The main objective of the present study was determine the effects of conservative treatment in JIS through a prospective approach. The study was conducted according to the SRS Committee criteria and the guidelines on standard of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research proposed by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)
[24, 34]. Analyses of our case series revealed that the large majority of patients with a definite outcome (82.5%) obtained a curve correction after brace treatment, whereas a curve stabilization was accomplished in 15.9% of cases. Only 4 patients (3.5%) were subsequently recommended for surgery during the follow-up. Taken as a whole, the current findings together with our previous observations suggest that the brace treatment is an effective option in JIS.
In the literature there are very few publications that have evaluated the effects of conservative treatment in JIS patients taking the outcome into account. The success rate of orthotic programs in the management of JIS is variable among the different authors, with conservative treatment mainly centered at slowing/stopping the progression of the curve and avoiding or delaying spine fusion. Kahanovitz
 reported an excellent prognosis with part-time bracing for smaller curves and a poor prognosis in patients with greater Cobb angles, all of whom eventually needed surgery. Tolo and Gillespie
 found that only 27.2% (16/59) of their patients treated with the Milwaukee brace needed surgery. Similar results were reported by Dabney and Browen
, with 33% of surgery recommendations. Other authors have reported much higher percentages of patients who needed surgery despite bracing. For instance, Figueiredo and James
 reported a 62% incidence of surgery in patients treated with a modified Milwaukee brace, Mannherz
 reported 80%, and McMaster 87%
. In a recent paper, Jarvis
 highlighted the difficult in comparing the results of the various studies because they involve patients with different characteristics, non standard indications for surgery, which varies from 19% to 87%, and outcome analysis. Moreover, he showed that patients treated with part-time Charleston bracing obtained correction in 52% of cases and underwent surgery in 30%.
To date, the only prospective study adopting the SRS criteria for outcome evaluation in juvenile scoliosis has been performed in patients treated with Dynamic SpineCor bracing
. Fifty-seven% of cases reached a curve correction or stabilization. However, 37% of patients needed surgical fusion while receiving treatment (26.3% with curves < 25° and 51.8% with curves > 25°).
Comparing our series to the findings reported above, we showed 75% of correction and only 5% of surgery in a larger sample of patients and with different braces. Furthermore, significant correction was detected both for CM and TA, demonstrating the efficacy of treatment on both parameters.
The greatest correction was observed in cases treated with PASB (lumbar and thoraco-lumbar curves), with none of the patients showing curve progression (>5°) at follow-up. In addition, correction was achieved early during treatment. This might have occurred because in the initial phase bracing acts mostly on the elastic component of the curve, leading to an early, substantial correction. However, derotation and vertebral remodeling proceed during the entire course of treatment, ensuring further curve correction and its maintenance over time.
With regard to curve severity, it is worth noting that patients with curves under 30° obtained a correction in 83% of cases (incidence of surgery: 1.6%), while curves over 30° reached a correction in 72.2% of cases, with surgery recommended in 5.5% of patients. These results cannot be explained only by mechanical aspects. Indeed, the response of the scoliotic spine to the actions exerted by the orthosis is determined by two factors: the ability to remodel the vertebrae (in accordance with the law of Hueter-Volkman) and the suitability of visco-elastic structures to respond adequately to the action of bracing. Any mechanical strain appears inadequate to promote the remodeling process without an adequate visco-elastic response of the structures involved. Therefore, the discs included in the scoliotic curve must be able to work in the field of linear elasticity. The state of disc’s hysteresis, in fact, would make it unable to transmit effective actions for recovery of the deformity
[40, 41]. Hence, the greater the rotation of the curve, the less the capacity of its correction. Therefore the early diagnosis of scoliosis is very important and to facilitate early administration of conservative treatments we can use school screening that is predictive and sensitive tool with a low referral rate
About the patients who abandoned the treatment the results showed a progression of curve, at the time of discontinuation, only in the 11% of cases. Therefore, were not the results to send away the patient but, probably, the trouble of a long term treatment. In particular the failure rate of treatment including the dropouts is 24% but the surgical rate is 12%.