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Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. eCollection 2018.

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.

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1Clinical and Experimental Sciences Department, University of Brescia Viale Europa 11, Brescia, Italy.
IRCCS Fondazione Don Gnocchi, Milan, Italy.
3ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, 20141 Milan, Italy.
U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, 00165 Rome, Italy.
Center of Body Posture, Olsztyn, Poland.
Department of Physiotherapy, Józef Rusiecki University College, Olsztyn, Poland.
7Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
8Alberta Health Services, Department of Surgery, Edmonton, Canada.
Orthopedic Medicine - Clinique du Parc, Lyon, France.
10Department of Orthopedics and Trauma Surgery, University Medical Center, Mainz, Germany.
11Department of Orthopaedics and Traumatology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece.
12Rosalind Franklin University of Medicine and Science, North Chicago, IL USA.
13Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland.
Scoliosis Physiotherapy & Posture Centre, 231 McLeod Street, Ottawa, Ontario K2P0Z8 Canada.
Schroth-Barcelona Institute, LLC, Spinal Dynamics of Wisconsin, SC., Barcelona, Spain.
Saitama Prefectural Rehabilitation Center, Saitama, Japan.
National Scoliosis Foundation, Stoughton, MA USA.
18Section of Spine Surgery, Children's Mercy Hospitals and Clinics, UMKC Orthopedics, Kansas City, MO USA.
Department of Physical Therapy, 2-50 Corbett Hall, Edmonton, AB T6G 2G4 Canada.
Salvá SLP (E. Salvá Institute), Vía Augusta 185, 08021 Barcelona, Spain.
National Scoliosis Center, 3023 Hamaker Court, Suite LL-50, Fairfax, VA 22124 USA.
Boston Orthotics & Prosthetics, Boston, MA USA.



The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS).


Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016.


The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8.


The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.


Guidelines; Idiopathic scoliosis; Treatment

Conflict of interest statement

Not applicable.Not applicable.All Commission Members are physicians, orthothists and physiotherapists who earn from their own work. The conflict of interests declared by the authors are as follows: ✓ Stefano Negrini has a stock of ISICO (Italian Scientific Spine Institute), Italy. ✓ Manuel Rigo is advisor of Ortholutions, Germany. ✓ Michele Romano has a stock of ISICO (Italian Scientific Spine Institute), Italy. ✓ James H. Wynne is an employee of Boston Brace Corp., USA: ✓ No other conflict of interests have been declared.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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