PURPOSE:Rigo Chêneau-style orthoses (RCSOs) have gained popularity for treating adolescent idiopathic scoliosis (AIS) due to their emphasis on 3-dimensional correction. However, previous studies lack objective measures of brace wear compliance and have not described in-brace correction (IBC) thresholds associated with treatment success. This study evaluated the relationship between IBC, brace wear, and treatment outcomes in AIS patients treated with RCSOs. METHODS:A retrospective review at a single academic institution included skeletally immature patients aged 10 to 18 years with AIS and a major curve of 20 to 40 degrees, who underwent full-time RCSO treatment with thermal wear-time sensors. Patients were followed until skeletal maturity or progression to surgery. Treatment success was defined as a change of ≤5 degrees in the major curve at the latest follow-up. Multivariable logistic regression identified predictors of treatment success. RESULTS:Fifty patients (45 females, 90%) were included, with 36 (72%) classified as Sanders stage 3 and a mean age at brace initiation of 12.4±1.2 years (range: 10.1 to 15.5). The mean baseline major curve was 31±5 degrees with an IBC of 55±20%. The mean brace wear was 11.7±3.6 hours per day. At a mean follow-up of 3.0±0.9 years (range: 1.1 to 5.3), 43 patients (86%) avoided surgery and 36 (72%) met criteria for treatment success, with a mean major curve of 32±12 degrees. Greater IBC (60% vs. 40%, P<0.001) and brace wear (12.4 vs. 10.0 h, P=0.034) were associated with treatment success in univariate analysis, with IBC remaining an independent predictor in multivariable analysis (P=0.013). An IBC ≥45% was associated with treatment success (AUC=0.79). Patients achieving ≥45% IBC (n=33) demonstrated significantly higher success rates (88% vs. 41%, P<0.001) and lower rates of progression to surgery (6% vs. 29%, P=0.037). CONCLUSIONS:In this study, which included objective compliance data, 3-dimensional RCSO bracing in AIS was associated with high rates of treatment success. Greater IBC and brace wear were associated with improved outcomes, with IBC emerging as the primary independent predictor of success. An IBC of 45% was associated with improved outcomes and may represent a clinically meaningful target in modern 3-dimensional bracing. LEVEL OF EVIDENCE:Level IV.

BACKGROUND:Orthopaedic management of spinal deformity in patients with early onset scoliosis (EOS) often prioritizes objective radiographic correction; radiographic improvement alone does not fully capture the treatment's meaningful benefits from the patient's perspective. The Early Onset Scoliosis Questionnaire (EOSQ-24) has been previously developed and validated to measure health-related quality of life (HRQoL) in patients with EOS. To date, the traditionally accepted assumption has been that a 10% difference in scores is clinically different. However, an evidence-based estimate for the minimal clinically important difference (MCID) in EOSQ-24 scores is needed. OBJECTIVES:To determine the MCID for the EOSQ-24 questionnaire and establish a clinically relevant threshold to assess changes in patient HRQoL. METHODS:This is a prospective, multicenter study of EOS patients. Eighty-five patients with EOS and/or their parents completed the EOSQ-24 before and after treatment, and the mean change in EOSQ-24 score was calculated. A global assessment survey using a Likert-based scale then evaluated if patients experienced a change (worsening or improvement) after the intervention, and if so, whether it was important to their HRQoL. An anchor-based MCID was determined using a receiver operating characteristic curve to find the threshold score change that optimally identified those with important change. A secondary, 1 standard error of measurement (1 SEM) distribution-based approach was then calculated using the standard deviation of pre-intervention EOSQ-24 scores and a reliability coefficient of 0.92, based on prior validation studies. These 2 methods were compared with determine the MCID. RESULTS:The mean change in EOSQ-24 score for all patients was 8.5 points (SD = 8.1). The anchor-based MCID was 5.2 with an area under the curve (AUC) of 0.600, indicating a limited discriminative ability of the EOSQ-24 score change. The data distribution-based MCID was 4.6, representing the minimum change to reflect a true difference beyond measurement error. CONCLUSIONS:The final MCID for EOSQ-24 scores in EOS patients is a 5-point change and was derived from 2 methods that were highly consistent, supporting the robustness of this threshold for meaningful change in EOSQ scores. Accurate clinician recognition of important HRQoL changes in this population is important to improve clinical care. LEVEL OF EVIDENCE:Level II.

The current classification of idiopathic scoliosis relies on chronological age cutoffs to differentiate juvenile (JIS) from adolescent (AIS) subtypes. However, age-based distinctions may not reliably reflect physiological maturity, a critical factor for predicting curve progression and guiding treatment. This study investigates skeletal maturity differences across the traditional JIS-AIS age threshold using the Sanders maturity scale (SMS). A retrospective review was conducted using a multicenter pediatric spine registry. Patients aged 7–13 years with idiopathic scoliosis and documented SMS scores were included. SMS distributions were analyzed across age bands surrounding the JIS-AIS cutoff (9–10 vs. 10–11 years). Demographic and anthropometric data evaluated factors associated with skeletal maturity variation. Among 637 patients (86

Curve flexibility plays an important role in the treatment of adolescent idiopathic scoliosis (AIS). This study aimed to describe the patterns and variability of curve flexibility in a large patient cohort. Five thousand two hundred sixty-seven surgical patients from an international AIS registry were analyzed. Curve flexibility was calculated as percent change from the major Cobb angle on bending radiographs. Associations between curve flexibility and demographic, clinical, and radiographic parameters were assessed using non-parametric tests and linear correlations. Thoracic curves were less flexible than lumbar curves (35.5

BACKGROUND:Hypotension is a critical, modifiable risk factor for neurological deficit in spine surgery. Patients with intraoperative neurophysiological monitoring (IONM) changes are particularly vulnerable, as their spinal cord has already demonstrated sensitivity to correction, and hypotension may exacerbate areas of inadequate perfusion. These patients are admitted postoperatively to the ICU for close neurological and hemodynamic monitoring. This study evaluated adherence to patient-specific mean arterial pressure (MAP) goals in the first 24 hours following IONM changes. METHODS:A retrospective review of patients undergoing spinal surgery with IONM changes between 2023 and 2025 at a single institution was conducted. Demographic and radiographic data were documented. Individual 24-hour postoperative "Target MAP" goals were established. Arterial line MAP values were collected. Hypotension was defined as MAP <5th percentile for age-based norms. RESULTS:Twenty-one patients [12 female, 9 male; mean age 14.3±2.6 y (range: 7.7 to 19.0)] with IONM changes during pediatric deformity surgery were included. Etiologies included 8 idiopathic, 6 neuromuscular, 5 congenital, and 2 syndromic patients. Of those with major coronal deformities (n=19), mean preoperative and postoperative major curves were 79±22 degrees (range: 40 to 120 degrees) and 38±16 degrees (range: 18 to 75 degrees), respectively, with an average correction of 56%±11% (range: 41% to 71%) in completed cases. Four surgeries were aborted. Six patients (29%) had persistent neurological deficits beyond the first postoperative day. The median MAP goal was >80 mm Hg (range: >60 to >100). Twenty patients (95%) did not continuously meet their MAP goal, defined as ≥1 instance of MAP beneath target. Seven patients' (33%) 24-hour average MAPs were below target. On average, patients spent 27% of the time (6.4 h) beneath their target MAP. Four patients (19%) had a documented period of hypotension. CONCLUSIONS:Despite ICU-level care and established MAP goals in critical patients with prior IONM loss or within warning criteria, postoperative blood pressure management often failed to meet MAP goals. This is the first study to highlight this crucial gap between management goals and postoperative hemodynamic adherence. LEVELS OF EVIDENCE:Level IV.

Selective thoracic fusion (STF) in adolescent idiopathic scoliosis (AIS) corrects the primary thoracic curve while achieving spontaneous lumbar curve correction (SLCC) and preserving flexibility. This study introduces a novel preoperative radiographic parameter defined as the ratio of the tilt of the upper and lower end vertebrae of the lumbar curve to the corresponding lumbar Cobb angle as a predictor of SLCC. A multicenter retrospective review identified Lenke 1–4 patients with lumbar modifiers B or C undergoing STF. Radiographic parameters through 2-year follow-up included lumbar Cobb angle, UEV/LEV tilt, lumbar flexibility, and apical translation. LEV:Cobb and UEV:Cobb ratios were calculated by dividing vertebral tilt by preoperative lumbar Cobb. Univariate and multivariate regression assessed predictors of SLCC. Subgroup analyses were performed by lumbar modifier and fusion level relative to the stable vertebra. 193 patients met inclusions criteria (mean age at time of surgery 15.0 ± 2.0 years, 86

BACKGROUND:Bracing is the primary non-operative treatment for adolescent idiopathic scoliosis (AIS), with in-brace correction (IBC) being a key predictor of long-term success. Although BMI has been linked to bracing outcomes, it fails to capture important aspects of body habitus, such as fat distribution and torso shape, that influence brace fit and force transmission. This study aims to evaluate a novel radiographic measure, the lateral waist-to-height (WH) ratio, as a more accurate predictor of IBC in AIS patients. METHODS:A retrospective review of AIS patients treated with Rigo-style braces between 2014 and 2024 at a single institution was conducted. Thoracolumbar (TL) height and waist width at the iliac crest were measured on AP and lateral radiographs to calculate WH ratios. Linear regression evaluated associations between IBC and BMI, WH ratios, and TL height change. Multivariate regression adjusted for major curve angle and curve apex. RESULTS:The study included 209 females (mean age 11.4±2.1 y, BMI 17.7±2.8). Mean pre-brace major curve angle was 28.2±7.3 degrees, with average IBC of 64.8%±31.6%. Lateral WH ratio correlated positively with IBC ( R =0.21, P =0.014), representing a weak but statistically significant correlation. By contrast, BMI and AP ratio did not demonstrate significant associations with IBC. In multivariate analysis, both major curve angle ( P <0.001) and lateral WH ratio ( P =0.009) were independent predictors of IBC. CONCLUSIONS:Lateral WH ratio offers a more holistic representation of body habitus than BMI and is independently associated with in-brace correction. These findings suggest that the lateral WH ratio may provide additional insight into brace fit and initial correction, warranting further study to determine its potential role in predicting long-term bracing outcomes in AIS. LEVEL OF EVIDENCE:Level III.

Significant variability exists in the current literature of bracing research and outcome reporting, highlighting the need to standardize study design and reporting practices to ensure cross-study consistency and comparability. The purpose of this study is to develop updated consensus-based recommendations for designing, reporting, and publishing bracing research in pediatric patients with idiopathic scoliosis. An anonymous Delphi process and a final in-person meeting using the nominal group technique (NGT) established consensus-based guidelines among a multidisciplinary group of bracing experts. Three consecutive, anonymous Delphi rounds were administered to 30 multidisciplinary bracing experts invited to participate in this study. An 80

To quantify the risk of rod fracture after growth-friendly early-onset scoliosis (EOS) surgery, compare the risk of fracture between magnetically controlled growing rods (MCGR) and traditional growing rods (TGR), and compare the risk of fracture based on rod diameter. EOS patients undergoing TGR or MCGR instrumentation were identified from a large, multi-national registry (Pediatric Spine Study Group). Subgroup analyses (chi-squared and Mann–Whitney U tests) were performed between rods with diameters ≤ 5 mm and > 5 mm and between MCGR and TGR. To account for difference in follow-up, a log-rank survival analysis was performed between subgroups over a 5-year period. A total of 1588 patients, representing 3176 rods, met the inclusion criteria. There was no difference in pre-operative Cobb angle or maximum kyphosis between MCGR and TGR groups. At index surgery, MCGR patients were slightly older, taller, and heavier, although BMI was similar. The overall 2-year risk of rod fracture was 3.05

BACKGROUND:Muscle flap reconstruction immediately after pediatric spinal fusion surgeries has been associated with favorable post-operative outcomes. This study employed a database with large geographic coverage to further characterize indications for and outcomes of such reconstructions. METHODS:Overall, 32,466 posterior spinal fusion cases from 2016 to 2022 were identified within the ACS-NSQIP Pediatric (NSQIP-P) database. Multivariable logistic regression was used to identify variables independently associated with the outcomes of flap reconstruction. Efficacy of muscle flap reconstruction was assessed using a training set, validation set without flap reconstruction, and test set with flap reconstruction, followed by difference-in-differences analysis between the validation and test sets (p<0.05). RESULTS:Muscle flap reconstruction occurred in 3.0% of the cases with the rate increasing from 1.7% in 2016 to 4.4% in 2022. When compared to idiopathic spinal deformity, neuromuscular (OR: 1.56, 95% CI: 1.27-1.91) classification was associated with an increased likelihood of flap reconstruction. Moreover, 13+ instrumented levels (OR: 2.41, 95% CI: 1.84-3.14), prior spine surgery (OR: 2.48, 95% CI: 2.08-2.97), and American Society of Anesthesiologists class >2 (OR: 1.47, 95% CI: 1.24-1.75) also increased the likelihood of flap reconstruction. Flap reconstruction was associated with a lower rate of post-operative complications than the expected rate calculated in a cohort that did not use such reconstruction (p<0.001). CONCLUSION:Muscle flap reconstruction in pediatric spinal fusion cases has increased more than twofold in prevalence and occurs in cases with higher surgical complexity and risk. Flap reconstruction is independently associated with a lower rate of post-operative complications than expected.

The efficacy of bracing for juvenile idiopathic scoliosis (JIS) remains controversial. Although full-time bracing is standard for curves > 25°, part-time bracing for smaller curves (< 25°) may prevent progression. This study evaluates the effectiveness of part-time bracing compared to observation in JIS patients with 15–24° curves, hypothesizing that part-time bracing reduces curve progression and the need for full-time bracing. This retrospective cohort study reviewed skeletally immature JIS patients (4–10 years old) with 15–24° curves. Patients underwent either observation or part-time bracing (8–12 h/day). Minimum two-year outcomes included: (1) curve change (> 5°), (2) progression to > 25° requiring full-time bracing, and (3) prescription for full-time bracing. Eighty-three patients (59

BACKGROUND:The Shilla technique offers direct apical control and allows continuous cranial and caudal guided growth in early-onset scoliosis (EOS), eliminating the need for repeated surgeries. For cases where bipolar growth is not feasible, we developed a modified "unipolar" Shilla technique, allowing for asymmetric growth modulation with fusion at the opposite end. This study examines the feasibility and effectiveness of this approach in a complex EOS population. METHODS:We conducted a retrospective review of all Shilla cases performed by 3 surgeons over 11 years at a single institution. We identified patients treated with the unipolar Shilla technique and collected socio-clinical variables, radiographic parameters, and growth metrics. "Rod slide" was measured to determine intra-Shilla construct growth. RESULTS:Thirteen patients treated with unipolar Shilla were identified. The mean major coronal curve decreased from 69 degrees preoperatively to 19 degrees postoperatively. Thoracic height (T1 to T12) increased from 17.5 to 21.9 cm, and T1 to S1 height from 26.8 to 34.0 cm. Rod slide in those with complete follow-up averaged 9.6 mm, and all patients had more than 5 mm of Shilla growth. Overall, there was one unplanned return to OR due to discomfort from a prominent rod, which was trimmed. CONCLUSIONS:The unipolar Shilla technique provided excellent correction of severe spinal deformities with minimal complications. Although growth was modest in most cases, this technique is potentially beneficial for patients requiring definitive apical control with limited growth potential or those who may have difficulty with follow-up. LEVEL OF EVIDENCE:Level IV-retrospective case series.

For early onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK. The effect of revising proximal rib-based implants to rib vs spine-based implants on PJK has not yet been investigated. This study compares risk of PJK for patients converted from rib- to spine-based cranial anchors (RTS) to those revised to rib-based anchors (RTR) as well as the effect of revising the upper instrumented vertebra (UIV) to keeping the same level. In this retrospective cohort study of EOS patients with rib-based growing constructs undergoing revision surgery with a minimum two-year follow-up, we assessed pre-revision, post-revision, and two-year follow-up radiographs. We excluded patients lacking lateral X-rays and attachment data and conducted descriptive analyses. Included were 280 subjects (51% female) with an average age of 7.2 years at revision with RTS patients slightly older (8.6y vs 7.2y). At two years, 32% of all patients developed PJK. This risk was higher in RTS patients compared to RTR patients (42.8% vs 30.2%, p=0.09). RTS patients had a greater pre-revision total spine height (p=0.02), greater post-revision sagittal kyphosis (p=0.04), a more negative two-year sagittal balance (p=0.01) and trended to have more males (p=0.08) compared to RTR; all these factors were associated with a greater risk of PJK. There was no difference in risk at two years of developing PJK among patients revised to a higher level compared to those revised to same level (33.3% vs 30.9%, p=0.74). 32% of all subjects developed PJK at two-year follow-up. The risk of PJK in RTS patients was 40% higher than in RTR patients. While this did not reach statistical significance to the 0.05 level, due to the associations of risk established by literature and replicated in this study, we believe these results to be clinically significant. We intend to re-evaluate this population in the future as more data becomes available. With no demonstrated risk in revision levels, it is worth considering revising fewer levels to maintain flexibility in these growing rods.

INTRODUCTION:The Early Onset Scoliosis Questionnaire (EOSQ-24) is a proxy survey designed to evaluate the health-related quality of life (HRQoL) of patients with early-onset scoliosis (EOS). In recent years, a number of studies have shown that mental health among children and adolescents is worsening even in the absence of surgical interventions. Changes in HRQoL of adolescents with idiopathic scoliosis (SRS22) have been studied, but no studies exist analyzing EOS patients and their parents. We aimed to determine changes in the HRQoL of EOS patients and the burden on their parents based on the results of the EOSQ-24. METHODS:A retrospective query of a multicenter database identified 1787 patients with EOS who had not yet had any intervention (observation only), whose parents completed a total of 3986 EOSQ-24s from 2012 to 2024. Diagnoses included 791 (44.3%) congenital, 522 (29.2%) idiopathic, 274 (15.3%) neuromuscular, and 200 (11.2%) syndromic cases. A mean score from 1 to 5 was calculated for each EOSQ-24 domain (general health, pain and discomfort, pulmonary function, transfer, physical function, daily living, fatigue and energy level, emotion, parental impact, financial impact, and child satisfaction) at each year. Multiple linear regression was performed to reduce the effect of confounding variables. The mean score of each EOSQ-24 domain at each year was the dependent variable, and the independent variable was the years from 2012. Coefficients with P <0.05 were considered significant. RESULTS:In the overall cohort, multiple linear regression revealed a significant decrease in transfer, physical function, daily living, fatigue and energy level, emotion, parental impact, and child satisfaction. General health, pain and discomfort, pulmonary function, and financial impact demonstrated no significant change. Patients with congenital and idiopathic etiologies had significant decreases in most of the same domains as the overall cohort, while neuromuscular and syndromic patients demonstrated no significant decreases in any domain. CONCLUSIONS:Parents of patients with EOS report that their children's HRQoL has decreased significantly in more than half of the domains in the last 12 years, suggesting that the burden on these patients and their parents has worsened over time. There is a particularly disproportionate effect in patients with congenital and idiopathic etiologies. These results indicate a significant need for improved mental health support for both EOS patient and their caregivers.

In cases of complex pediatric spinal deformity, posterior spinal instrumentation crossing the cervicothoracic junction (CTJ) may be required. This is most frequently encountered for revision surgery to address proximal junctional kyphosis (PJK). In the cervical spine, lateral mass screws are most commonly used, although they may result in biomechanically weak proximal constructs and predispose to instrumentation failure. The use of supplemental anterior constructs has recently been reported with promising results, but this necessitates an additional surgical procedure. Subaxial cervical pedicle screws can provide good biomechanical fixation without the need for an anterior approach, but outcome data have been very limited. The purpose of this study was to assess radiographic and clinical outcomes at two years in pediatric patients who have undergone posterior spinal instrumentation and fusion (PSIF) crossing the CTJ using subaxial cervical spine pedicle screws. The Pediatric Spine Study Group (PSSG) registry was queried to identify patients ≤ 21 years old who underwent PSIF crossing the CTJ with two-year minimum clinical and radiographic follow-up. Patients were excluded if they had a history of anterior stabilization or if their fusion construct with subaxial pedicle screws started below C6. Clinical, surgical, and radiographic parameters were assessed, and measurements were compared statistically. Then, 8 patients (6 female and 2 male) met inclusion criteria, with a mean age at surgery of 11.2 ± 3.3 years. All patients underwent PSIF crossing the CTJ (mean levels fused 15.6 ± 6.6). The mean density of subaxial cervical pedicle screws was 61.9

BACKGROUND:CHARGE syndrome is a rare congenital disorder characterized by a spectrum of anomalies, including coloboma, heart defects, choanal atresia, and ear abnormalities. Spinal deformities, particularly scoliosis, are frequently observed and may significantly impair quality of life by limiting pulmonary function, reducing mobility, and increasing pain. This study provides the first comprehensive evaluation of scoliosis management and outcomes in CHARGE syndrome, assessing both surgical and nonsurgical approaches. METHODS:An international multicenter registry was queried to identify patients with a confirmed diagnosis of CHARGE syndrome and scoliosis. Demographic, clinical, and radiographic data were collected. Complications were categorized using the modified Clavien-Dindo-Sink system. Patient-reported outcomes were assessed using the EOSQ-24 and compared with a normative syndromic early-onset scoliosis cohort. RESULTS:Eleven patients were identified: 5 underwent growth-friendly surgery (2 TGR, 1 VEPTR, and 2 MCGR), of which 3 progressed to fusion; 3 had primary fusion; and 3 were braced. Growth-friendly surgery reduced the average major curve from 74 to 49 degrees postoperatively, but this correction regressed over time, with major curves averaging 58 degrees at 5 years. In contrast, fusion provided more stable outcomes, reducing major curve from 54 degrees pre-fusion to 36 degrees at 2 years postoperatively. Four complications were reported in 2 of 8 surgical patients, yielding an instrument-related complication rate of 25%. All complications occurred after growth-friendly procedures and included hardware dislodgement and rod fractures. EOSQ-24 scores were similar to other syndromic cohorts across most domains. CONCLUSION:Scoliosis in CHARGE syndrome is frequently severe and may require surgical intervention. While growth-friendly implants offer initial deformity correction, the benefit tends to diminish over time-potentially influenced by atypical growth patterns in CHARGE patients. Spinal fusion demonstrated greater long-term stability and a lower complication burden. The 25% complication rate observed in this cohort exceeds rates reported in other syndromic scoliosis populations, emphasizing the need for tailored perioperative planning for this population. Larger studies are needed to guide optimal treatment strategies in this complex patient population. LEVEL OF EVIDENCE:Level IV-retrospective case series.

For early-onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK compared to spine-based anchors. However, the effect of revising proximal rib-based implants to rib vs. spine-based implants on PJK has not yet been investigated. (1) Patients converted from rib-based to spine-based proximal anchors (RTS) have a higher risk of PJK two years post-revision compared to those revised to rib-based anchors (RTR). (2) Revising the upper instrumented vertebra (UIV) to a lower level increases the risk of PJK at two years post-revision compared to revising to a higher or same level. In this retrospective cohort study of EOS patients with rib-based growing constructs undergoing revision surgery with a minimum 2-year follow-up, we assessed pre-revision, post-revision, and 2-year follow-up radiographs. We excluded patients lacking lateral radiographs and attachment data and conducted descriptive analyses. 280 subjects were included, with an average age of 7.2 years at revision; RTS patients were slightly older (8.6y vs 7.2y), and 51

BACKGROUND:For patients with adolescent idiopathic scoliosis (AIS), full-time scoliosis braces are effective in preventing curve progression but are a source of stress for patients and families. Nighttime hypercorrective braces have minimal impact on daily life, but there is little evidence to guide prescription. It is not known how providers with expertise in scoliosis incorporate nighttime bracing into their routine clinical practice. The aim of this study is to assess provider perspectives and recommendations regarding the use of nighttime and full-time scoliosis bracing for patients with AIS. METHODS:Providers engaged in nonoperative scoliosis management were invited to complete an online survey that included 12 scoliosis case scenarios. For each case scenario, respondents were asked to indicate their bracing recommendation and their willingness to randomize each case into a hypothetical clinical trial. The survey also queried respondents' use of nighttime and full-time bracing in their practice. Descriptive statistics were used to summarize findings; a linear mixed effects model was used to determine patient characteristics related to bracing recommendations and willingness to randomize. RESULTS:A total of 214 respondents completed the survey; most had been in practice for >15 years (58%) and dedicate the majority of their practice to pediatric spine (57%). Just over half (54%) currently prescribe nighttime braces. Across case scenarios, most respondents recommended full-time bracing (70% to 92%); recommendations varied by curve type, curve magnitude, and skeletal maturity. For providers who use nighttime braces, the most important factors that led providers to prescribe nighttime over full-time braces were patient willingness to wear the brace (58%), skeletal maturity (57%), and curve type (56%). CONCLUSIONS:Most providers preferred to prescribe full-time over nighttime braces. Providers were more willing to recommend a nighttime brace for patients with lumbar/thoracolumbar curves and those who were at lower risk for curve progression (ie, more skeletally mature and smaller curve magnitudes). Ultimately, results provide insights into current practice and will inform eligibility criteria and feasibility for a future study comparing nighttime and full-time braces. LEVEL OF EVIDENCE:Expert opinion.