The Role of Sagittal Alignment in the Efficacy of Brace Treatment in Adolescent Idiopathic Scoliosis: A Brief Systematic Review

ABSTRACT Introduction Recently, sagittal profile and spinopelvic parameters have been proposed as predictors of in-brace curve correction and the final outcome of brace treatment in adolescents with idiopathic scoliosis (AIS). A systematic understanding of how the prebrace and in-brace sagittal profile of AIS patients contributes to brace treatment outcomes is still lacking. Objective This paper reviews the evidence for determining the effects of initial sagittal spine, pelvic, and spinopelvic parameters on the effectiveness of brace treatment in AIS Study Design This is a systematic review. Methods This study utilized PubMed/MEDLINE (NLM), Scopus, Ovid, CINAHL, PEDro, Google Scholar, and Cochrane Library, accessed through computerized search. We included studies evaluating the effects of initial sagittal spine, pelvic, and spinopelvic parameters on bracing outcomes in AIS cases aged ≥10 years. Results Eight studies were selected, and 494 participants were assessed, among which six and two had high and moderate quality, respectively. The results of the studies were classified into prebrace and in-brace evaluations. Despite inconsistent results, findings showed that higher prebrace lumbar lordosis (LL) poorly predicted brace success, especially in hypokyphotic patients. Moreover, maintaining a normal sagittal vertical axis (SVA) or matched PI-LL in-brace indicated a protective effect against brace treatment failure. Higher in-brace LL was associated with increased brace success, while in-brace hypokyphosis posed a risk for curve progression. Conclusions The reliability of sagittal and pelvic parameters as predictors of brace success remains uncertain and debated. However, since some spine and spinopelvic parameters may have a role in brace success, assessing the prebrace sagittal profile and adjusting the in-brace sagittal alignment is exclusively important when fabricating braces. Clinical Relevance Statement The findings of this study should be considered during the clinical evaluation and brace prescription for scoliotic patients, as they may help predict treatment success and guide the design of braces for optimal alignment.