Letter to “Early Night-Time Bracing for Mild Adolescent Idiopathic Scoliosis: A Retrospective Cohort Study”

To the Editor,

We read with great interest the recent article by Stefan Zwingenberger and colleagues evaluating the efficacy of early night-time bracing using the Dresdner Night-Time Brace (DNTB) for mild adolescent idiopathic scoliosis (AIS). ¹ The authors should be congratulated for addressing an important and relatively underexplored clinical question regarding the management of skeletally immature patients with Cobb angles between 15° and 25°. Their findings suggesting high compliance rates and favorable curve stabilization outcomes contribute valuable preliminary evidence supporting earlier conservative intervention in AIS.

Nevertheless, several issues merit further discussion. First, an additional area warranting further investigation is the impact of early night-time bracing on health-related quality of life and psychosocial well-being in patients with mild AIS. Compared with full-time bracing, night-time bracing may reduce social stigma, improve body image, and minimize interference with daily activities, thereby enhancing treatment acceptance and long-term compliance. Prospective studies incorporating validated patient-reported outcome measures, such as SRS-22 and quality-of-life assessments,^2,3 are needed to determine whether night-time bracing can achieve comparable radiographic outcomes while offering superior patient-centered benefits.

Second, although the present study demonstrated favorable radiographic outcomes until skeletal maturity, the long-term effects of early night-time bracing in patients with mild AIS remain unclear. Future studies with extended adult follow-up are needed to evaluate long-term curve stability, chronic back pain, spinal degeneration, functional outcomes, and the potential reduction in surgery rates during adulthood. Such investigations are essential to determine whether early intervention with night-time bracing can truly modify the natural history of AIS beyond adolescence.

Third, future studies should also evaluate the cost-effectiveness of early night-time bracing for mild AIS. Although earlier intervention may increase the number of patients requiring brace treatment, it could potentially reduce long-term healthcare costs by preventing curve progression and avoiding surgical intervention. Comprehensive analyses incorporating direct medical expenses, family burden, surgery avoidance rates, and quality-adjusted life years ⁴ are needed to better determine the economic value of early bracing strategies across different healthcare systems.

Despite these limitations, this study provides important preliminary evidence supporting the feasibility and potential effectiveness of early night-time bracing for mild AIS. The work by Zwingenberger et al. represents a meaningful contribution to the ongoing discussion regarding optimal timing and indications for conservative scoliosis treatment. Future prospective multicenter investigations incorporating objective compliance monitoring and standardized radiographic protocols will be essential to validate these promising findings.