Presented by Jonathan Fasciana with Lloyd A. Hey, MD MS — SOSORT 2026, Turin, Italy

Authors: Jonathan Fasciana¹, Peter Sells¹·², Nicholas Ratnesar¹, Lloyd Hey¹, Nathan Metcalf¹, Joseph Dalola³, KC Wheeler¹

¹ Hey Clinic for Scoliosis and Spine Care, Raleigh, NC
² Campbell University School of Osteopathic Medicine, Lillington, NC
³ UNC School of Medicine, Chapel Hill, NC

This research was conceived, analyzed, and presented by Jonathan Fasciana, a CareGuard apprentice at Hey Clinic during his gap year before medical school. Jonathan led a 14-year analysis comparing outcomes between two of the most widely used scoliosis braces — the traditional Boston brace, developed in the 1970s at Boston Children’s Hospital, and the Rigo-Chêneau brace, developed in the 1990s by Drs. Manuel Rigo and Jacques Chêneau as a more individualized brace with derotational forces designed to help patients grow into a corrected posture.

The findings were presented at SOSORT 2026 in Turin, Italy — the international scoliosis research community’s premier conference. Presenting original research at SOSORT as a pre-medical student is an extraordinary accomplishment.

Study Design

Data was drawn from Hey Clinic’s local EHR (Aqueduct), spanning patients from 2005 to 2024. Beginning with over 40,000 patients, the dataset was narrowed using SOSORT-aligned inclusion criteria:

• Diagnosis of adolescent idiopathic scoliosis (AIS) with scoliosis X-rays
• Documented orthotist appointment
• Age 10–15 at onset of bracing
• Starting Cobb angle between 20° and 45°
• Risser stage under 3 (skeletal immaturity)
• Braced for at least 6 months, to skeletal maturity, or to surgery

This yielded a final cohort of 135 patients: 28 in the Boston brace group and 107 in the Rigo-Chêneau group. The two groups were similar on most baseline characteristics, with two notable differences: Schroth PSSE participation was higher in the Rigo group, and there were small differences in BMI and starting age. These factors were controlled for in multivariate analysis.

Key Findings

Across every primary outcome measured, Rigo-Chêneau bracing significantly outperformed the traditional Boston brace.

• Surgical rate: 57% (Boston) vs. 30% (Rigo-Chêneau) — a 48% relative reduction. Number Needed to Treat = 4.
• Final Cobb angle under 30° (the “green zone”): 4% (Boston) vs. 42% (Rigo-Chêneau)
• Curve progression under 5° from baseline: 18% (Boston) vs. 70% (Rigo-Chêneau)
• Curve improvement (correction): 7% (Boston) vs. 39% (Rigo-Chêneau)
• Mean curve progression: 9.4° (Boston) vs. 1.1° (Rigo-Chêneau) — an 8.3° difference

Why the “Green Zone” Matters

Prior research from Weinstein and Hey Clinic’s own dataset has established that scoliosis curves finishing under 30° at skeletal maturity have less than a 5% chance of progressing in adulthood. We call this the “green zone.”

The green zone is the central goal of conservat