Sensory feeding problems, pica-related behaviors, and sleep habits among children with autism spectrum disorder in palestine: a parent-reported cross-sectional study.

Adolescent Idiopathic Scoliosis (AIS) is the most common three-dimensional spinal deformity, with a global incidence of approximately 0.5%–5.2% (, ). When the major curve Cobb angle progresses beyond 40°, surgical intervention is typically indicated to prevent further deformity deterioration (–). However, clinicians frequently encounter patients or their guardians who explicitly refuse surgery and strongly prefer conservative treatment due to concerns regarding surgical risks, anesthesia-related complications, postoperative rehabilitation duration, or financial burden (–). For this specific population of patients with severe AIS who meet surgical indications yet explicitly refuse operative intervention, the clinical benefit of bracing treatment remains uncertain and warrants rigorous evaluation. Conventional clinical wisdom holds that once scoliosis progresses to the severe stage (Cobb angle >40°), brace treatment is of limited effectiveness and may delay the optimal timing for surgery (, ). Nevertheless, recent studies have suggested a significant “dose-response” relationship between brace efficacy and daily wearing time (, ). For this specific subgroup, the effectiveness, safety, and key influencing factors of bracing therapy have not been fully characterized. Therefore, this study aimed to evaluate the radiographic outcomes and associated factors of conservative bracing within a shared decision-making framework for patients with severe AIS who meet surgical indications yet explicitly refuse operative intervention. Additionally, we explored the relationship between daily wearing time, patient motivation, and radiographic improvement. A schematic overview of the study design is shown in . Schematic of the chêneau bracing protocol and follow-up for patients with severe AIS declining surgery.