This systematic review and meta-analysis assessed the effectiveness of nighttime bracing in patients with AIS. Methods A systematic review of studies evaluating nighttime bracing was performed. PubMed, Medline, Embase, CINAHL and Cochrane library databases were searched (01/1975-03/2020); two reviewers assessed eligibility. Eligible articles were peer reviewed, in English, and reported outcomes for patients who met Scoliosis Research Society (SRS) criteria. The primary outcome was curve progression ≥ 6°. Pooled progression rates were calculated from random effects meta-analyses with inverse-variance weights; 95% CIs were calculated. Results Nine studies (n = 595) were included. The overall pooled progression rate to ≥ 6° was 40.7% (95% CI: 30.4-51.5%). The pooled progression rate to surgical magnitude was 24.8% (95% CI: 4.5-53.6%). The most successful outcomes were in subjects with thoracolumbar/lumbar curves and subjects who initiated bracing at Risser 1/2 (pooled progression rates were 27.8% (95% CI: 17.0-40.0%) and 16.5% (95% CI: 11.7-21.8%), respectively). Univariate sub-analyses were conducted due to sample sizes. Conclusions Progression rates in patients with primary thoracolumbar/lumbar curves and in patients who initiated nighttime bracing at Risser 1/2 were comparable to published progression rates for full-time bracing, indicating that nighttime bracing may be equally effective for these patients. However, the strength of these conclusions is limited by the sample size and the overall quality of included studies.

Anterior vertebral body tethering (AVBT) is an emerging approach for idiopathic scoliosis. However, overcorrection and under-correction are common causes of revision surgery, and intraoperative tensioning of the cord is one key component to achieve appropriate curve correction. We sought to determine whether preoperative flexibility radiographs or intraoperative radiographs would predict correction at first erect imaging for scoliosis patients undergoing anterior vertebral body tethering (AVBT). Single-center retrospective review. Fifty-one patients with a diagnosis of idiopathic scoliosis underwent anterior body tethering. Preoperative flexibility films and intraoperative radiographs were compared to first erect standing radiographs to determine if there was a correlation in Cobb angle. Preoperative major Cobb angle measured 52° ± 9°. Major Cobb angle on bending films was 24° ± 8°. Intraoperative imaging showed correction to a mean of 17° ± 8°. Postoperative first erect standing radiographs showed correction to a mean of 26° ± 10°. The mean difference in major Cobb angle between intraoperative radiograph and a first erect radiograph was 10° ± 4°, whereas the mean difference from preoperative bending radiograph at first erect was 2° ± 7°. Thus, correction on preoperative flexibility films correlated with the first erect radiograph. Preoperative bending radiographs provide a reasonable estimate of postoperative correction for patients undergoing AVBT with tensioning of the cord. Surgeons should expect the major Cobb angle to increase on first erect radiographs compared to intraoperative radiographs. These findings may guide patient selection and assist surgeons in achieving appropriate correction intraoperatively.

Standard treatment for skeletally immature adolescents with moderate Adolescent Idiopathic Scoliosis (AIS) is a full-time spinal orthosis. However, adherence to full-time wear (≥ 18 h/day) is often challenging for these patients. Nighttime bracing is an alternative option that may improve patient adherence and/or satisfaction. This systematic review and meta-analysis assessed the effectiveness of nighttime bracing in patients with AIS.A systematic review of studies evaluating nighttime bracing was performed. PubMed, Medline, Embase, CINAHL and Cochrane library databases were searched (01/1975-03/2020); two reviewers assessed eligibility. Eligible articles were peer reviewed, in English, and reported outcomes for patients who met Scoliosis Research Society (SRS) criteria. The primary outcome was curve progression ≥ 6°. Pooled progression rates were calculated from random effects meta-analyses with inverse-variance weights; 95% CIs were calculated.Nine studies (n = 595) were included. The overall pooled progression rate to ≥ 6° was 40.7% (95% CI: 30.4-51.5%). The pooled progression rate to surgical magnitude was 24.8% (95% CI: 4.5-53.6%). The most successful outcomes were in subjects with thoracolumbar/lumbar curves and subjects who initiated bracing at Risser 1/2 (pooled progression rates were 27.8% (95% CI: 17.0-40.0%) and 16.5% (95% CI: 11.7-21.8%), respectively). Univariate sub-analyses were conducted due to sample sizes.Progression rates in patients with primary thoracolumbar/lumbar curves and in patients who initiated nighttime bracing at Risser 1/2 were comparable to published progression rates for full-time bracing, indicating that nighttime bracing may be equally effective for these patients. However, the strength of these conclusions is limited by the sample size and the overall quality of included studies.

Anterior vertebral body tethering (AVBT) is an emerging approach for idiopathic scoliosis. However, overcorrection and under-correction are common causes of revision surgery, and intraoperative tensioning of the cord is one key component to achieve appropriate curve correction. We sought to determine whether preoperative flexibility radiographs or intraoperative radiographs would predict correction at first erect imaging for scoliosis patients undergoing anterior vertebral body tethering (AVBT).Single-center retrospective review. Fifty-one patients with a diagnosis of idiopathic scoliosis underwent anterior body tethering. Preoperative flexibility films and intraoperative radiographs were compared to first erect standing radiographs to determine if there was a correlation in Cobb angle.Preoperative major Cobb angle measured 52° ± 9°. Major Cobb angle on bending films was 24° ± 8°. Intraoperative imaging showed correction to a mean of 17° ± 8°. Postoperative first erect standing radiographs showed correction to a mean of 26° ± 10°. The mean difference in major Cobb angle between intraoperative radiograph and a first erect radiograph was 10° ± 4°, whereas the mean difference from preoperative bending radiograph at first erect was 2° ± 7°. Thus, correction on preoperative flexibility films correlated with the first erect radiograph.Preoperative bending radiographs provide a reasonable estimate of postoperative correction for patients undergoing AVBT with tensioning of the cord. Surgeons should expect the major Cobb angle to increase on first erect radiographs compared to intraoperative radiographs. These findings may guide patient selection and assist surgeons in achieving appropriate correction intraoperatively.