A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis

Study Design: Observational Cohort study. Objectives: We aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. Methods: We reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi(2) were used for comparison. Results: 152 patients met inclusion criteria. 89 patients (age:12.1y.o.+/- 1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.+/- 1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26 degrees and finished with 27 degrees. The mean difference between measurements was +.65 degrees +/- 7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27 degrees and finished with 32 degrees, with a mean increase of +5 degrees +/- 8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery. Conclusion: The abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates.