title: Juvenile idiopathic scoliosis: the effectiveness of part-time bracing.
abstract: METHODS
  A retrospective review of 34 patients with juvenile idiopathic scoliosis (JIS) treated with a nighttime bending brace.
  
  
  OBJECTIVE
  To determine the effectiveness of part-time bracing in JIS.
  
  
  BACKGROUND
  Although previous bracing studies have focused on adolescent idiopathic scoliosis, no authors have dealt specifically with part-time bracing for JIS.
  
  
  METHODS
  Twenty-three patients included in the study met the following criteria: curves greater than 20 degrees and Risser zero at initiation of bracing, brace wear more than 12 months, completion of the bracing program and Risser sign greater than or equal to 4 at final follow-up. Patients were analyzed according to 3 groups: (1) success (progression equal or less than 5 degrees), (2) progression more than 5 degrees (but not requiring surgery and achieving curve stabilization at skeletal maturity), and (3) surgery (curve progressing to greater than 45 degrees ) with failure of bracing treatment during skeletal immaturity.
  
  
  RESULTS
  Seven boys and 16 girls with a total of 37 curves were analyzed. The average age at referral and initiation of bracing was 8.3 and 10.3 years, respectively. Average curve magnitude at time of bracing was 30 degrees. Length of bracing averaged 3.7 years with follow-up after brace discontinuation of 2.5 years. Nine patients met the criteria for success, with 7 patients progressing and 7 patients eventually requiring spinal fusion. Of the 37 curves, 19 (51%) were successfully managed in the brace. The magnitude of curvature at initiation of bracing did not relate to a successful outcome, whereas success did correlate with higher radiographic in-brace correction. Given the longer course of treatment for JIS patients, part-time bracing offers potential psychosocial and compliance benefits.
  
  
  CONCLUSIONS
  Part-time bracing in JIS is successful and is better than the natural history.
authors.affiliation: Division of Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Ottawa, Canada. jarvis@cheo.on.ca
authors.forename: James
authors.initials: J
authors.lastname: Jarvis
authors.forename: Shawn
authors.initials: S
authors.lastname: Garbedian
authors.forename: Ganesh
authors.initials: G
authors.lastname: Swamy
mesh_terms: D001915:Braces; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D012600:Scoliosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013131:Spine / Q000254:growth & development / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome