title: Outcomes of bracing in juvenile idiopathic scoliosis until skeletal maturity or surgery.
abstract: METHODS
  Retrospective comparative study.
  
  
  OBJECTIVE
  To evaluate the outcome of bracing in patients with juvenile idiopathic scoliosis (JIS) at either skeletal maturity or time of scoliosis surgery.
  
  
  BACKGROUND
  JIS is generally thought to have poor outcomes with high rates of surgical fusion.
  
  
  METHODS
  All patients with JIS between the ages of 4 and 10 years treated with a brace at the Hospital for Sick Children (SickKids) between 1989 and 2011 were eligible. Data were collected from patient health records until either 2 years after skeletal maturity or date of surgery.
  
  
  RESULTS
  The average age at diagnosis of 88 patients with JIS was 8.4 ± 1.4 years, with a female to male ratio of approximately 8:1. Pretreatment, Risser score was zero for 80 patients (91%); 72 (92%) of the females were premenarche; and primary Cobb angles ranged from 20° to 71°. Of the 88 patients, 60 (68%) had used a thoracolumbosacral orthosis exclusively; 28 (32%) patients used "other braces" (Milwaukee, Charleston, or a combination of braces), with an average treatment duration of 3.6 ± 1.9 years.As per Scoliosis Research Society definitions, a "non-curve-progression" (≤5° change) group consisted of 25 (28%) patients; and a "curve-progression" group consisted of 63 (72%) patients where the curve had progressed 6° or more.Of the 88 patients, 44 (50%) underwent surgery. The operative rate was higher for patients with curves 30° or more than those with curves 20° to 29° prior to brace treatment (37/58 [64%] vs. 7/30 [23%], respectively; P = 0.001); other braces compared with thoracolumbosacral orthosis (19/28 [68%] vs. 25/60 [42%], respectively; P = 0.02); Lenke I and III curves compared with Lenke VI curves (33/54 [61%] vs. 2/14 [14%], respectively; P = 0.007).
authors.affiliation: *Faculty of Orthopaedic Surgery, University of Toronto †Child Health Evaluative Sciences ‡Developmental and Stem Cell Biology Program §Centre for Orthotics and Medical Devices; ¶Department of Rehabilitation Services; and ∥Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Khoshbin
authors.forename: Liora
authors.initials: L
authors.lastname: Caspi
authors.forename: Peggy W
authors.initials: PW
authors.lastname: Law
authors.forename: Sandra
authors.initials: S
authors.lastname: Donaldson
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Trevor
authors.initials: T
authors.lastname: da Silva
authors.forename: Catharine S
authors.initials: CS
authors.lastname: Bradley
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D001846:Bone Development; D001915:Braces; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D013123:Spinal Fusion; D016896:Treatment Outcome