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Adolescent idiopathic scoliosis can progress during growth, with larger curves creating a greater risk of surgery. The multicentre BRAIST trial compared bracing with observation in adolescents who met accepted criteria for a high risk of curve progression. The randomized component was stopped early because the efficacy signal favoured bracing. Across the combined randomized and preference cohorts, bracing substantially increased the probability of treatment success, defined as reaching skeletal maturity without progression to a curve magnitude associated with surgery. The benefit was related to the number of hours the brace was worn. For HCPs, the study established that bracing is an effective strategy for appropriately selected skeletally immature adolescents rather than a low-value holding measure. Adherence is central, and counselling should address comfort, body image, school activities and practical barriers. The trial also illustrates why early recognition matters: bracing is intended to prevent progression while substantial growth remains, not to reverse a mature deformity. Shared decision-making should integrate curve magnitude, skeletal maturity, expected progression risk and patient preferences.
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Adolescent idiopathic scoliosis can progress during growth, with larger curves creating a greater risk of surgery. The multicentre BRAIST trial compared bracing with observation in adolescents who met accepted criteria for a high risk of curve progression. The randomized component was stopped early because the efficacy signal favoured bracing. Across the combined randomized and preference cohorts, bracing substantially increased the probability of treatment success, defined as reaching skeletal maturity without progression to a curve magnitude associated with surgery. The benefit was related to the number of hours the brace was worn. For HCPs, the study established that bracing is an effective strategy for appropriately selected skeletally immature adolescents rather than a low-value holding measure. Adherence is central, and counselling should address comfort, body image, school activities and practical barriers. The trial also illustrates why early recognition matters: bracing is intended to prevent progression while substantial growth remains, not to reverse a mature deformity. Shared decision-making should integrate curve magnitude, skeletal maturity, expected progression risk and patient preferences.
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