title: Low rate of surgery in juvenile idiopathic scoliosis treated with a complete and tailored conservative approach: end-growth results from a retrospective cohort.
abstract: BACKGROUND
  The main distinctive aspect of Juvenile Idiopathic Scoliosis (JIS) with respect to Adolescent Idiopathic Scoliosis (AIS) is the high risk of severe deformity and surgery. Approximately 70% of curves in patients with JIS progress and ultimately require surgery. There are presently very few studies with long-term follow-up of JIS and even fewer looking specifically at bracing Purpose To verify the effectiveness of a complete conservative treatment, including bracing and exercises, for JIS.
  
  
  METHODS
  Retrospective cohort observational study nested in a clinical prospective database of consecutive outpatients. Patient Sample Inclusion criteria: JIS, no previous treatment, all consecutive radiographies available from treatment start to end of growth (Risser sign 3). We found 30 patients, 27 females, 10 JIS type 1; mean age at first diagnosis was 7.8 +/-1.5 and mean treatment lasted 5.8 years. Cobb degrees 24.4+/-10 degrees, with 7 cases >30 degrees, and 2 > 45degrees. Outcome Measures Physiological measures. Radiographic and clinical data.
  
  
  METHODS
  Treatment (exercises alone, or elastic-rigid-highly rigid braces plus exercises) was tailored and continuously changed according to Cobb degrees, individual preferences, anthropometric characteristics, pubertal spurt, remaining growth, rotation, hump, lumbar curve take-off, and imbalance. The SOSORT Guidelines for patients' management have been followed. Funding and Conflict of Interest: no.
  
  
  RESULTS
  33.3% (95% Confidence Interval 16.4-50.2%) of patients worsened over the years. At the end of growth, 6.6% (0-15.5%) had surgical deformities (>45degrees). We observed a good correction in the first years of treatment until pubertal growth spurt, when progression was usually noted and treatment changed increasing corrective forces (hours or rigidity of bracing). 23 cases were followed up until they had two consecutive radiographies showing Risser sign 5 and showed stability.
  
  
  CONCLUSIONS
  Conservative treatment initiated already in childhood may favorably change the natural history of JIS with the aim of reaching a curve as far as possible from surgical thresholds. Observation, physical exercises, braces can be useful tools in the hand of physicians, but they must be carefully utilized by a deep knowledge of JIS.
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fusco
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Donzelli
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy.
authors.forename: Monia
authors.initials: M
authors.lastname: Lusini
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy.
authors.forename: Minnella
authors.initials: M
authors.lastname: Salvatore
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Zaina
authors.affiliation: Physical and Rehabilitation Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ; IRCCS Don Gnocchi Foundation, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini