{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:02:46Z","timestamp":1784872966540,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgery is typically recommended for patients with severe adolescent idiopathic scoliosis (AIS); however, some patients explicitly refuse due to concerns about surgical risks and other factors. Conventional wisdom suggests that bracing has limited effectiveness for severe cases, yet evidence for this specific population remains insufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included patients with severe AIS (Cobb angle &amp;gt;40\u00b0) who met surgical indications but refused surgery during the study period (January 2021 to April 2025). All patients received custom-fitted Ch\u00eaneau braces; a dual-verification compliance was monitored using a dual-verification approach (structured daily diaries cross-checked against physician-assessed skin indentation grading). Multivariate linear regression was used to analyze predictors of treatment outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 82 patients were enrolled, with a mean follow-up of 14.4\u2009\u00b1\u20092.1 months. The overall correction rate was 18.0%\u2009\u00b1\u200914.0%, with 56.1% of patients achieving a Cobb angle below 40\u00b0, and 39.0% showing improvement greater than 10\u00b0. Multivariate analysis revealed that daily brace-wearing time was an independent predictor of correction rate (each additional hour increased the correction rate by 1.88%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003). In the high-compliance group (&amp;gt;16\u2005h\/day), 71.7% of patients achieved a final Cobb angle below 40\u00b0. The four core domains of the SRS-22r quality-of-life questionnaire (function\/activity, pain, self-image, and mental health) demonstrated significant improvement, and treatment satisfaction was high at final follow-up. Patient motivation showed a strong positive correlation with wearing time (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.654). Complications were infrequent\n                      <jats:bold>.<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For patients with severe AIS who refused surgery, conservative bracing achieved satisfactory short-to-mid-term outcomes with a favorable safety profile within a shared decision-making framework. Actual daily wearing time demonstrated the strongest independent association with radiographic outcomes among measured variables, while patients' intrinsic motivation showed a strong correlation with compliance, suggesting a potential indirect pathway to improved outcomes. It should be emphasized that this study did not establish bracing as equivalent or superior to surgical correction in severe AIS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1851816","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:35:56Z","timestamp":1784871356000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of high-compliance bracing in patients with severe adolescent idiopathic scoliosis declining operative intervention"],"prefix":"10.3389","volume":"14","author":[{"given":"Dingqi","family":"You","sequence":"first","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Guo","sequence":"additional","affiliation":[{"name":"Henan Xinzhi Medical Technology Company Limited","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenxing","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianchao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weichao","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wensheng","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Spinal Cord Surgery, People\u2019s Hospital of Zhengzhou University, Henan Provincial People\u2019s Hospital","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1760636","DOI":"10.3389\/fcell.2026.1760636","article-title":"Current insights into circulating biomarkers and their potential for predicting adolescent idiopathic scoliosis progression","volume":"14","author":"Raimondi","year":"2026","journal-title":"Front Cell Dev Biol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1038\/s12276-026-01658-7","article-title":"The asymmetrical ROS-METTL3-ESR1 axis in paraspinal muscle progenitor cells determines the progression of adolescent idiopathic scoliosis","volume":"58","author":"Li","year":"2026","journal-title":"Exp Mol Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"5272","DOI":"10.3390\/jcm14155272","article-title":"Curve progression in adolescent idiopathic scoliosis with cobb angles between 40 and 50 degrees at the late stage of skeletal growth: a Minimum 5-year follow-up study","volume":"14","author":"Nam","year":"2025","journal-title":"J Clin Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"6707","DOI":"10.3390\/jcm14196707","article-title":"Anterior vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis of comparative outcomes","volume":"14","author":"Abdelaal","year":"2025","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/bpo.0000000000002213","article-title":"Disparities in pediatric scoliosis: the impact of race and insurance type on access to nonoperative treatment for adolescent idiopathic scoliosis","volume":"42","author":"Heffernan","year":"2022","journal-title":"J Pediatr Orthop"},{"key":"B6","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1302\/2633-1462.71.Bjo-2025-0218.R1","article-title":"Identification of important outcomes for surgical and brace treatment of adolescent idiopathic scoliosis: qualitative analysis of the perspectives of young people, parents, and healthcare professionals","volume":"7","author":"Graham-Wisener","year":"2026","journal-title":"Bone Jt Open"},{"key":"B7","doi-asserted-by":"publisher","first-page":"203","DOI":"10.31616\/asj.2022.0162","article-title":"Does bracing control the progression of adolescent idiopathic scoliosis in curves higher than 40\u00b0? A systematic review and meta-analysis","volume":"17","author":"Babaee","year":"2023","journal-title":"Asian Spine J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1055\/s-0043-1771267","article-title":"Efficacy and advantages of spinal anesthesia in lumbar disk surgery","volume":"85","author":"Akgun","year":"2024","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e345","DOI":"10.3346\/jkms.2020.35.e345","article-title":"Incidence and risk factors of gastrointestinal and hepatobiliary complications after spinal fusion surgery: a retrospective cohort study","volume":"35","author":"Bahk","year":"2020","journal-title":"J Korean Med Sci"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e1324","DOI":"10.1002\/jsp2.1324","article-title":"Range of international surgical strategies for adolescent idiopathic scoliosis: evaluation of a multi-center survey","volume":"7","author":"Wilke","year":"2024","journal-title":"JOR Spine"},{"key":"B11","doi-asserted-by":"publisher","first-page":"638","DOI":"10.31616\/asj.2024.0358","article-title":"Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis","volume":"19","author":"Hevia","year":"2025","journal-title":"Asian Spine J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"5232","DOI":"10.1007\/s00586-025-09124-0","article-title":"Wearing a brace for idiopathic scoliosis above 18\u2005h\/day shows a dose-response effect on the outcomes improvement and end-of-treatment cobb angle below 30 degrees","volume":"34","author":"Negrini","year":"2025","journal-title":"Eur Spine J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"8648","DOI":"10.3390\/jcm14248648","article-title":"Adherence and radiological outcomes in braced adolescents with idiopathic scoliosis: a real-world study using thermal sensors","volume":"14","author":"Pjani\u0107","year":"2025","journal-title":"J Clin Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000005652","article-title":"Defining age-stratified baseline norms for the scoliosis research society (SRS)-22r questionnaire in U.S adults","author":"de Oliveira","year":"2026","journal-title":"Spine"},{"key":"B15","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1302\/2633-1462.32.Bjo-2021-0110.R1","article-title":"Population-based normative data for the scoliosis research society 22r, EQ-5D, and VAS questionnaires among individuals aged 20 to 69 years","volume":"3","author":"Tsirikos","year":"2022","journal-title":"Bone Jt Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3000","DOI":"10.1007\/s00586-022-07360-2","article-title":"Scoliosis research society-22r score is affected by standing whole body sagittal alignment, age, and sex, but not by standing balance or skeletal muscle mass in healthy volunteers","volume":"31","author":"Hasegawa","year":"2022","journal-title":"Eur Spine J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e505","DOI":"10.1097\/bpo.0000000000003182","article-title":"A comparative analysis of patients with adolescent idiopathic scoliosis treated with rigo cheneau, Boston-style, and Providence braces: a preliminary report","volume":"46","author":"Davis","year":"2026","journal-title":"J Pediatr Orthop"},{"key":"B18","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00586-018-05870-6","article-title":"Predictive factors for brace treatment outcome in adolescent idiopathic scoliosis: a best-evidence synthesis","volume":"28","author":"Van Den Bogaart","year":"2019","journal-title":"Eur Spine J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth","volume":"13","author":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1097\/brs.0000000000005501","article-title":"Improving the effectiveness of adolescent idiopathic scoliosis (AIS) screening: a prospective study","volume":"51","author":"Huang","year":"2026","journal-title":"Spine"},{"key":"B21","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s43390-024-00984-y","article-title":"Investigating the long-term outcomes and efficacy of surgical intervention in patients with adolescent idiopathic scoliosis and cobb angles ranging between 40 and 50 degrees","volume":"13","author":"Friedman","year":"2025","journal-title":"Spine Deform"},{"key":"B22","first-page":"19","article-title":"Adolescent idiopathic scoliosis: common questions and answers","volume":"101","author":"Kuznia","year":"2020","journal-title":"Am Fam Physician"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1016\/j.spinee.2019.07.008","article-title":"Brace treatment in adolescent idiopathic scoliosis: risk factors for failure-a literature review","volume":"19","author":"Hawary","year":"2019","journal-title":"Spine J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"440","DOI":"10.23736\/s1973-9087.17.04461-6","article-title":"Effects of the schroth exercise on idiopathic scoliosis: a meta-analysis","volume":"54","author":"Park","year":"2018","journal-title":"Eur J Phys Rehabil Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1186\/s12891-020-03517-6","article-title":"Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review","volume":"21","author":"Fan","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"B26","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1097\/01.bpo.0000161097.61586.bb","article-title":"The association between brace compliance and outcome for patients with idiopathic scoliosis","volume":"25","author":"Rahman","year":"2005","journal-title":"J Pediatr Orthop"},{"key":"B27","doi-asserted-by":"publisher","first-page":"437","DOI":"10.14245\/ns.2040654.327","article-title":"The effect of brace treatment on large curves of 40\u00b0 to 55\u00b0 in adolescents with idiopathic scoliosis who have avoided surgery: a retrospective cohort study","volume":"18","author":"Razeghinezhad","year":"2021","journal-title":"Neurospine"},{"key":"B28","doi-asserted-by":"publisher","first-page":"212","DOI":"10.23736\/s1973-9087.23.07605-0","article-title":"Intensive bracing management combined with physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis patients with a major curve ranging from 40 to 60\u00b0 who refused surgery: a prospective cohort study","volume":"59","author":"Zhang","year":"2023","journal-title":"Eur J Phys Rehabil Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"A16","DOI":"10.1227\/01.Neu.0000320447.61835.Ea","article-title":"Classification systems for adolescent and adult scoliosis","volume":"63","author":"Smith","year":"2008","journal-title":"Neurosurgery"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1097\/brs.0000000000004760","article-title":"Association between lenke classification, the extent of lumbar spinal fusion, and health-related quality of life after instrumented spinal fusion for adolescent idiopathic scoliosis","volume":"48","author":"Frantz\u00e9n","year":"2023","journal-title":"Spine"},{"key":"B31","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12893-025-03481-9","article-title":"Advances in fusion level selection and surgical approaches for adolescent idiopathic scoliosis based on the lenke classification system: a narrative review","volume":"26","author":"Chen","year":"2026","journal-title":"BMC Surg"},{"key":"B32","first-page":"1141","article-title":"Pour une th\u00e9orie unique de l'\u00e9volution des scolioses [A unique theory on the course of scoliosis]","volume":"78","author":"Duval-Beaup\u00e8re","year":"1970","journal-title":"Presse Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1851816\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:35:57Z","timestamp":1784871357000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1851816\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":32,"alternative-id":["10.3389\/fped.2026.1851816"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1851816","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"1851816"}}