Evidence-based conservative approach to idiopathic scoliosis during growth in everyday clinics

Conservative approach to idiopathic scoliosis is particularly challenging due to the not well-known natural history of the disease and the relative uncertainty on the efficacy of available treatments. Recently patients recruitment in a large Randomized Controlled Trial (RCT) on a high-risk population was stopped for ethical reasons due to the clear efficacy of bracing versus natural history, and this led to an increased worldwide attention toward conservative approach. Also, the current knowledge on natural history was challenged by this RCT, since it appeared worse than expected. In this thesis we discuss: the current knowledge of the natural history, and provide a model of the natural history of idiopathic scoliosis during growth to be applied in everyday clinics and that can also serve as a benchmark for future studies (Part I: the problem); the current evidence on conservative treatment of idiopathic scoliosis (Part II: the evidence); the efficacy of a complete personalized rehabilitation approach (Part III: the clinical approach).