Free Pelvis Brace works: this is demonstrated by the study presented at Sosort

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At the latest Sosort international conference, held a few months ago, Isico presented the study Increasing Brace Comfort, Durability and Sagittal Balance through Semi-rigid Pelvis Material does not change Short-Term Very-Rigid Sforzesco Brace Results.
For years, Isico has replaced plaster cast with the Sforzesco brace, a particular type of very rigid brace for the most demanding scoliotic curves: developed in the Institute itself in 2004, it obtained results equal to casting, highlighted in several published studies.
The Sforzesco brace is a way to avoid casting for severe curves, because of the significant costs involved both at the individual (side effects including cast syndrome, skin problems, significant psychological impact, inability to shower for months, etc.) and social (repeated inpatient treatments) levels.
“In recent years, thanks to the experience with the Sforzesco brace, we have worked to improve our brace – explains dr Francesco Negrini, physiatrist, and one of the authors of the research presented at Sosort – We have therefore recently introduced a particular innovation, the system “Free Pelvis”, which consists of releasing the pelvis corset using a less rigid material at that level, increasing comfort while wearing. The “Free Pelvis” system is a very important innovation, a potentially big step forward in conservative treatment of scoliosis”.
The study presented compared the Sforzesco brace classical version (VRB) versus the Free Pelvis one (FPB): “The results obtained showed us that the Sforzesco “Free Pelvis” has no inferior results to the classic Sforzesco – concludes dr Negrini – furthermore it reassures the effectiveness of the Sforzesco “Free Pelvis”, and allows us to continue with greater confidence and conviction in the process of introducing this new and revolutionary instrument into our regular clinical practice”.

Andrea’s story

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Hi, I’m Andrea. It’s now been nearly two years, and I finally feel ready, and brave enough, to speak out.
Over time, I have come to realise that people are often judged for the way they look and not for who they really are. So, I may not have a six-pack with super-toned abs, and I haven’t got a straight back like other teenagers, but to be honest, none of that worries me anymore.
It is the people who can see your worth without bothering about your appearance who really love you for yourself. I am now half-way through a journey that seemed endless to begin with. I spent an entire year wearing this thing for 23 hours a day.
I had to cope with a whole summer when I couldn’t spend more than an hour a day by the sea, and holidays when I couldn’t do what everyone else was doing, and I was always finding excuses not to go out simply because I was too ashamed to admit that I had, and have, this “problem”.
Now, though, I am perfectly happy with who and what I am, and I know that the people who really care about me will continue to be there for me come what may.
I’d like to dedicate these few lines to myself, to acknowledge the fact that, after the initial tears and the anger at not being able to have a “normal” adolescence, I have finally grown self-confident enough not to feel ashamed.
This is not one of life’s real problems, it’s just an obstacle I need to overcome in order to become a better person. I am proud of who I am today. 

ISYQOL: Polish adaptation study published

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The study Polish Adaptation of the Italian Spine Youth Quality of Life Questionnaire has just been published (Edyta Kinel, Krzysztof Korbel, Piotr Janusz, Mateusz Kozinoga, Dariusz Czaprowski, Thomas Kotwicki), developed by the University of Medical Science of Poznan and from Olsztyn University, Bydgoska for the adaptation of our Italian Spine Youth Quality of Life Questionnaire (ISYQOL) into Polish (ISYQOL-PL).

Recall that ISYQOL is the questionnaire developed by Isico that measures the health-related quality of life of adolescents with spinal deformities and has proved particularly appropriate in patients with adolescent idiopathic scoliosis (AIS) not treated surgically.
The questionnaire is available for free online on a dedicated website, where you can also find the English and Polish versions of the questionnaire:   https://www.isyqol.org

The study aimed to carry on the process of the cultural adaptation of the Italian Spine Youth Quality of Life Questionnaire (ISYQOL) into Polish (ISYQOL-PL). The prior hypothesis was: the ISYQOL-PL questionnaire is reliable and appropriate for adolescents with a spinal deformity. Fifty-six adolescents (mean age 13.8 ± 1.9) were enrolled.
The ISYQOL questionnaire is based on patients’ concerns and has been shown to be particularly appropriate in AIS and SJK patients undergoing non-surgical management. The ISYQOL is a 20 items questionnaire. The process of the cross-cultural adaptation of the ISYQOL-PL was performed following the guidelines set up by the International Quality of Life Assessment (IQOLA). The implementation of this method includes the following steps: forward translation, back-translation and expert panel, pre-testing and cognitive interviewing, development of the final version. The total sample size was decided based on previous recommendations for validation studies.

What about study’s conclusions? “The ISYQOL-PL is a brief and practical tool for quantifying HRQoL in adolescents with a spine deformity – comments the coordinator of the study, the spine surgeon Dr. Tomasz Kotwicki from the Department of Spine Disorders and Pediatric Orthopedics –  Filling in the questionnaire takes less than 10 minutes to be completed. The ISYQOL-PL questionnaire is reliable and can be used in adolescents with spinal deformities”. 

Full text available here:  https://pubmed.ncbi.nlm.nih.gov/34066225/

Simona’s story

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Hi, I’m Simona, and, like many of you, I wear a back brace. My “brace-wearing” journey began some years ago. To be precise, it was 26 October 2017 when I got my first Lyon brace. How could I forget it?!

I had discovered my scoliosis in May that year, after suddenly realising, during a PE lesson one day, that there was something wrong with me. During a run, I felt a very sharp pain in my shoulders, so I stopped and asked my PE teacher what might be the reason.

 She asked me to bend forwards, and after checking me over and getting me to do some movements, she said I had one shoulder higher than the other.

After talking over the problem at length with my parents, we went to a hospital to see an orthopaedic specialist. Needless to say, it was a disaster, partly due to the doctor’s lack of empathy: according to him, I needed to wear a Milwaukee brace for 18 hours a day!

The first time I saw an X-ray of my back, I was shocked, as I hadn’t seen anything like it before. I felt like a freak, also because up until that point, I had never even heard of scoliosis. I had no idea what it was. After realising that this doctor would not be at all interested in helping me cope with the considerable psychological impact of having to wear a brace (and I could already see that this was going to be considerable), my parents and I decided it would be better to consult another doctor.

That is what we did, and we couldn’t have found a better one! He turned out to be the best doctor ever: from our very first meeting, he always wanted to hear my opinion, even though I was still only young.

Thanks to him, I was able to embark on this bracing adventure with much more peace of mind. He prescribed me a Lyon brace with a removable neck support (8 hours of wear per day) to treat my cervical spine too and a right shoe-lift. Since then, I have had two new braces and two new shoe-lifts, and the treatment has reduced my degrees of curvature considerably. 

I can’t deny that having to wear a brace still had a strong psychological impact on me, but with the help of my family, my physiotherapist and my doctor, I managed to cope. And even though it’s not over yet, I know that the worst part is now behind me.

 I am very proud of all that I have achieved. My message to anyone else who wears a brace, or needs to start wearing one, is this: wear it as much as you can, and always for all the hours your doctor tells you to! The reason I have improved so much is that I have always worn mine even more than I had to. You’ll probably be really amazed to learn this, but I have actually decided that I want to train to be an orthopaedic specialist one day! 

Yesterday, I told my doctor this, and he was surprised. But it’s true! He has always been so kind and understanding with me. Thanks to him, I have even grown quite fond of my “condition”!  So, make sure you find a good doctor, and above all, one who treats you not as a laboratory animal but as a person who needs more than just physical attention. One day I want to be able to help other people get through what I have been through, and I’m still going through. If I succeed, I’ll be really proud of myself! 

I know this is rather a long message, but I have been a reader of this blog for so long now. The doctors who write it have often given me the answers I needed, and since it has often helped lift my spirits in blacker moments, I decided I should now share my story in the hope of encouraging others too!

eSosort2021: ISICO awarded for the third time in a row

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And the winner is: Isico! For the third consecutive year, our Institute has been awarded the highest international recognition for those involved in the rehabilitation treatment of vertebral pathologies. On Saturday, May 1st, on the occasion of the annual SOSORT conference, this year in online mode due to the pandemic, our studio “Efficacy of bracing in infantile scoliosis. A 5.5 years prospective cohort shows that idiopathic respond better than secondary” was awarded the SOSORT Award. 

It is not the first time, because only in the last two years Isico has won the coveted international recognition for the best research by SOSORT, to which is added, in 2019, the award won as co-authors of a research study in collaboration with the University of Hong Kong. A truly unique continuity.
“An award that once again certifies the high quality achieved by the scientific research carried out in our Institute at an international level – explains Prof. Stefano Negrini, scientific director of Isico and first author of the awarded research (the other authors are Dr Sabrina Donzelli, Dr Greta Jurenaite, Dr Francesco Negrini and Dr Fabio Zaina) – through this research the main goal was we have set ourselves the goal to check the results in the medium term of bracing of infantile scoliosis, comparing the two groups: idiopathic and secondary scoliosis.”
According to Mehta results, casting is considered the gold standard conservative treatment for infantile scoliosis, still casting requires repeated general anaesthesia, and recently doubts have been raised that this could cause potential brain damages in the long term. 

“In our Institute, we have been using bracing for a long time to reduce invasivity for the patient – says Prof. Negrini – Moreover, the results of the Sforzesco brace have shown to be similar to casting in adolescents. Thanks to the clinical and research experience gained over the years, we have developed a retrospective study in a prospective cohort. We have been using braces since 2004 and have been able to present the largest case history on braces to date (34 patients), with an average follow-up of 5 years, documenting excellent results in idiopathic scoliosis (success in 50% of cases – only one failure), while in those secondary to other pathologies it is possible to delay surgery over time even in the face of more frequent failures (surgery inevitable in 20% of cases)”.
We remind you that infantile scoliosis is very rare, about 1 case in 10,000 children, and for this reason, it must be treated by very expert and dedicated specialized clinics with specialists who  have been managing spine deformity for long and have a rich clinical experience
“In this context, we are also the only Italian structure that is participating in an international multicentre study, which involves clinical centres in 40 countries around the world, to verify the effectiveness of braces compared to casts – concludes prof. Negrini – During the two-year duration of the project, we will bring about 5 cases treated at our Institute for research purposes. Isico has several years of experience in the use of braces, our participation will not include the application of casts, but our results in bracing will be compared with those of other centres that apply casts”.

Online congress in Brazil for the month of scoliosis

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On behalf of the “Green June 2021 – Organisation Committee” from the Brazilian Scoliosis Treatment Society (Sociedade Brasileira de Tratamento da Escoliose – SBTE), the 1st online Brazilian Scoliosis Congress will take place in June from 25th to 27th.
“This initiative is unprecedented in Brazil and tries to provide quality information – comments Isis Navarro, physiotherapist cooperating with the organizer- in this way, we want to promote awareness of scoliosis for patients, families, students and professionals”.
Three Isico scoliosis experts have been included among the international speakers in the online event: Dr Sabrina Donzelli will give a presentation focusing on the current evidence in the conservative treatment of scoliosis; Michele Romano, Isico physiotherapy director, will give a lecture on the SEAS approach, while Alessandra Negrini, an Isico physiotherapist as well, will talk about “Sports and Scoliosis”.
For more information and for registration please follow this link 

Dress green with us in June!

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As every year, Isico dresses in green throughout June with a particular initiative. During the four weeks of the month, we will launch mini videos with the “Best” of each edition of the Concorsetto, the Isico competition dedicated to those who wear the corset to offer a series of testimonials from those who live with the corset in their daily lives.
Recall that National Scoliosis Awareness Month occurs every June to underline the importance of early diagnosis and public awareness of scoliosis and its prevalence within the community.
Initialised more than a decade ago by the Scoliosis Research Society, the oldest scientific society dealing with scoliosis, founded in 1966, this campaign aims to raise public awareness of scoliosis and related spinal deformities through educational campaigns and the defence of local activities and community events during June and throughout the year.
There is a green ribbon to characterise the campaign throughout the month and a day for this 2021 edition, June 26th, to tell the own story, a personal one or that of a friend or a family member, to spread the awareness of the existence of this pathology.
Everyone can participate in the campaign, just like us at Isico: sharing the green ribbon on the social profile, posting participation or even only a photo or a story are all ways to make this pathology known. Or follow our Social profiles and share our mini-videos “The Best of Concorsetto”, with the hashtag #scoliosisawarenessmonth.
Knowing about scoliosis is already a first important step towards its recognition; the sooner this happens, the better it is to be able to intervene with adequate therapy.
Mark the month of June in green and leave your green mark on June 26th!

Here you have the full video The best of Concorsetto

Daytime versus night-time bracing: what to do when scientific evidence is of no help?

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When we sit down in front of a doctor, we often expect him or her to have the solution to all our problems, but of course this is not the case. Unfortunately, that isn’t how evidence-based medicine (EBM) works!

EBM is defined as the explicit, conscientious and judicious use of the best current scientific evidence in decision making regarding the treatment of an individual patient or population. Indeed, the term “evidence” refers not to that which is “evident”, but rather to what has been discovered through specific research.

Evidence-based clinical practice is built on 3 key elements: 

– the best research evidence;

– the clinical experience of the treating physician;

– the patient’s values and expectations.

In other words, optimal clinical decision-making is based on knowledge of the best available scientific evidence, which must be combined with the values and preferences of the patient, who is involved directly in the process of choosing his or her treatment. 

But scientific evidence cannot answer all the questions that crop up in medicine. In the field of scoliosis treatment, for example, there are no studies showing that brace wearing is more effective during the day than at night. 

So, what are doctors meant to do when they are faced with situations like this? In the absence of available scientific evidence, the decision has to be based on the other two foundation stones of clinical practice (the doctor’s personal experience and the patient’s values), so as to achieve the best possible outcome. 

As far as bracing is concerned, there is an important study “Adolescent Idiopathic Scoliosis Bracing Success Is Influenced by Time in Brace: Comparative Effectiveness Analysis of BrAIST and ISICO Cohorts” which shows that the outcome, in terms of curve correction, depends on the number of hours the brace is worn: the longer it is worn the better the result will be.
On the basis of this knowledge, and also with the aim of increasing our patients’ compliance with the treatment, we at ISICO have decided that patients should always wear their brace at night, and enjoy their brace-off hours (as prescribed by their doctor) during the daytime.
After all, if patients sleep without their brace on, this means they lose 7-8 hours of correction every 24 hours. What is more, using brace-off hours during the daytime makes it easier for youngsters to take part in the daily activities they enjoy (sports, going out with friends, and so on), and this increases not only the level of compliance with the treatment, but also their quality of life.
Finally, we know that our spine does not remain passive during sleep; on the contrary, when we are in bed, swelling of the intervertebral discs (shock-absorbing “sponges” situated between our vertebrae) causes lengthening and tension of this entire structure, which is so important in growth.
This is one of the reasons why ISICO (and pretty much all practitioners worldwide) now recommend that, when the time comes to do so, bracing hours should be reduced during the daytime, until the point is finally reached when patients, in the last months of their treatment, are wearing their brace only at night. This, then, is an example of how the clinical experience of a specialist team and the particular needs of patients can together serve as the basis for making sound therapeutic choices in the absence of hard scientific evidence.

Bracing adults with scoliosis: a new published study

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The research paper “Bracing adults with chronic low back pain secondary to severe scoliosis: six months results of a prospective pilot study”, has just been published by the European Spine Journal.
It is one of the few articles published in the literature on the use of braces for adults affected by scoliosis. Although scoliosis has been estimated to affect up to 68% of the population over 60, there is scant literature about conservative treatment for adult scoliosis.
While during growth, the main concern is aesthetic, with a quite good quality of life and pain is quite unusual, backache characterizes adult scoliotic patients.

“For our research, we took into account twenty adults with chronic low back pain (cLBP) secondary to Idiopathic Scoliosis (IS) – explains dr Fabio Zaina, a specialized physiatrist of Isico and the author of the publication – Patients were evaluated at baseline immediately before starting with the brace and after six months. We have used a new brace, called “Peak”, designed to alleviate pain for adult patients with chronic pain secondary to scoliosis.”

The objective of the study was to test the efficacy of a prefabricated brace in reducing pain in adult scoliosis patients because the quality of life and pain are the main reason for seeking treatment. 
Patients, especially women with severe scoliosis, wore the brace for a few hours, from 2 to 4, a day: “This study has some shortcomings: including a limited number of females only patients, as well as not having a control group. It would have been interesting to compare this group with those who refused to wear the brace or to another similar group that only did exercises – ends dr Zaina – from the data collected, we found an initial impact on pain reduction, none instead on the quality of life according to the questionnaires filled in by patients. Considering that the extension of follow-up produced improved results, our recommendation could be to pursue the part-time brace-wearing permanently. Starting with such a short period of brace wear (2–4 h per day) would also allow the expert clinicians to increase the dosage in case of need”.

eSosort2021: Isico competes for the AWARD

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Isico, too will be present with several presentations at the annual international conference Sosort, online from April 29th to May 1st.
A presence, albeit virtual, characterized by the possibility of competing again for the SOSORT Award. We recall that Isico has been awarded already in the last two years the prestigious international recognition given by SOSORT for the best research, to which is added, in 2019, the Award won as co-authors of a research study in collaboration with the University of Hong Kong.

“In this online edition, our study Efficacy of bracing in infantile scoliosis. A 4-years prospective cohort shows that idiopathic respond better than secondary scoliosis will compete for the Award along with six other studies – explains Prof Stefano Negrini, scientific director of Isico and first author of the research – an important result that recognizes the high quality of the research we are performing in Isico. Also, the study Adults with idiopathic scoliosis: progression over 5 Cobb degrees is predicted by menopause and metabolic bone disease, which sees as first author Dr Sabrina Donzelli (who won the Award in 2020) was nominated among the 7 best research studies: Dr. Donzelli will hold the presentation but will not compete for the Award this year.”
In addition, another study, Increasing Brace Comfort, Durability and Sagittal Balance through Semi-rigid Pelvis Material does not change Short-Term Very-Rigid Sforzesco Brace Results, is among those selected for the Podium presentation and will be presented during the event by Dr Francesco Negrini, an Isico physiatrist.

Isico also distinguished itself for the works accepted as Posters, available to subscribers to the event in an on-demand session, and they are three: Can the tilt-differences of limiting vertebrae be a prognostic factor for the worsening of the scoliosis curves treated with specific exercises? A pilot study using a series of matched patients, edited by our director of physiotherapy, Michele Romano, Reducing the pelvis constriction changes the sagittal plane in the brace. A retrospective case-control study of 37 free-pelvis vs 336 classical consecutive very-rigid Sforzesco braces and The modular MI-brace is as effective as the classical custom-made Sforzesco brace. A matched case-control study of 120 consecutive high-degree female AIS, both from Prof Stefano Negrini.

This year’s virtual meeting will begin with synchronous (live) presentations on Thursday, April 29th and Friday, April 30th, from 9 am to 11 am Eastern Time, and on Saturday, May 1st, from 9 am to 1 pm Eastern Time.

All the presentations will be recorded and be made available on-demand for a duration of 1 year on the SOSORT conference website for registered participants. For more information and registration, visit the event website https://esosort21.sosort.org