Available via license: CC BY 4.0
Content may be subject to copyright.
Citation: Del Prete, C.M.;
Tarantino, D.; Viva, M.G.; Murgia, M.;
Vergati, D.; Barassi, G.; Sparvieri, E.;
Di Stanislao, E.; Perpetuini, D.;
Russo, E.F.; et al. Spinal Orthosis in
Adolescent Idiopathic Scoliosis:
An Overview of the Braces Provided
by the National Health Service in
Italy. Medicina 2024,60, 3. https://
doi.org/10.3390/medicina60010003
Academic Editor: Ho-Joong Kim
Received: 31 October 2023
Revised: 6 December 2023
Accepted: 14 December 2023
Published: 19 December 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
medicina
Review
Spinal Orthosis in Adolescent Idiopathic Scoliosis:
An Overview of the Braces Provided by the National Health
Service in Italy
Cristina Maria Del Prete 1, † , Domiziano Tarantino 2, † , Mattia Giuseppe Viva 3, Massimiliano Murgia 3,
Daniele Vergati 4, Giovanni Barassi 5, Eleonora Sparvieri 6,* , Eugenio Di Stanislao 7, David Perpetuini 8,
Emanuele Francesco Russo 9, Serena Filoni 10 and Raffaello Pellegrino 11,12
1Department of Physical Medicine and Rehabilitation, ASL LE, 73100 Lecce, Italy; cridelprete@tin.it
2
Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; domiziano22@gmail.com
3Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics,
Sapienza University of Rome, 00183 Rome, Italy; mattiagiuseppe.viva@uniroma1.it (M.G.V.);
massimiliano.murgia@uniroma1.it (M.M.)
4Orthopedic Workshops Orthogea, 72017 Ostuni, Italy; medicalvergati@libero.it
5
Center for Physiotherapy, Rehabilitation and Re-Education-CeFiRR-Gemelli Molise, 86100 Campobasso, Italy;
giovanni.barassi@unicatt.it
6Department of Internal Medicine, ASL Teramo, 64100 Teramo, Italy
7Orthopedic Workshops I.T.O.P., 00036 Palestrina, Italy; distanislao.e@itop.it
8
Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy;
david.perpetuini@unich.it
9Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy;
emanuele.fr88@gmail.com
10 I.R.R.C.S. Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; serena.diba@gmail.com
11 Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University,
6912 Lugano–Pazzallo, Switzerland; raffaello.pellegrino@uniludes.ch
12 Santa Chiara Institute, 73100 Lecce, Italy
*Correspondence: eleonora.sparvieri@aslteramo.it; Tel.: +39-0871-355-33-33
†These authors contributed equally to this work.
Abstract:
Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a
3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the
most common form of scoliosis in the pediatric population. The etiology is multifactorial, including
genetic and environmental factors. The incidence is roughly equal between males and females, while
there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels
of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we
carried out a review of the scientific literature about the indication and success rates of the braces
provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the
efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment
is present in the scientific literature, demonstrating a high degree of variability. The overall success
rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the
treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.
Keywords: adolescent idiopathic scoliosis; conservative treatment; bracing treatment; braces
1. Introduction
Adolescent idiopathic scoliosis (AIS) is the most common form of all scoliosis in the
pediatric population (80%) [
1
,
2
] and consists of a lateral, rotated curvature of the spine. It is
a 3-dimensional deformity that affects healthy children around puberty.
Ponseti et al.
distin-
guished four major types of scoliosis: thoracic, lumbar, thoraco-lumbar, and S-shaped [3].
Medicina 2024,60, 3. https://doi.org/10.3390/medicina60010003 https://www.mdpi.com/journal/medicina
Medicina 2024,60, 3 2 of 14
The etiology is multifactorial, including genetic and environmental factors [
4
]. Ac-
cording to different studies, the prevalence of AIS ranges from 0.47% to 5.2% in the general
population [
5
,
6
]. At least 10% of those with AIS will require treatment, and 0.1–0.3% will
require surgical correction [
5
,
7
]. The progression of AIS is much more frequent in females,
especially in severe scoliosis [4].
The diagnosis of AIS is defined when other causes of scoliosis, such as neuromuscular
diseases, syndromes, and malformations of the spine, have been excluded [
1
,
8
,
9
]. Adam’s
Forward Bending Test, the gold standard clinical test for scoliosis screening (sensitivity
of 84.37% and specificity of 93.44%) [
10
], allows us to differentiate scoliosis into two
categories: I) dysmorphism postural disfunction (Adam’s Forward Bending Test positive),
which involves an element of permanent rotation within the spine and ribcage in addition
to the lateral curvature; and II) paramorphism (Adam’s Forward Bending Test negative), in
which postural or other asymmetries mimic scoliosis and its symptoms [11].
The natural history of scoliosis was described by Weinsten et al. [
12
,
13
], and to quantify
the risk of progression, several methods have been developed. Of these, the most used is
the one proposed by Lonstein and Carlson, which includes the Cobb angle, Risser sign,
and chronological age in the evaluation [
14
]. The Cobb angle is one of the most important
parameters when assessing curve severity and is measured on a posteroanterior X-ray spine
film. A curve with a Cobb’s angle less than 20 degrees is classified as mild. A moderate
curve is between 25 degrees and 40 degrees. A severe curve is more than 40 degrees [
15
,
16
].
The instrumental diagnosis of AIS based on a frontal curve of the spine is greater than 10
◦
Cobb, as measured on a postero-anterior (P-A) spine radiograph (X-ray) [17].
The six-point Risser system is used to classify the stage of bone maturation since it
was noticed how the progression of scoliosis occurs, especially during the phase of greater
growth, and then the curve stabilizes at the end of growth. Risser stated that the attachment
of the iliac apophysis could be used as a marker of the completion of vertebral growth, so
its classification is based on the amount of excursion of the iliac apophysis [17].
A conservative rehabilitative approach is first-line treatment for AIS. Several thera-
peutic exercises have been studied in the literature, such as aerobic and resistance train-
ing [
18
], Schroth exercises [
3
,
19
], and different scoliosis schools’ approaches to physiother-
apy scoliosis-specific exercises (PSSE) [
20
–
22
]. The goals are either morphological (stop
or even reduce the curve progression at puberty and improve aesthetics) or functional
(prevent or treat respiratory dysfunction and prevent or treat spinal pain syndromes) [
23
].
The most recent guidelines of the International Scientific Society on Scoliosis Ortho-
pedic and Rehabilitation Treatment (SOSORT, 2016) [
24
] and the recent review by Alison
et al. (2021) [
1
] have rigorously indicated the operative modalities of the rehabilitation
treatment of patients with AIS; furthermore, they have highlighted the important role of
bracing in the rehabilitation process, considered perceptual and not just as a mechanical
value. The SOSORT guidelines, published in 2018, marked an important point in the
evidence on conservative treatment for idiopathic scoliosis due to the presence of emerging
high-quality evidence, allowing the formulation of some grade-I recommendations about
the effectiveness of PSEE and bracing [
24
]. Some findings were outlined by the guidelines
of the Scoliosis Research Society (SRS) for AIS treatment, identifying three levels of treat-
ment: observation, PSSE, and braces [
25
]. Halsey et al. in 2021 assessed the percentage of
concordance with the SOSORT Guidelines of AIS specialists, finding that the large majority
(99% of the sample) use braces in the treatment of AIS, and almost 90% of them refer to
the SRS criteria in bracing prescription [
26
]. A brace is a mechanical system that effectively
counteracts a mechanical problem. The mechanism of action is based on the application
of external forces; the purpose is to redistribute mechanical stress to promote vertebral
remodeling, reduce scoliosis, and aim to restore axiality. Bracing a scoliotic curve unloads
the growth plates on the concave side of the vertebral bodies near the curve’s apex. Growth
stimulation, leading to structural remodeling of the vertebral bodies on the curve’s concave
side, may explain the improvement or lack of curve progression reported with successful
brace management of AIS [
27
,
28
]. The response of the scoliosis curve to the action of a
Medicina 2024,60, 3 3 of 14
brace and the reactivity of the viscoelastic structures allows the remodeling of the curve
itself, and the effectiveness of this process is inversely proportional to the skeletal age of
the patient.
The goal of brace treatment is to prevent further progression of the AIS and to prevent
the need for surgery [
29
]. Early diagnosis and early bracing could decrease the risk of spine
surgery [
24
]. Unfortunately, most AIS patients present too late for effective management
with braces [
1
,
24
]. Brace treatment should be reserved for curves above 20
±
5
◦
Cobb and
residual growth periods. Curves below 15
±
5
◦
Cobb should not be placed in orthotic
treatment. Part-time bracing or night-time bracing has been described by some physicians
and is widely advocated in some institutions. There is a lack of long-term follow-up results
to prove the effectiveness of this type of treatment in AIS, and all series on effective orthotic
treatment are with full-time wear [30,31].
In 2013, a multicenter randomized clinical trial (RCT) on patients with suggestions
for bracing considering age, skeletal immaturity, and degree of scoliosis was performed by
Weinstein et al. [
13
]. The analysis included patients randomly assigned into two groups:
a treatment group, which underwent a bracing treatment (for at least 18 h/day), and an
observational control group. The bracing treatment did not improve the outcome of the
progression of curves greater than 50 degrees, while it was effective in the progression of
curves of lesser degrees. In addition, there was a significant association between hours
of brace wearing and treatment success. Therefore, the authors concluded that bracing
prevents the need for surgery [
13
]. Although there is consensus on the effectiveness of
bracing treatment, a high degree of variability in the clinical approach and prescription is
present. These include, for example, the prescribed hours, the frequency of follow-up and
X-ray examinations, the use of the brace at night, and the times of suspension and weaning.
Since a variation in these parameters could make the difference between a therapeutic
success and a therapeutic failure, SOSORT and the SRS agreed that there is a need for
standardization of research methods to ensure more effective evidence.
However, it is worth highlighting that the effectiveness of braces for scoliosis treat-
ment is multifaceted. In fact, while braces are generally recommended for adolescents
with idiopathic scoliosis to halt curvature progression [
32
], their effectiveness is limited
in certain cases. For instance, in children with scoliosis complicated by spinal cord injury,
bracing may not prevent surgery or may delay the need for surgical correction as the
curve size increases [
33
]. Additionally, a randomized controlled trial found no significant
difference in preventing curve progression for moderate scoliosis between bracing and
scoliosis-specific exercises [
34
]. Furthermore, the success of stabilizing or improving scolio-
sis through bracing is modest, often requiring virtually continuous brace wear and resulting
in low compliance [
35
]. Moreover, the type of brace used can impact its effectiveness, with
hard braces being considered more effective than soft braces for scoliosis treatment [
36
].
In this perspective, Niu et al. developed a robotic brace that is able not only to apply
active corrective forces to the spine but also to support rehabilitation exercises, indicating
the potential for robotic technology to assist in the conservative management of spinal
deformities [
37
]. Notably, while the direct application of robotic assistive
training [38,39]
(for scoliosis treatment) is not extensively documented in the literature, the broader evi-
dence on the use of robotic technology in musculoskeletal rehabilitation and orthopedic
interventions suggests its potential utility in the management of scoliosis, as corroborated
by the effectiveness of the robotic brace developed by Niu et al. [37].
However, for adolescents with severe idiopathic scoliosis, alternative treatments
such as vertebral body tethering or surgical intervention may be necessary if the curves
continue to progress despite bracing [
40
]. It is important to note that physical therapy
plays a key role in preventing scoliosis curve progression and improving outcomes and
quality of life through manual therapy, bracing, core stabilization, and strengthening [
41
].
With the aim of strengthening back muscles, transcutaneous electrical nerve stimulation
(TENS) has been explored as a potential treatment for scoliosis. While some studies
have dismissed electrical stimulation as a viable treatment for scoliosis [
42
], others have
Medicina 2024,60, 3 4 of 14
suggested its potential to induce muscle contraction and improve back asymmetry in
subjects with scoliosis [
21
]. Additionally, it has been proposed that TENS can excite
muscle spindles or Golgi tendon organs to induce proprioceptive illusions, similar to
the approach of mechanical vibration [
43
]. Furthermore, TENS has been widely used to
induce muscle contraction in both clinical neurorehabilitation and laboratory settings [
44
].
In the context of scoliosis, lateral electrical surface stimulation (LESS) has been found
to be effective in improving trunk balance in children with severe cerebral palsy and
scoliosis [
45
]. Importantly, TENS can also be delivered through wearable devices, such as
suits equipped with electrodes able to administer customized electrical stimulation [
46
].
The effectiveness of these suits to improve trunk control was demonstrated in children
affected by cerebral palsy [47].
This paper aims to provide an overview of the scientific literature regarding the
commonly used braces that are included in the Essential Levels of Care (LEA) of the Italian
National Health Service (SSN) and provided to citizens free of charge in terms of indications
and success rate [48].
2. Materials and Methods
All the procedures related to this overview were organized and reported after per-
forming a search in the main scientific electronic databases (PubMed, Scopus, and Web of
Science) to identify the available scientific articles about the braces included in the LEA of
the SSN, with no restriction of time. Only articles in English were reviewed.
The search was performed by three independent authors (CM.DP, D.T, and R.P.) at their
own institutions, and two independent reviewers (D.T. and R.P.) extracted and evaluated
the data from the selected articles. For the purposes of our review, the following keywords
were used alone or in combination: adolescent idiopathic scoliosis, scoliosis, conservative
treatment, bracing.
Only articles regarding the braces included in the LEA of the SSN were selected,
regardless of the type of article. The information about the braces provided by the SSN was
directly extracted from the institution’s website [48].
To facilitate the understanding of the results, the braces were reported as single sub-
sections with specific information about each one. Given the nature of our work, we neither
performed a systematic search nor reported the results in a systematic review fashion.
3. Results
3.1. Standard Rigid Braces
The principle that determines the mechanism of action of the main spinal orthoses is that
of three-point pressure (Figure 1), which aims at the correction of deformities with traction,
lateral deflection, and derotation. If made correctly, a brace can drive vertebral growth and stop
the evolution of scoliosis. There is a wide variety of braces to choose from; the choice depends
on the location and rigidity of the curves, the age, and specific patient preferences [30].
Medicina 2023, 59, x FOR PEER REVIEW 5 of 15
Figure 1. Three-point pressure brace principle. a) clinical assessment of the scoliosis; b)
radiographic evaluation; c) brace derotation point of action; d) radiological assessment of the
brace; e) definitive brace; f) radiological assessment during the follow-up.
3.2. Milwaukee Brace
The Milwaukee brace (Figure 2) was developed in 1954 for the conservative treatment
of idiopathic scoliosis; it is contraindicated for mature individuals. It consists of a neck
ring and a pelvic mold that fix and extend the spine, inducing constant self-elongation.
An axillary sling and thoracic and lumbar pads apply transverse corrective forces to the
curves, resulting in a consequent correction of the deformity [49].
The corrective mechanism is based on the elongation of the trunk and the opening of
the convexities of the curves through the thrusts located on the ribs afferent to the apex of
the curves to carry out a derotation of the vertebral body through the ribs. In this type of
brace, the three-point system has a less important role in the final outcome, as the primary
mechanism of action is to stimulate the muscles of the trunk, allowing a redirection of
spinal growth [50].
The indications for the Milwaukee brace treatment include the following [51]:
1. Mild and moderate curves, up to 40–45 degrees, during the skeletal growth period;
2. In cases of severe curves, it is more effective than other braces in upper-thoracic and
cervical curves, and it is the only brace recommended for proximal curves up to D5;
3. Patients require less chest restriction and more ventilation and comfort.
The use of the Milwaukee brace for curves between 20° and 29° with a Risser sign
between 0 and 1 showed less progression (28%) than untreated curves of similar
magnitude. When using the Milwaukee brace for curves of similar magnitude but with a
Risser sign of 2 or more, the progression rate is 10% less than for untreated curves.
Similarly, curves between 30° and 39° with a Risser sign between 0 and 1 progressed 14%
less using the Milwaukee brace than untreated curves of similar magnitude, and treated
curves of similar magnitude, but a Risser sign of 2 or more progressed 21% less than
untreated curves [14,52]. The rate of success of this kind of brace ranges from 43% to
53.33% [53,54].
Among the side effects of this brace, the most relevant are the psychological impact
due to its neck ring [55] and the induction of a flat back. Today, in clinical practice, it has
apparently been replaced by TLSOs (thoraco-lumbo-sacral orthoses), such as the Boston
brace and the Cheneau brace. Studies comparing the Milwuakee and the Boston braces
showed that the Boston brace was more successful than the Milwaukee brace irrespective
of initial curve magnitude and skeletal maturity, especially for lumbar and thoracic
scoliosis [55,56]. The Cheneau brace was shown to provide beer spinal decompensation
as well when compared to the Milwaukee brace [57].
Figure 1.
Three-point pressure brace principle. (
A
) clinical assessment of the scoliosis; (
B
) radio-
graphic evaluation; (
C
) brace derotation point of action; (
D
) radiological assessment of the brace;
(E) definitive brace; (F) radiological assessment during the follow-up.
Medicina 2024,60, 3 5 of 14
3.2. Milwaukee Brace
The Milwaukee brace (Figure 2) was developed in 1954 for the conservative treatment
of idiopathic scoliosis; it is contraindicated for mature individuals. It consists of a neck
ring and a pelvic mold that fix and extend the spine, inducing constant self-elongation. An
axillary sling and thoracic and lumbar pads apply transverse corrective forces to the curves,
resulting in a consequent correction of the deformity [49].
Medicina 2023, 59, x FOR PEER REVIEW 6 of 15
Figure 2. Milwaukee brace.
3.3. Boston Brace
The Boston brace (Figure 3) was designed by Hall and Miler in 1972 [58], and its
efficiency was first reported by Was et al. in 1977 [59]. It is a prefabricated polypropylene
brace, open on the back, subsequently personalized for the patient. The correction of the
curve on the coronal plane and the vertebral rotation take place through pads added to
complete the brace that push the spine, giving a rotational force to the ribs and increasing
the upright position of the spine [60,61]. The biomechanical action produced by the Boston
brace allows, through the project performed on radiographic examination, the placement
of thrusts capable of derotating the vertebral bodies. The main goal is to correct the lateral
deviation and rotation of the vertebral bodies, bringing the trunk back into trim on the
sacrum.
The TLSO Boston brace is indicated as follows:
1. Lumbar and thoracolumbar or thoracic (below T8) curves between 20 and 50 Cobb
degrees. In 2013, a RCT by Weinstein et al. [13] found that pediatric patients with
idiopathic scoliosis who wore Boston braces had a 72% success rate of achieving a
Cobb angle of <50 degrees, against the 48% in the observation (control) group.
2. Similar curves greater than 50 Cobb degrees exist in patients who cannot undergo
surgery for clinical reasons.
The aim of the Boston brace is a correction of at least 50%, so the permanent correction
two years after brace discontinuance can be 15% in relation to the initial angle [30]. Using
the Boston brace, 49% of the curves remain unchanged, 39% of the scoliosis has a
permanent correction of 5° to 15°, 4% are stabilized with a correction of at least 15°, 4%
lose between 5° and 15°, and 3% progress more than 15° [30]. A study by Emans et al.
described that 11% of patients treated by Boston had a surgical indication during the
period of bracing [58].
Figure 2. Milwaukee brace.
The corrective mechanism is based on the elongation of the trunk and the opening of
the convexities of the curves through the thrusts located on the ribs afferent to the apex of
the curves to carry out a derotation of the vertebral body through the ribs. In this type of
brace, the three-point system has a less important role in the final outcome, as the primary
mechanism of action is to stimulate the muscles of the trunk, allowing a redirection of
spinal growth [50].
The indications for the Milwaukee brace treatment include the following [51]:
1. Mild and moderate curves, up to 40–45 degrees, during the skeletal growth period;
2.
In cases of severe curves, it is more effective than other braces in upper-thoracic and
cervical curves, and it is the only brace recommended for proximal curves up to D5;
3. Patients require less chest restriction and more ventilation and comfort.
The use of the Milwaukee brace for curves between 20
◦
and 29
◦
with a Risser sign
between 0 and 1 showed less progression (28%) than untreated curves of similar magnitude.
When using the Milwaukee brace for curves of similar magnitude but with a Risser sign
of 2 or more, the progression rate is 10% less than for untreated curves. Similarly, curves
between 30
◦
and 39
◦
with a Risser sign between 0 and 1 progressed 14% less using the
Milwaukee brace than untreated curves of similar magnitude, and treated curves of similar
magnitude, but a Risser sign of 2 or more progressed 21% less than untreated curves [
14
,
52
].
The rate of success of this kind of brace ranges from 43% to 53.33% [53,54].
Among the side effects of this brace, the most relevant are the psychological impact
due to its neck ring [
55
] and the induction of a flat back. Today, in clinical practice, it has
apparently been replaced by TLSOs (thoraco-lumbo-sacral orthoses), such as the Boston
brace and the Cheneau brace. Studies comparing the Milwuakee and the Boston braces
showed that the Boston brace was more successful than the Milwaukee brace irrespective
of initial curve magnitude and skeletal maturity, especially for lumbar and thoracic scolio-
sis [
55
,
56
]. The Cheneau brace was shown to provide better spinal decompensation as well
when compared to the Milwaukee brace [57].
Medicina 2024,60, 3 6 of 14
3.3. Boston Brace
The Boston brace (Figure 3) was designed by Hall and Miler in 1972 [
58
], and its efficiency
was first reported by Watts et al. in 1977 [
59
]. It is a prefabricated polypropylene brace, open
on the back, subsequently personalized for the patient. The correction of the curve on the
coronal plane and the vertebral rotation take place through pads added to complete the
brace that push the spine, giving a rotational force to the ribs and increasing the upright
position of the spine [
60
,
61
]. The biomechanical action produced by the Boston brace allows,
through the project performed on radiographic examination, the placement of thrusts capable
of derotating the vertebral bodies. The main goal is to correct the lateral deviation and rotation
of the vertebral bodies, bringing the trunk back into trim on the sacrum.
Medicina 2023, 59, x FOR PEER REVIEW 6 of 15
Figure 2. Milwaukee brace.
3.3. Boston Brace
The Boston brace (Figure 3) was designed by Hall and Miler in 1972 [58], and its
efficiency was first reported by Was et al. in 1977 [59]. It is a prefabricated polypropylene
brace, open on the back, subsequently personalized for the patient. The correction of the
curve on the coronal plane and the vertebral rotation take place through pads added to
complete the brace that push the spine, giving a rotational force to the ribs and increasing
the upright position of the spine [60,61]. The biomechanical action produced by the Boston
brace allows, through the project performed on radiographic examination, the placement
of thrusts capable of derotating the vertebral bodies. The main goal is to correct the lateral
deviation and rotation of the vertebral bodies, bringing the trunk back into trim on the
sacrum.
The TLSO Boston brace is indicated as follows:
1. Lumbar and thoracolumbar or thoracic (below T8) curves between 20 and 50 Cobb
degrees. In 2013, a RCT by Weinstein et al. [13] found that pediatric patients with
idiopathic scoliosis who wore Boston braces had a 72% success rate of achieving a
Cobb angle of <50 degrees, against the 48% in the observation (control) group.
2. Similar curves greater than 50 Cobb degrees exist in patients who cannot undergo
surgery for clinical reasons.
The aim of the Boston brace is a correction of at least 50%, so the permanent correction
two years after brace discontinuance can be 15% in relation to the initial angle [30]. Using
the Boston brace, 49% of the curves remain unchanged, 39% of the scoliosis has a
permanent correction of 5° to 15°, 4% are stabilized with a correction of at least 15°, 4%
lose between 5° and 15°, and 3% progress more than 15° [30]. A study by Emans et al.
described that 11% of patients treated by Boston had a surgical indication during the
period of bracing [58].
Figure 3. Boston brace.
The TLSO Boston brace is indicated as follows:
4.
Lumbar and thoracolumbar or thoracic (below T8) curves between 20 and 50 Cobb
degrees. In 2013, a RCT by Weinstein et al. [
13
] found that pediatric patients with
idiopathic scoliosis who wore Boston braces had a 72% success rate of achieving a
Cobb angle of <50 degrees, against the 48% in the observation (control) group.
5.
Similar curves greater than 50 Cobb degrees exist in patients who cannot undergo
surgery for clinical reasons.
The aim of the Boston brace is a correction of at least 50%, so the permanent correction
two years after brace discontinuance can be 15% in relation to the initial angle [30]. Using
the Boston brace, 49% of the curves remain unchanged, 39% of the scoliosis has a permanent
correction of 5
◦
to 15
◦
, 4% are stabilized with a correction of at least 15
◦
, 4% lose between 5
◦
and 15
◦
, and 3% progress more than 15
◦
[
30
]. A study by Emans et al. described that 11%
of patients treated by Boston had a surgical indication during the period of bracing [58].
3.4. Cheneau Brace
Jacques Chêneau designed the original Chêneau brace in 1979 [
30
]. The brace (Figure 4)
is fabricated in polypropylene and has an anterior opening with Velcro. It is a lightweight
and well-accepted brace that corrects in the three planes of space with good effective-
ness on rotation. The Cheneau brace is asymmetrical, used for patients of all degrees of
severity and maturity, and often worn for 20 to 23 h/day [
30
]. The brace principally aims
to allow lateral and longitudinal rotation and movement [
62
]. The aim of the Chêneau
brace is to obtain a three-dimensional correction of the scoliotic curve. The detorsion on
the sagittal plane would also lead to normalization on the coronal and transverse planes
and a consequent elongation of the spine without the application of distractive forces.
According to Cheneau, the deformation of the scoliotic body consists of the following:
1. convexities and concavities; 2. sagittal configuration deformity; 3. rotation of the pelvis
and shoulders; and 4. lateral displacement. The corset acts through a three-dimensional,
Medicina 2024,60, 3 7 of 14
three-point system, allowing it to reduce humps, mobilize the flat parts, and leave respira-
tory movements free. It provides for a triple action: active, passive, and dynamic. It corrects
the deformity without favoring the flat back that is commonly associated with scoliosis.
The biomechanical principle is to apply thrusts on the convex side of the curves and on
all the humps detectable on the trunk, both front and rear, and develop large expansion
chambers where there are depressions and on the concave side of the curves.
Medicina 2023, 59, x FOR PEER REVIEW 7 of 15
Figure 3. Boston brace.
3.4. Cheneau Brace
Jacques Chêneau designed the original Chêneau brace in 1979 [30]. The brace (Figure
4) is fabricated in polypropylene and has an anterior opening with Velcro. It is a
lightweight and well-accepted brace that corrects in the three planes of space with good
effectiveness on rotation. The Cheneau brace is asymmetrical, used for patients of all
degrees of severity and maturity, and often worn for 20 to 23 h/day [30]. The brace
principally aims to allow lateral and longitudinal rotation and movement [62]. The aim of
the Chêneau brace is to obtain a three-dimensional correction of the scoliotic curve. The
detorsion on the sagial plane would also lead to normalization on the coronal and
transverse planes and a consequent elongation of the spine without the application of
distractive forces. According to Cheneau, the deformation of the scoliotic body consists of
the following: 1. convexities and concavities; 2. sagial configuration deformity; 3.
rotation of the pelvis and shoulders; and 4. lateral displacement. The corset acts through
a three-dimensional, three-point system, allowing it to reduce humps, mobilize the flat
parts, and leave respiratory movements free. It provides for a triple action: active, passive,
and dynamic. It corrects the deformity without favoring the flat back that is commonly
associated with scoliosis. The biomechanical principle is to apply thrusts on the convex
side of the curves and on all the humps detectable on the trunk, both front and rear, and
develop large expansion chambers where there are depressions and on the concave side
of the curves.
The indication for the Cheneau brace is progressive AIS with an apex lower than T5
and a Cobb angle between 25° and 45° [63].
One study showed that the Cobb angle was reduced by an average of 16.4° [64], and
two studies reported a success rate (defined as no more than 5 degrees of curve
progression) of 76% and 81% using, respectively, a Rigo Cheneau brace and a modified
Cheneau (called “Cheneau-P”) [65,66], while another study reported a success rate
(defined as preventing curve progression beyond 50 degrees) of 81% [67].
Some studies demonstrate how Cheneau brace correction could not only influence
the progression of the scoliotic curve, but also its natural history [68–70], even if there is
no consensus on its efficacy. A retrospective study comparing the Cheneau to the Boston
brace outlined that the Cheneau led to a lower mean and percent major curve progression
than the Boston brace [71]. The use of different criteria for outcome assessment could at
least partially explain the lack of agreement in the literature. Most commonly, failure is
defined by the need for surgery or by a certain amount of radiographic curve progression
during treatment or follow-up, while standardized criteria are needed [72].
Figure 4. Cheneau brace.
3.5. Lyon Brace
The Lyon brace was invented by Stagnara et al. in 1947 and is also known as the
Stagnara brace. This brace system is the first to have prospective studies and consistent
Figure 4. Cheneau brace.
The indication for the Cheneau brace is progressive AIS with an apex lower than T5
and a Cobb angle between 25◦and 45◦[63].
One study showed that the Cobb angle was reduced by an average of 16.4
◦
[
64
], and
two studies reported a success rate (defined as no more than 5 degrees of curve progression)
of 76% and 81% using, respectively, a Rigo Cheneau brace and a modified Cheneau (called
“Cheneau-P”) [
65
,
66
], while another study reported a success rate (defined as preventing
curve progression beyond 50 degrees) of 81% [67].
Some studies demonstrate how Cheneau brace correction could not only influence the
progression of the scoliotic curve, but also its natural history [
68
–
70
], even if there is no
consensus on its efficacy. A retrospective study comparing the Cheneau to the Boston brace
outlined that the Cheneau led to a lower mean and percent major curve progression than
the Boston brace [
71
]. The use of different criteria for outcome assessment could at least
partially explain the lack of agreement in the literature. Most commonly, failure is defined
by the need for surgery or by a certain amount of radiographic curve progression during
treatment or follow-up, while standardized criteria are needed [72].
3.5. Lyon Brace
The Lyon brace was invented by Stagnara et al. in 1947 and is also known as the
Stagnara brace. This brace system is the first to have prospective studies and consistent
documented efficacy [
30
]. The Lyon is a rigid brace (Figure 5) used to treat lumbar or
low thoracolumbar scoliotic curves between 30 and 50 Cobb degrees. Can also be treated
with Lyon brace curves greater than 50 Cobb degrees that cannot be operated on for
medical reasons or skeletal immaturity. It is also prescribed after surgical treatment for 3 to
6 months
. The principles of Lyon brace are based on the three-point pressure theory, with
an application of a force on the two neutral vertebras and a counterforce at the apex of the
curve. Derotational forces are also applied on the spine, from the posterior convexity to the
anterior concavity [
73
]. The overall efficacy of the Lyon brace is 95%. However, it drops to
87% for thoracic curves and to 80% in patients with Risser sign 0 [30].
Medicina 2024,60, 3 8 of 14
Medicina 2023, 59, x FOR PEER REVIEW 8 of 15
documented efficacy [30]. The Lyon is a rigid brace (Figure 5) used to treat lumbar or low
thoracolumbar scoliotic curves between 30 and 50 Cobb degrees. Can also be treated with
Lyon brace curves greater than 50 Cobb degrees that cannot be operated on for medical
reasons or skeletal immaturity. It is also prescribed after surgical treatment for 3 to 6
months. The principles of Lyon brace are based on the three-point pressure theory, with
an application of a force on the two neutral vertebras and a counterforce at the apex of the
curve. Derotational forces are also applied on the spine, from the posterior convexity to
the anterior concavity [73]. The overall efficacy of the Lyon brace is 95%. However, it drops
to 87% for thoracic curves and to 80% in patients with Risser sign 0 [30].
Figure 5. Lyon brace.
3.6. Very Rigid Braces
The SPoRT (symmetrical, patient-oriented, rigid, three-dimensional, active) is a new
concept of bracing that follows specific principles of correction, and on this concept are
based the Sibilla and Sforzesco braces [74,75]. These braces are custom-made according to
the patient’s individual needs using technologies such as CAD-CAM that allow maximum
customization of the orthosis [39]. The brace is then tested on the patient to modify and
adapt it, depending on his or her real interaction between the body and the brace [75]. The
Sforzesco brace (Figure 6), which is provided for free by the SSN, is formed by two lateral
polycarbonate structures that envelop the trunk and connect along the posterior midline
to a longitudinal metal rod. The correction takes place through three-dimensional elonga-
tion (a new concept different from the other corrective systems: 3-point, traction, postural,
and movement-based) that pushes the spine longitudinally upwards, achieved through a
system of thrusts on the major elevations and a creation of spaces on the pathological de-
pressions [46,47]. CAD-CAM construction allows for a highly customizable prescription
tailored to the patient’s curve, respecting the three planes, and allowing adjustments and
customizations even in the control phase. Negrini et al., in 2011, identified a variation in
time and duration of treatment depending on the severity from 18 to 23 h per day until
Risser 3, then a gradual reduction. They also recommend the association with SEAS (Sci-
entific Exercises Approach to Scoliosis) for the achievement of therapeutic success [74].
In a case/control and prospective cohort study conducted following both the SRS and
SOSORT criteria by Negrini et al. [74], the Sforzesco brace was shown to be more effective
than the Lyon brace and the Risser cast even when considered in association (Lyon brace
plus Risser cast) in treating curves over 45 degrees Cobb. Furthermore, no patients
showed a worsening beyond 45 Cobb degrees or underwent surgery, and an improvement
in aesthetics was also observed [74].
Figure 5. Lyon brace.
3.6. Very Rigid Braces
The SPoRT (symmetrical, patient-oriented, rigid, three-dimensional, active) is a new
concept of bracing that follows specific principles of correction, and on this concept are
based the Sibilla and Sforzesco braces [
74
,
75
]. These braces are custom-made according to
the patient’s individual needs using technologies such as CAD-CAM that allow maximum
customization of the orthosis [
39
]. The brace is then tested on the patient to modify and
adapt it, depending on his or her real interaction between the body and the brace [
75
]. The
Sforzesco brace (Figure 6), which is provided for free by the SSN, is formed by two lateral
polycarbonate structures that envelop the trunk and connect along the posterior midline to
a longitudinal metal rod. The correction takes place through three-dimensional elongation
(a new concept different from the other corrective systems: 3-point, traction, postural,
and movement-based) that pushes the spine longitudinally upwards, achieved through
a system of thrusts on the major elevations and a creation of spaces on the pathological
depressions [
46
,
47
]. CAD-CAM construction allows for a highly customizable prescription
tailored to the patient’s curve, respecting the three planes, and allowing adjustments and
customizations even in the control phase. Negrini et al., in 2011, identified a variation
in time and duration of treatment depending on the severity from 18 to 23 h per day
until Risser 3, then a gradual reduction. They also recommend the association with SEAS
(Scientific Exercises Approach to Scoliosis) for the achievement of therapeutic success [
74
].
Medicina 2023, 59, x FOR PEER REVIEW 9 of 15
Figure 6. Sforzesco brace.
A comprehensive summary of the key points of our overview is reported in Table 1.
Table 1. A summary of the indication of bracing.
Which age group wears the braces more? 10–16 years [76]
Which brace is worn widely? Boston brace [77]
What is the mean Cobb’s angle when a therapist suggests a
particular brace for an individual?
40–45° Milwaukee,
20–50° Boston,
25–45° Cheneau,
30–50° Lyon, Sforzesco
How many hours the braces were worn per day?
23 h Milwaukee,
18–23 h Boston,
20–23 h Cheneau,
18–22 h Lyon,
18–23 h Sforzesco
Total treatment duration of wearing the brace. 2–4 years [30]
Success rates after wearing the braces?
48% (mean) Milwaukee,
72% Boston,
79% (mean) Cheneau,
88% (mean) Lyon,
78% (mean) Sforzesco
4. Discussion and Conclusions
The aim of this review is to describe the braces provided by the Italian Health Na-
tional Service for scoliosis treatment. The role of braces in scoliosis treatment is multifac-
eted and has been a subject of extensive research and clinical practice. Bracing has been
found to be effective in preventing the progression of spinal curvature, particularly in ad-
olescent idiopathic scoliosis. It aims to prevent spinal curve deterioration beyond a certain
point, typically 45°, to avoid the need for surgery and preserve long-term quality of life.
Bracing has also been shown to be effective in halting the progression of at-risk curves
and, in some cases, even improving the Cobb angle. Furthermore, the use of braces can
reduce thoracic hyperkyphosis in adolescents with scoliosis, demonstrating its impact on
spinal alignment.
Despite a general consensus on the efficacy of rigid bracing treatment and its use in
AIS, an important heterogeneity about the treatment is present in the scientific literature,
demonstrating a high degree of variability [78,79].
The results of the studies included in this overview showed the superiority of the
Boston and Cheneau braces over the Milwaukee braces, with Boston, Cheneau, and Lyon
braces showing an overall high rate of success (range between 71% and >90%) in reducing
Figure 6. Sforzesco brace.
In a case/control and prospective cohort study conducted following both the SRS
and SOSORT criteria by Negrini et al. [
74
], the Sforzesco brace was shown to be more
effective than the Lyon brace and the Risser cast even when considered in association (Lyon
brace plus Risser cast) in treating curves over 45 degrees Cobb. Furthermore, no patients
showed a worsening beyond 45 Cobb degrees or underwent surgery, and an improvement
in aesthetics was also observed [74].
A comprehensive summary of the key points of our overview is reported in Table 1.
Medicina 2024,60, 3 9 of 14
Table 1. A summary of the indication of bracing.
Which age group wears the braces more? 10–16 years [76]
Which brace is worn widely? Boston brace [77]
What is the mean Cobb’s angle when a therapist suggests a particular brace for an individual?
40–45◦Milwaukee,
20–50◦Boston,
25–45◦Cheneau,
30–50◦Lyon, Sforzesco
How many hours the braces were worn per day?
23 h Milwaukee,
18–23 h Boston,
20–23 h Cheneau,
18–22 h Lyon,
18–23 h Sforzesco
Total treatment duration of wearing the brace. 2–4 years [30]
Success rates after wearing the braces?
48% (mean) Milwaukee,
72% Boston,
79% (mean) Cheneau,
88% (mean) Lyon,
78% (mean) Sforzesco
4. Discussion and Conclusions
The aim of this review is to describe the braces provided by the Italian Health National
Service for scoliosis treatment. The role of braces in scoliosis treatment is multifaceted and
has been a subject of extensive research and clinical practice. Bracing has been found to
be effective in preventing the progression of spinal curvature, particularly in adolescent
idiopathic scoliosis. It aims to prevent spinal curve deterioration beyond a certain point,
typically 45
◦
, to avoid the need for surgery and preserve long-term quality of life. Bracing
has also been shown to be effective in halting the progression of at-risk curves and, in some
cases, even improving the Cobb angle. Furthermore, the use of braces can reduce thoracic
hyperkyphosis in adolescents with scoliosis, demonstrating its impact on spinal alignment.
Despite a general consensus on the efficacy of rigid bracing treatment and its use in
AIS, an important heterogeneity about the treatment is present in the scientific literature,
demonstrating a high degree of variability [78,79].
The results of the studies included in this overview showed the superiority of the
Boston and Cheneau braces over the Milwaukee braces, with Boston, Cheneau, and Lyon
braces showing an overall high rate of success (range between 71% and >90%) in reducing
curves less than 50 Cobb degrees. The efficacy of bracing increases with more time spent in
the brace, so compliance is the key to treatment for both patients and parents [
13
,
80
,
81
]. It
is also suggested to combine the brace with specific physiotherapy exercises for scoliosis
(PSE) according to the SOSORT guidelines [
24
,
82
,
83
].The articles in the available scientific
literature about the number of hours/day of bracing showed that the more hours per day
the brace is worn, the better the result [
30
,
83
]. For this reason, braces are usually prescribed
for at least 18 h/day, and they are usually removed for showers, swimming, physical
education, and sports [
84
]. The patient should be stimulated to be active in sports and to
continue to wear the brace if possible [30]. A combined treatment of bracing and physical
activity was shown to be effective not only for correcting scoliotic curvature, but also to
improve the antero-posterior and mediolateral body balance and to reduce the plantar
load on the rearfoot region during gait, demonstrating effective mechanical action on the
spine [85].
Unfortunately, there is a high rate of failure reported in the RCTs, which may be due
to the difficulties found in performing RCTs in a field where parents reject randomization
of their children, and this could impact the quality of the evidence. Usually, a curve
evolution of six degrees or more during bracing treatment is considered a bad result,
while progression to the need for surgical stabilization is considered a failure of brace
Medicina 2024,60, 3 10 of 14
treatment [
30
]. As suggested by Negrini et al., the predefined criteria identified by SRS
and SOSORT could be used for the design of other studies, such as expertise-based trials
or prospective controlled cohort studies, focusing on patient outcomes, adverse effects,
the association between bracing treatment and PSSE, and patient compliance [
7
,
86
]. In the
last few years, several studies have focused on how to increase patient compliance with
bracing, and this step could be achieved using specific sensor monitoring [87].
In fact, while the effectiveness of bracing in the treatment of scoliosis has been well
documented, challenges related to compliance and patient experience have also been
noted. Rigid braces, although effective, have been described as uncomfortable, bulky,
and aesthetically unappealing, leading to issues with compliance and psychological stress.
Future directions in the employment of braces for scoliosis treatment are poised to be influ-
enced by advancements in orthotic design, technology, and patient-centered approaches.
The development of CAD/CAM-based brace models has shown promise in providing
a classification-based approach to bracing scoliosis, offering superior in-brace correction
and compliance compared to standard brace applications [
88
]. Additionally, the integra-
tion of 3D printing technology in the workflow of scoliosis brace adjustment presents
significant potential for personalized and user-friendly brace design, enhancing the overall
effectiveness of bracing treatment [
89
]. Furthermore, the use of very high-rigidity and
high-precision CAD/CAM technologies has enabled the creation of corrective braces for
adult scoliosis, indicating a shift towards more precise and tailored orthotic solutions [
90
].
The future of scoliosis bracing is also expected to be influenced by the digital world of
artificial intelligence (AI), mathematical model calculations, and potentially 3D printing
technology, reflecting a trend towards more technologically advanced and innovative
approaches to brace therapy [
91
]. Moreover, the development of a novel robotic spinal
brace for scoliosis treatment has been proposed as a potential solution to address the
shortcomings of current braces, indicating a shift towards more advanced and sophisticated
orthotic devices [37].
In addition to technological advancements, the future of bracing for scoliosis treatment
is likely to be shaped by a focus on patient experience and quality of life. In fact, the success
of any therapeutic intervention is profoundly influenced by the patient’s engagement
and acceptance of the therapy. Active participation and a positive attitude towards the
treatment significantly enhance its effectiveness, fostering better outcomes [
92
]. In this
perspective, the experience of brace treatment in children/adolescents with scoliosis has
been a subject of study, contributing to a better understanding of significant issues related
to the experience of bracing therapy [
93
]. Particularly, stigmatization due to the orthopedic
brace, restrictions on mobility, discomfort associated with its use, and the lack of acceptance
among peers have been identified as significant problems affecting the effectiveness of
treatment [
94
]. Furthermore, the psychological impact of brace use on children has become a
major concern, highlighting the importance of considering the psychological and emotional
aspects of brace treatment in scoliosis [95].
The strength of this overview is that, given the sound scientific evidence about their
use, we can state that the spinal orthoses for AIS provided for free by the SSN (Milwaukee,
Boston, Cheneau, Lyon, and rigid braces) arrest the progression of the scoliotic curve in
the treatment of AIS. There is broad consensus on the approach to treatment and on the
indications for the prescription of these spinal orthoses, including through tables and
algorithms for assessing the risk of progression of the scoliotic curve.
The main limitation of this overview is that only braces provided for free by the
SSN were reported, so other kinds of braces (such as Providence or Charleston night-time
braces) were not included. The braces reported in the present overview and provided for
free by the SSN have solid scientific evidence to suggest their use. Further clinical trials
are needed to provide unambiguous indications regarding the times of use, the clinical
and radiological follow-up during treatment, the prevalent night or day use of the spinal
orthosis, the timing, and methods of weaning from the brace.
Medicina 2024,60, 3 11 of 14
Author Contributions:
Conceptualization: C.M.D.P., D.T., M.G.V., M.M., D.V., G.B., E.S., E.D.S.,
D.P., E.F.R., S.F. and R.P.; writing—original draft preparation: M.G.V., M.M., E.S., E.D.S. and D.P.
writing—review and editing: C.M.D.P., D.T., M.G.V., M.M., D.V., G.B., E.S., E.D.S., D.P., E.F.R., S.F.
and R.P. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments:
Direzione Tecnica di Produzione Ricerca & Sviluppo (ITOP) kindly helped the
authors with iconographic materials.
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
Anthony, A.; Zeller, R.; Evans, C.; Dermott, J.A. Adolescent idiopathic scoliosis detection and referral trends: Impact treatment
options. Spine Deform. 2021,9, 75–84. [CrossRef] [PubMed]
2.
Peng, Y.; Wang, S.R.; Qiu, G.X.; Zhang, J.G.; Zhuang, Q.Y.; Wang, N.N. Research progress on the etiology and pathogenesis of
adolescent idiopathic scoliosis. Chin. Med. J. 2020,133, 483–493. [CrossRef] [PubMed]
3.
Park, J.H.; Jeon, H.S.; Park, H.W. Effects of the Schroth exercise on idiopathic scoliosis: A meta-analysis. Eur. J. Phys. Rehabil. Med.
2018,54, 440–449. [CrossRef]
4.
Saggini, R.; Anastasi, G.P.; Battilomo, S.; Maietta Latessa, P.; Costanzo, G.; Di Carlo, F.; Festa, F.; Giardinelli, G.; Macrì, F.;
Mastropasqua, L.; et al. Consensus paper on postural dysfunction: Recommendations for prevention, diagnosis and therapy.
J. Biol. Regul. Homeost. Agents 2021,35, 441–456. [CrossRef] [PubMed]
5.
Konieczny, M.R.; Senyurt, H.; Krauspe, R. Epidemiology of adolescent idiopathic scoliosis. J. Child. Orthop.
2013
,7, 3–9. [CrossRef]
[PubMed]
6.
Thomas, J.J.; Stans, A.A.; Milbrandt, T.A.; Kremers, H.M.; Shaughnessy, W.J.; Larson, A.N. Trends in Incidence of Adolescent
Idiopathic Scoliosis: A Modern US Population-based Study. J. Pediatr. Orthop. 2021,41, 327–332. [CrossRef] [PubMed]
7.
Negrini, S.; Minozzi, S.; Bettany-Saltikov, J.; Zaina, F.; Chockalingam, N.; Grivas, T.B.; Kotwicki, T.; Maruyama, T.; Romano, M.;
Vasiliadis, E.S. Braces for idiopathic scoliosis in adolescents. Spine 2010,35, 1285–1293. [CrossRef]
8. Goldstein, L.A.; Waugh, T.R. Classification and terminology of scoliosis. Clin. Orthop. Relat. Res. 1973,93, 10–22. [CrossRef]
9.
Barassi, G.; Di Simone, E.; Supplizi, M.; Prosperi, L.; Marinucci, C.; Pellegrino, R.; Galasso, P.; Guerri, S.; Della Rovere, M.;
Younes, A.; et al.
Bio-Physico-Metric approach: Integrated postural assessment in musculoskeletal dysfunctions. J. Biol. Regul.
Homeost. Agents 2022,36, 129–135. [CrossRef]
10.
Karachalios, T.; Sofianos, J.; Roidis, N.; Sapkas, G.; Korres, D.; Nikolopoulos, K. Ten-year follow-up evaluation of a school
screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine
1999,24, 2318–2324. [CrossRef]
11.
Stokes, I.A.F.; Bigalow, L.C.; Moreland, M.S. Three-dimensional spinal curvature in idiopathic scoliosis. J. Orthop. Res.
1987
,5,
102–113. [CrossRef] [PubMed]
12. Weinstein, S.L. Natural history. Spine (Phila. Pa. 1976). 1999,24, 2592–2600. [CrossRef] [PubMed]
13.
Weinstein, S.L.; Dolan, L.A.; Wright, J.G.; Dobbs, M.B. Effects of Bracing in Adolescents with Idiopathic Scoliosis. N. Engl. J. Med.
2013,369, 1512. [CrossRef] [PubMed]
14.
Lonstein, J.E.; Carlson, J.M. The prediction of curve progression in untreated idiopathic scoliosis during growth. J. Bone Jt. Surg.
1984,66, 1061–1071. [CrossRef]
15.
Prestigiacomo, F.G.; Hulsbosch, M.H.H.M.; Bruls, V.E.J.; Nieuwenhuis, J.J. Intra- and inter-observer reliability of Cobb angle
measurements in patients with adolescent idiopathic scoliosis. Spine Deform. 2022,10, 79–86. [CrossRef] [PubMed]
16.
Babaee, T.; Moradi, V.; Hashemi, H.; Shariat, A.; Anastasio, A.T.; Khosravi, M.; Bagheripour, B. Does Bracing Control the
Progression of Adolescent Idiopathic Scoliosis in Curves Higher Than 40
◦
? A Systematic Review and Meta-analysis. Asian Spine J.
2023,17, 203–212. [CrossRef]
17.
Troy, M.J.; Miller, P.E.; Price, N.; Talwalkar, V.; Zaina, F.; Donzelli, S.; Negrini, S.; Hresko, M.T. The “Risser+” grade: A new
grading system to classify skeletal maturity in idiopathic scoliosis. Eur. Spine J. 2019,28, 559–566. [CrossRef]
18.
Xavier, V.B.; Avanzi, O.; de Carvalho, B.D.M.C.; Alves, V.L.d.S. Combined aerobic and resistance training improves respiratory
and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: A randomised trial. J. Physiother.
2020
,
66, 33–38. [CrossRef]
19.
Schreiber, S.; Parent, E.C.; Hill, D.L.; Hedden, D.M.; Moreau, M.J.; Southon, S.C. Patients with adolescent idiopathic scoliosis
perceive positive improvements regardless of change in the Cobb angle—Results from a randomized controlled trial comparing a
6-month Schroth intervention added to standard care and standard care alone. SOSORT 2018 Award winner. BMC Musculoskelet.
Disord. 2019,20, 319. [CrossRef]
Medicina 2024,60, 3 12 of 14
20.
Laita, L.C.; Cubillo, C.T.; Gómez, T.M.; Del Barrio, S.J. Effects of corrective, therapeutic exercise techniques on adolescent
idiopathic scoliosis. A systematic review. Arch. Argent. Pediatr. 2018,116, e582–e589. [CrossRef]
21.
Berdishevsky, H.; Lebel, V.A.; Bettany-Saltikov, J.; Rigo, M.; Lebel, A.; Hennes, A.; Romano, M.; Białek, M.; M’hango, A.;
Betts, T.; et al.
Physiotherapy scoliosis-specific exercises—A comprehensive review of seven major schools. Scoliosis Spinal Disord.
2016,11, 20. [CrossRef] [PubMed]
22.
Negrini, S.; Atanasio, S.; Zaina, F.; Romano, M. Rehabilitation of adolescent idiopathic scoliosis: Results of exercises and bracing
from a series of clinical studies. Europa Medicophysica-SIMFER 2007 Award Winner. Eur. J. Phys. Rehabil. Med.
2008
,44, 169–176.
[PubMed]
23.
Pellegrino, R.; Paolucci, T.; Brindisino, F.; Mondardini, P.; Di Iorio, A.; Moretti, A.; Iolascon, G. Effectiveness of High-Intensity
Laser Therapy Plus Ultrasound-Guided Peritendinous Hyaluronic Acid Compared to Therapeutic Exercise for Patients with
Lateral Elbow Tendinopathy. J. Clin. Med. 2022,11, 5492. [CrossRef] [PubMed]
24.
Negrini, S.; Donzelli, S.; Aulisa, A.G.; Czaprowski, D.; Schreiber, S.; de Mauroy, J.C.; Diers, H.; Grivas, T.B.; Knott, P.;
Kotwicki, T.; et al.
2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.
Scoliosis Spinal Disord. 2018,13, 3. [CrossRef] [PubMed]
25.
Marti, C.L.; Glassman, S.D.; Knott, P.T.; Carreon, L.Y.; Hresko, M.T. Scoliosis Research Society members attitudes towards physical
therapy and physiotherapeutic scoliosis specific exercises for adolescent idiopathic scoliosis. Scoliosis 2015,10, 16. [CrossRef]
26.
Halsey, M.; Dolan, L.A.; Hostin, R.A.; Adobor, R.D.; Dayer, R.; Dema, E.; Letaif, O.B. Scoliosis Research Society survey: Brace
management in adolescent idiopathic scoliosis. Spine Deform. 2021,9, 697–702. [CrossRef] [PubMed]
27. Castro, F.P. Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle. Spine J. 2003,3, 180–185. [CrossRef]
28.
Burwell, R.G.; Clark, E.M.; Dangerfield, P.H.; Moulton, A. Adolescent idiopathic scoliosis (AIS): A multifactorial cascade concept
for pathogenesis and embryonic origin. Scoliosis Spinal Disord. 2016,11, 8. [CrossRef]
29.
Zaina, F.; Cordani, C.; Donzelli, S.; Lazzarini, S.G.; Arienti, C.; Del Furia, M.J.; Negrini, S. Bracing Interventions Can Help
Adolescents with Idiopathic Scoliosis with Surgical Indication: A Systematic Review. Children 2022,9, 1672. [CrossRef]
30.
Kaelin, A.J. Adolescent idiopathic scoliosis: Indications for bracing and conservative treatments. Ann. Transl. Med.
2020
,8, 28.
[CrossRef]
31.
Maruyama, T. Bracing adolescent idiopathic scoliosis: A systematic review of the literature of effective conservative treatment
looking for end results 5 years after weaning. Disabil. Rehabil. 2008,30, 786–791. [CrossRef]
32.
Rabin, M.L.; Earnhardt, M.C.; Patel, A.; Ganihong, I.; Kurlan, R. Postural, Bone, and Joint Disorders in Parkinson’s Disease. Mov.
Disord. Clin. Pract. 2016,3, 538–547. [CrossRef]
33.
Wang, Y.; Wang, D.; Zhang, G.; Ma, B.; Ma, Y.; Yang, Y.; Xing, S.; Kang, X.; Gao, B. Effects of spinal deformities on lung
development in children: A review. J. Orthop. Surg. Res. 2023,18, 246. [CrossRef]
34.
Fan, Y.; Ren, Q.; To, M.K.T.; Cheung, J.P.Y. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis:
A systematic review. BMC Musculoskelet. Disord. 2020,21, 495. [CrossRef]
35.
Qiabi, M.; Chagnon, K.; Beaupré, A.; Hercun, J.; Rakovich, G. Scoliosis and bronchial obstruction. Can. Respir. J.
2015
,22, 206–208.
[CrossRef]
36.
Niu, X.; Yang, C.; Tian, B.; Li, X.; Zheng, S.; Cong, D.; Han, J.; Agrawal, S.K. Investigation of robotic braces of patients with
iodiopathic scoliosis (IS)—Review of the literature and description of a novel brace. J. Mech. Med. Biol.
2019
,18, 1840038.
[CrossRef]
37.
Niu, X.; Yang, C.; Han, J.; Agrawal, S.K. Concept design of a novel robotic spinal brace for the treatment of scoliosis. Proc. Inst.
Mech. Eng. Part H J. Eng. Med. 2018,232, 1230–1244. [CrossRef]
38.
Perpetuini, D.; Russo, E.F.; Cardone, D.; Palmieri, R.; Filippini, C.; Tritto, M.; Pellicano, F.; De Santis, G.P.; Calabrò, R.S.; Merla, A.;
et al. Identification of Functional Cortical Plasticity in Children with Cerebral Palsy Associated to Robotic-Assisted Gait Training:
An fNIRS Study. J. Clin. Med. 2022,11, 6790. [CrossRef]
39.
Perpetuini, D.; Russo, E.F.; Cardone, D.; Palmieri, R.; Filippini, C.; Tritto, M.; Pellicano, F.; De Santis, G.P.; Pellegrino, R.; Calabrò,
R.S.; et al. Psychophysiological Assessment of Children with Cerebral Palsy during Robotic-Assisted Gait Training through
Infrared Imaging. Int. J. Environ. Res. Public Health 2022,19, 15224. [CrossRef] [PubMed]
40.
Hammad, A.M.; Balsano, M.; Ahmad, A.A. Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic
scoliosis? Front. Pediatr. 2023,11, 1133049. [CrossRef] [PubMed]
41. Athawale, V.; Phansopkar, P.; Darda, P.; Chitale, N.; Chinewar, A. Impact of Physical Therapy on Pain and Function in a Patient
with Scoliosis. Cureus 2021,13, e15261. [CrossRef]
42.
Curtin, M.; Lowery, M.M. Musculoskeletal modelling of muscle activation and applied external forces for the correction of
scoliosis. J. Neuroeng. Rehabil. 2014,11, 52. [CrossRef]
43.
Rangwani, R.; Park, H. A new approach of inducing proprioceptive illusion by transcutaneous electrical stimulation. J. Neuroeng.
Rehabil. 2021,18, 73. [CrossRef]
44.
Nakagawa, K.; Fok, K.L.; Masani, K. Neuromuscular recruitment pattern in motor point stimulation. Artif. Organs
2023
,47,
537–546. [CrossRef]
45.
Ko, E.J.; Sung, I.Y.; Yun, G.J.; Kang, J.A.; Kim, J.Y.; Kim, G.E. Effects of lateral electrical surface stimulation on scoliosis in children
with severe cerebral palsy: A pilot study. Disabil. Rehabil. 2018,40, 192–198. [CrossRef]
Medicina 2024,60, 3 13 of 14
46.
Perpetuini, D.; Russo, E.F.; Cardone, D.; Palmieri, R.; De Giacomo, A.; Pellegrino, R.; Merla, A.; Calabrò, R.S.; Filoni, S. Use
and Effectiveness of Electrosuit in Neurological Disorders: A Systematic Review with Clinical Implications. Bioengineering
2023
,
10, 680. [CrossRef] [PubMed]
47.
Perpetuini, D.; Russo, E.F.; Cardone, D.; Palmieri, R.; De Giacomo, A.; Intiso, D.; Pellicano, F.; Pellegrino, R.; Merla, A.;
Calabrò, R.S.; et al.
Assessing the Impact of Electrosuit Therapy on Cerebral Palsy: A Study on the Users’ Satisfaction and
Potential Efficacy. Brain Sci. 2023,13, 1491. [CrossRef]
48.
LEA. Min Salute. Available online: https://www.salute.gov.it/portale/lea/dettaglioContenutiLea.jsp?lingua=italiano&id=4702
&area=Lea&menu=distrettuale (accessed on 29 November 2023).
49.
Maruyama, T.; Takesita, K.; Kitagawa, T.; Nakao, Y. Milwaukee brace. Physiother. Theory Pract.
2011
,27, 43–46. [CrossRef]
[PubMed]
50. Blount, W.P.; Schmidt, A.C.; Bidwell, R.G. Making the Milwaukee brace. J. Bone Jt. Surg. Am. 1958,40, 526–624. [CrossRef]
51.
Grivas, T.B.; Negrini, S.; Aubin, C.E.; Aulisa, A.G.; De Mauroy, J.C.; Donzelli, S.; Hresko, M.T.; Kotwicki, T.; Lou, E.;
Maruyama, T.; et al.
Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet. Orthot. Int.
2022
,46, 383–391. [CrossRef]
[PubMed]
52.
Lonstein, J.E.; Winter, R.B. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand
and twenty patients. J. Bone Jt. Surg. 1994,76, 1207–1221. [CrossRef] [PubMed]
53.
Misterska, E.; Głowacki, J.; Głowacki, M.; Okr˛et, A. Long-term effects of conservative treatment of Milwaukee brace on body
image and mental health of patients with idiopathic scoliosis. PLoS ONE 2018,13, e0193447. [CrossRef] [PubMed]
54.
Razeghinezhad, R.; Kamyab, M.; Babaee, T.; Ganjavian, M.S.; Bidari, S. The Effect of Brace Treatment on Large Curves of 40
◦
to
55
◦
in Adolescents with Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study. Neurospine
2021
,18,
437–444. [CrossRef]
55.
Climent, J.M.; Sánchez, J. Impact of the type of brace on the quality of life of Adolescents with Spine Deformities. Spine
1999
,24,
1903–1908. [CrossRef] [PubMed]
56.
Karavidas, N. Bracing In The Treatment Of Adolescent Idiopathic Scoliosis: Evidence To Date. Adolesc. Health Med. Ther.
2019
,10,
153–172. [CrossRef] [PubMed]
57.
Von Deimling, U.; Wagner, U.A.; Schmitt, O. Der langfristige Einfluß der Korsettbehandlung auf die spinale Dekompensation der
idiopathischen Skoliose. Z. Für Orthopädie 2008,133, 270–273. [CrossRef]
58.
Emans, J.B.; Kaelin, A.; Bancel, P.; Hall, J.E.; Miller, M.E. The Boston bracing system for idiopathic scoliosis. Follow-up results in
295 patients. Spine 1986,11, 792–801. [CrossRef]
59.
Watts, H.G.; Hall, J.E.; Stanish, W. The Boston brace system for the treatment of low thoracic and lumbar scoliosis by the use of a
girdle without superstructure. Clin. Orthop. Relat. Res. 1977,126, 87–92. [CrossRef]
60.
Karimi, M.T.; Rabczuk, T. Evaluation of the efficiency of Boston brace on scoliotic curve control: A review of literature. J. Spinal
Cord Med. 2020,43, 824–831. [CrossRef]
61.
Périé, D.; Aubin, C.-E.; Petit, Y.; Beauséjour, M.; Dansereau, J.; Labelle, H. Boston brace correction in idiopathic scoliosis:
A biomechanical study. Spine 2003,28, 1672–1677. [CrossRef]
62.
Kotwicki, T.; Cheneau, J. Biomechanical action of a corrective brace on thoracic idiopathic scoliosis: Cheneau 2000 orthosis.
Disabil. Rehabil. Assist. Technol. 2008,3, 146–153. [CrossRef] [PubMed]
63.
van den Bogaart, M.; van Royen, B.J.; Haanstra, T.M.; de Kleuver, M.; Faraj, S.S.A. Predictive factors for brace treatment outcome
in adolescent idiopathic scoliosis: A best-evidence synthesis. Eur. Spine J. 2019,28, 511–525. [CrossRef] [PubMed]
64. Weiss, H.R.; Werkmann, M. “Brace Technology” Thematic Series—The ScoliOlogiC®Chêneau lightTM brace in the treatment of
scoliosis. Scoliosis 2010,5, 19. [CrossRef] [PubMed]
65.
Maruyama, T.; Kobayashi, Y.; Miura, M.; Nakao, Y. Effectiveness of brace treatment for adolescent idiopathic scoliosis. Scoliosis
2015,10, S12. [CrossRef] [PubMed]
66.
Pasquini, G.; Cecchi, F.; Bini, C.; Molino-Lova, R.; Vannetti, F.; Castagnoli, C.; Paperini, A.; Boni, R.; Macchi, C.; Crusco, B.; et al.
The outcome of a modified version of the Cheneau brace in adolescent idiopathic scoliosis (AIS) based on SRSand SOSORTcriteria:
A retrospective study. Proc. Eur. J. Phys. Rehabil. Med. 2016,52, 618–629.
67.
Fang, M.Q.; Wang, C.; Xiang, G.H.; Lou, C.; Tian, N.F.; Xu, H.Z. Long-term effects of the Chêneau brace on coronal and sagittal
alignment in adolescent idiopathic scoliosis. J. Neurosurg. Spine 2015,23, 505–509. [CrossRef] [PubMed]
68.
Karimi, M.; Rabczuk, T. Scoliosis conservative treatment: A review of literature. J. Craniovertebral Junction Spine
2018
,9, 3–8.
[CrossRef]
69.
De Giorgi, S.; Piazzolla, A.; Tafuri, S.; Borracci, C.; Martucci, A.; De Giorgi, G. Chêneau brace for adolescent idiopathic scoliosis:
Long-term results. Can it prevent surgery? Eur. Spine J. 2013,22 (Suppl. S6), 815–822. [CrossRef]
70.
Paolucci, T.; Morone, G.; Di Cesare, A.; Grasso, M.R.; Fusco, A.; Paolucci, S.; Saraceni, V.M.; Iosa, M. Effect of Chêneau brace on
postural balance in adolescent idiopathic scoliosis: A pilot study. Eur. J. Phys. Rehabil. Med. 2013,49, 649–657.
71.
Minsk, M.K.; Venuti, K.D.; Daumit, G.L.; Sponseller, P.D. Effectiveness of the Rigo Chêneau versus Boston-style orthoses for
adolescent idiopathic scoliosis: A retrospective study. Scoliosis Spinal Disord. 2017,12, 7. [CrossRef]
72.
Korovessis, P.; Syrimpeis, V.; Tsekouras, V.; Vardakastanis, K.; Fennema, P. Effect of the Chêneau Brace in the Natural History of
Moderate Adolescent Idiopathic Scoliosis in Girls: Cohort Analysis of a Selected Homogenous Population of 100 Consecutive
Skeletally Immature Patients. Spine Deform. 2018,6, 514–522. [CrossRef] [PubMed]
Medicina 2024,60, 3 14 of 14
73.
de Mauroy, J.C.; Lecante, C.; Barral, F. “Brace Technology” Thematic Series—The Lyon approach to the conservative treatment of
scoliosis. Scoliosis 2011,6, 4. [CrossRef] [PubMed]
74.
Negrini, S.; Marchini, G.; Tessadri, F. Brace technology thematic series—The Sforzesco and Sibilla braces, and the SPoRT
(Symmetric, Patient oriented, Rigid, Three-dimensional, active) concept. Scoliosis 2011,6, 8. [CrossRef]
75.
Zaina, F.; Fusco, C.; Atanasio, S.; Negrini, S. The SPoRT concept of bracing for idiopathic scoliosis. Physiother. Theory Pract.
2011
,
27, 54–60. [CrossRef]
76.
Canavese, F.; Kaelin, A. Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment. Indian J. Orthop.
2011
,
45, 7–14. [CrossRef] [PubMed]
77.
Lee, Y.J.; Wang, W.J.; Mohamad, S.M.; Chandren, J.R.; Gani, S.M.A.; Chung, W.H.; Chiu, C.K.; Chan, C.Y.W. A comparison
between Boston brace and European braces in the treatment of adolescent idiopathic scoliosis (AIS) patients: A systematic review
based on the standardised Scoliosis Research Society (SRS) inclusion criteria for brace treatment. Eur. Spine J. 2023. [CrossRef]
78.
Costa, L.; Schlosser, T.P.C.; Jimale, H.; Homans, J.F.; Kruyt, M.C.; Castelein, R.M. The Effectiveness of Different Concepts of
Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis. J. Clin. Med.
2021
,10, 2145. [CrossRef]
79.
Negrini, S.; Minozzi, S.; Bettany-Saltikov, J.; Zaina, F.; Chockalingam, N.; Grivas, T.B.; Kotwicki, T.; Maruyama, T.; Romano, M.;
Vasiliadis, E.S. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst. Rev. 2010, CD006850. [CrossRef]
80.
Karimi, M.T.; Rabczuk, T.; Kavyani, M.; Macgarry, A. Evaluation of the efficacy of part-time versus full-time brace wear in subjects
with adolescent idiopathic scoliosis (AIS): A review of literature. Curr. Orthop. Pract. 2019,30, 61–68. [CrossRef]
81.
Cordani, C.; Malisano, L.; Febbo, F.; Giranio, G.; Del Furia, M.J.; Donzelli, S.; Negrini, S. Influence of Specific Interventions on
Bracing Compliance in Adolescents with Idiopathic Scoliosis-A Systematic Review of Papers Including Sensors’ Monitoring.
Sensors 2023,23, 7660. [CrossRef] [PubMed]
82.
Ma, K.; Wang, C.; Huang, Y.; Wang, Y.; Li, D.; He, G. The effects of physiotherapeutic scoliosis-specific exercise on idiopathic
scoliosis in children and adolescents: A systematic review and meta-analysis. Physiotherapy
2023
,121, 46–57. [CrossRef] [PubMed]
83.
Fahim, T.; Virsanikar, S.; Mangharamani, D.; Khan, S.N.; Mhase, S.; Umate, L. Physiotherapy Interventions for Preventing Spinal
Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Review. Cureus 2022,14, e30314. [CrossRef] [PubMed]
84.
Konieczny, M.R.; Hieronymus, P.; Krauspe, R. Time in brace: Where are the limits and how can we improve compliance and
reduce negative psychosocial impact in patients with scoliosis? A retrospective analysis. Spine J.
2017
,17, 1658–1664. [CrossRef]
[PubMed]
85.
da Silveira, G.E.; Andrade, R.M.; Guilhermino, G.G.; Schmidt, A.V.; Neves, L.M.; Ribeiro, A.P. The Effects of Short- and Long-Term
Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis. Medicina
2022
,
58, 1024. [CrossRef]
86.
Negrini, S.; Aulisa, A.G.; Cerny, P.; de Mauroy, J.C.; McAviney, J.; Mills, A.; Donzelli, S.; Grivas, T.B.; Hresko, M.T.;
Kotwicki, T.; et al.
The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by
ESPRM. Eur. Spine J. 2022,31, 980–989. [CrossRef]
87.
Li, X.; Huo, Z.; Hu, Z.; Lam, T.P.; Cheng, J.C.Y.; Chung, V.C.H.; Yip, B.H.K. Which interventions may improve bracing compliance
in adolescent idiopathic scoliosis? A systematic review and meta-analysis. PLoS ONE 2022,17, e0271612. [CrossRef]
88.
Weiss, H.R.; Kleban, A. Development of CAD/CAM based brace models for the treatment of patients with scoliosis-classification
based approach versus finite element modelling. Asian Spine J. 2015,9, 661. [CrossRef]
89.
Weiss, H.R.; Tournavitis, N.; Nan, X.; Borysov, M.; Paul, L. Workflow of CAD/CAM scoliosis brace adjustment in preparation
using 3D printing. Open Med. Inform. J. 2017,11, 44. [CrossRef]
90.
de Mauroy, J.C.; Gagliano, F.; Gagliano, R.; Lusenti, P. Bracing Adult Scoliosis: From Immobilization to Correction of Adult
Scoliosis. In Spinal Deformities in Adolescents, Adults and Older Adults; IntechOpen: London, UK, 2019.
91. Landauer, F.; Trieb, K. Scoliosis: Brace treatment–from the past 50 years to the future. Medicine 2022,101, e30556. [CrossRef]
92.
Russo, S.; Lorusso, L.; D’Onofrio, G.; Ciccone, F.; Tritto, M.; Nocco, S.; Cardone, D.; Perpetuini, D.; Lombardo, M.;
Lombardo, D.; et al.
Assessing Feasibility of Cognitive Impairment Testing Using Social Robotic Technology Augmented with
Affective Computing and Emotional State Detection Systems. Biomimetics 2023,8, 475. [CrossRef]
93.
Sapountzi-Krepia, D.; Psychogiou, M.; Peterson, D.; Zafiri, V.; Iordanopoulou, E.; Michailidou, F.; Christodoulou, A. The
experience of brace treatment in children/adolescents with scoliosis. Scoliosis 2006,1, 8. [CrossRef] [PubMed]
94.
Kołban, M.; Szwed, A. Application of the SPineCOR dynamic corrective brace in treating idiopathic scoliosis. Chir. Narzadow
Ruchu Ortop. Pol. 2018,83, 1–4. [CrossRef]
95.
Ólafsson, Y.; Saraste, H.; Ahlgren, R.M. Does bracing affect self-image? A prospective study on 54 patients with adolescent
idiopathic scoliosis. Eur. Spine J. 1999,8, 402–405. [CrossRef]
Disclaimer/Publisher’s Note:
The statements, opinions and data contained in all publications are solely those of the individual
author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to
people or property resulting from any ideas, methods, instructions or products referred to in the content.
