O2081: Who Gets a Break? Predicting Brace Holiday Eligibility in Juvenile Idiopathic Scoliosis

Background: When a child with Juvenile idiopathic scoliosis (JIS) develops a curve that exceeds 20-25°, bracing is recommended to prevent progression and to delay or prevent the need for surgical treatment. Unfortunately for younger children with JIS, this may occur 10 or more years before skeletal maturity. Families often ask: “will s/he be in a brace for their entire childhood”? Fortunately, with modern brace technology, many JIS curves correct dramatically in brace, and at follow-up visits during bracing, the curve is well under 25° (out of brace). When a JIS child grows out of their brace (typically 2-3 years after initial prescription) and the curve is < 25°, the family is often offered a Brace Holiday for months or even years, as long as the curve stays < 25°. Despite this metric, rigorous clinical indications for taking a break from the brace have yet to be described, with many factors at play such as curve size, in-brace correction, skeletal maturity, brace compliance, and BMI, among others. Understanding who might qualify for a Brace Holiday would be valuable in our discussions with the family at the time of brace initiation for JIS.

Methods: A retrospective cohort study at a single institution was performed on patients with JIS aged 3-9 years old who were prescribed a first-time Boston Brace from 2016-2022. Objective brace compliance data was collected from all patients old using embedded temperature sensitive buttons. A Brace Holiday was defined as discontinuation of bracing before skeletal maturity due to improvement and stabilization of the primary curve to below bracing criteria. Patients with etiologies besides idiopathic scoliosis before the age of 10 were excluded. Binary logistic regression was performed to determine the effect of significant variables on the likelihood of brace holiday.

Results: 56 patients met inclusion criteria, of which 52 were female (93%). Of these, 20 were able to take a brace holiday (36%). The mean duration of the brace holiday was 11 months (ranging from 6 to 35 months). Patients with higher brace compliance and larger in-brace curve correction were more likely to get a brace holiday (p = 0.015, 0.004). Patients with higher BMIs and larger curves at initial presentation were less likely to get a brace holiday (p = 0.002, 0.014).

Conclusion: Compliant brace wearers with good in-brace curve correction are most likely to be eligible for a brace holiday. While some elements of treatment remain immutable, others are modifiable, such as bracing compliance. Understanding how outcomes differ between patients who do and do not take a brace holiday will be crucial to elucidating if the psychological benefit of taking a break from the brace can be justified.