Radiographic and perceptual outcomes of shoulder imbalance in AIS: bracing alone versus bracing with Schroth methods

Abstract Purpose To evaluate the effectiveness of underarm bracing alone versus combined underarm bracing with Schroth methods for radiographic shoulder imbalance in adolescent idiopathic scoliosis (AIS) patients and whether radiographic changes translate into patient-perceived changes. Methods This retrospective study included moderate AIS patients with radiographic shoulder imbalance, categorized into brace-alone and combined (brace with Schroth methods) groups. Shoulder balance was assessed using standardized radiographs at baseline, first follow-up, and final follow-up. Primary outcomes were changes in T1 tilt (medial) and clavicle angle (lateral); secondary outcomes included additional radiographic measures. Associations between changes in primary radiographic parameters and patient-reported shoulder appearance were evaluated using the revised 22-item Scoliosis Research Society questionnaire appearance domain. Between-group differences were analyzed using analysis of covariance, with linear mixed-effects models for supplementary analyses; correlations were assessed using Pearson’s or Spearman’s coefficients. Results A total of 54 patients were included, with 25 in the combined group and 29 in the brace-alone group. The combined group showed greater improvement in lateral shoulder balance, with larger ΔCA from baseline to final follow-up (1.04°, p = 0.026) and a significant group × time interaction ( p = 0.041). Medial shoulder changes were comparable between groups. T1 tilt changes correlated with patient-reported appearance overall ( r = 0.698, p = 0.037) and in the combined group ( r = 0.917, p = 0.029), whereas clavicle angle changes did not. Conclusions Combined bracing with Schroth methods improves lateral but not medial shoulder imbalance. Medial shoulder changes, not lateral, relate to patient-perceived appearance, highlighting the multidimensional nature of shoulder imbalance.