SEAS Therapy: 20 Minutes of Daily Exercises at Home – Too Much or Too Little?

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The International Society for Conservative Scoliosis Treatment (SOSORT) recommends exercises based on self-correction, which involves movement aimed at counteracting spinal curves, stabilising this position, and integrating it into daily life【1.

At ISICO, we have developed and use the SEAS approach. These exercises involve actively achieving the self-corrected position and working to maintain it despite various challenges. The exercises are designed to test the stability of the correction, requiring the patient to stabilise their spine and recover the correction if control is lost【2.
Gradually, as therapy progresses and through continuous practice, patients become more adept at incorporating self-correction into their daily lives—for example, while eating, walking, or doing homework.

How much time should be dedicated to practising the exercises each day?
Typically, 20 minutes daily is a significant commitment, especially as this therapy can last for a long time—sometimes several years. Patients are given one rest day per week, making the total weekly commitment about two hours.

Some parents, particularly at the beginning, ask whether more than the prescribed amount can be done. We usually respond that it is important to train without overwhelming the patient. For example, consider marathon training: a young person should not exhaust all their energy at the start and then abandon therapy, but instead maintain endurance and continue until skeletal maturity. At this point, we can say that the risk of scoliosis progression has decreased.
Conversely, reducing the duration would result in an insufficient period of practice. When we think about how much time young people spend on their phones daily, 20 minutes is not much.

How much time is needed for exercises in other scoliosis treatment approaches?
According to current data, the other most widely used approach globally is the Schroth therapy, developed in Germany.
This method involves hospitalisation in a specialised clinic for 3–4 weeks, during which patients undergo daily two-hour sessions to learn the exercises properly. After the training period, patients are instructed to continue the exercises at home and visit the clinic one to four times a month to ensure proper execution【3.
Alternatively, patients can learn the exercises through closely spaced individual sessions with a therapist, lasting 60–90 minutes, followed by weekly group sessions of 60 minutes, combined with a daily home exercise programme lasting 30–45 minutes【4.
This represents a significantly greater commitment than the 20 minutes required for SEAS therapy.

1. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289.

2. Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, Negrini S. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. 2015 Feb 5;10:3. doi: 10.1186/s13013-014-0027-2. PMID: 25729406; PMCID: PMC4344739.

3. Rigo M, Reiter C, Weiss H-R. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil. 2003;6(3–4):209–14.

4. Burger M, Coetzee W, du Plessis LZ, Geldenhuys L, Joubert F, Myburgh E, van Rooyen C, Vermeulen N. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019 Jun 3;75(1):904. doi: 10.4102/sajp.v75i1.904. PMID: 31206094; PMCID: PMC6556933.

How to Write a Winning Abstract: 10 Key Tips for SOSORT 2025

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The deadline for SOSORT abstract submissions is fast approaching! December 7th is just around the corner, and with the conference scheduled for April 23-26, 2025, in Dubrovnik, it’s time to refine your submissions.
To assist those still working on their abstracts, ISICO has prepared a practical pocket guide with tips. These are based on SOSORT’s guidelines, provided by the Scientific Committee. For more detailed insights, a SOSORT webinar on the topic is also available. Additionally, we’ve included a special tip from our researchers, offering a glimpse into the unique approach we follow at our institute.
ISICO’s approach emphasises the direct link between research and clinical applications, reinforcing the idea that addressing existing clinical challenges can lead to advancements in understanding and rehabilitation therapies.

SOSORT Guidelines for Presenting an Effective Abstract

  1. Craft a Clear and Specific Title
    • Keep the title concise but informative. Focus on the essence of the work, using terms that reflect your main objectives and findings. The title word count is not included in the abstract text but should be condensed and not exceed 300 characters.
  2. Highlight Key Objectives and Results
    • Define the primary goal of the study and the hypothesis tested. Summarize your findings briefly, emphasising data that strongly support your conclusions.
  3. Follow the Required Structure
    • Organize your abstract according to the conference’s format: introduction, methods, results, and conclusions. This makes your abstract easier to read and aligns with reviewers’ expectations.
  4. Be Compact and Precise
    • Avoid unnecessary details and focus on delivering the most essential information. Each sentence should add value to the abstract and enhance overall clarity. The body of the abstract text must NOT exceed 450 words and must include the following sections: title, authors, background, objectives, study design, method, result, clinical significance, and level of evidence. 
  5. Avoid Brand Names and Commercial References
    • Maintain a neutral tone by using generic terms instead of brand names, enhancing scientific objectivity.
  6. Use Tables or Graphs Strategically
    • If allowed to include one table or figure, choose the data that best summarizes a key aspect of your work. Make sure it’s clear and enhances understanding.
  7. Check Ethical Compliance
    • For studies involving human subjects, ensure you have the necessary approvals, as you’ll be required to confirm this during submission.
  8. Request Feedback and Mentorship
    • If pre-submission mentorship is available, use it to get feedback on impact, clarity, and quality.
  9. Review Additional Writing Resources

ISICO’s Insightful Tip

  1. Identify Clinical Needs or New Insights in the Field
  • Stefano Negrini, ISICO Scientific Director: “When it comes to research, start from a clinical need. Focus on something that has already been explored to some degree or choose a topic highlighted by recent articles in the field. This approach adds value, ensures relevance to clinical practice, and drives improvements in the therapies themselves.”
  • Fabio Zaina, physiatrist: “By following these guidelines, you can ensure your abstract aligns with SOSORT’s standards, effectively communicates your research, and contributes to advancing evidence-based scoliosis care and conservative treatment practices. Additionally, ensure the title is clear, focused, and engaging, as this will help attract attention to the research.”

Gym workouts and scoliosis: can the two go hand in hand?

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In recent years, fitness has become a booming industry, driven by a growing interest among young people and on social media. This trend has resulted in the emergence of better-qualified fitness professionals, triggering a virtuous circle in terms of improving the quality and safety of training.

From our perspective, it is worth remembering that physical activity, if performed correctly, can have a protective role in the management of scoliosis.
We are often asked whether patients with scoliosis, particularly those undergoing bracing treatment, can work out in the gym.
Before answering this question, let’s make two things clear:

● the literature contains nothing specific on this topic;

● “working out in the gym” means more than one thing (i.e., not all training is the same).

The importance of goals
Before embarking on a training programme, it is crucial to establish your personal goals. Among adolescents, the main reasons for working out are often the desire to build muscle (boys) or tone up (girls). However, in adolescence, learning the correct training techniques and improving your physical abilities, such as coordination, balance, strength, and resistance, are more important than immediately seeking to bulk up your muscles.
Young people will find that efforts to gain muscle mass give more gratifying results once they have finished growing (i.e. after reaching 16-18 years of age).
The best approach, then, is to try to focus on what you actually do in the gym, striving to do it better and more effectively and thinking less about what you see in the mirror.

The benefits of training in the gym

Training in the gym offers you the chance to monitor your body and safely regulate training stimuli, unlike when practising many competitive sports, during which you are more likely to sustain an injury. Several studies show that the gym is associated with a lower injury rate than other sports.

Advice for those with scoliosis

We should first point out that young people with scoliosis (boys and girls) are, in most cases, no different from their peers who do not have scoliosis. Having said this, we do have some advice.

  1. Find a professional. A properly qualified trainer can help you do the exercises correctly and adapt the training programme to your individual requirements. It might also be a good idea to put your doctor/physiotherapist and trainer in contact with each other, so that the training programme can be refined and any doubts addressed.
  2. Don’t be in a hurry. Targeted warm-up exercises can improve flexibility and reduce stiffness in the spine.
  3. Choose your exercises. It is important to start with simple and controlled exercises, then gradually increase the difficulty level.
  4. Take care with axial loads. Axial loading exercises must be performed carefully to avoid sudden or compensatory movements. When it comes to the squat, for example, the goblet squat may be the best option as it is performed with the weight (dumbbell/plate/kettlebell) held in your hands, at chest height, in front of you. By facilitating load management, this version guarantees greater stability and makes it easier to control the movement.
  5. Learn to “dose” self-correction. When you are working out in the gym, the amount of self-correction you apply (i.e., the extent to which you adopt the position designed to counteract the scoliotic curves and therefore keep your spine more aligned) will depend on the type of exercise you are doing and the level of fatigue you are experiencing. The objective of exercises done in the gym differs from that of the specific exercises taught you by your physiotherapist, where self-correction is the key element, and determines how the exercises are performed. When you are using weights, the priority is to focus on the specific training stimulus, while at the same time trying to keep your spine properly supported.

Should a brace be worn in the gym?

Individuals who are being treated with a brace can consider doing their physical activity during their brace-on hours, so as to take full advantage of the support provided by the brace itself. However, if they prefer to train during their brace-off window, they should make sure they do a longer warm up, so as to prepare their back for the training session.

So, finally

Working out in the gym is possible for those with scoliosis and can indeed be beneficial if the necessary precautions are taken. Be sure to find a professional trainer, keep your doctor in the loop, and listen to your body because these are the keys to safe and effective training.

Luca Selmi comments on SEAS course in Egypt

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A few weeks ago, our physiotherapist Luca Selmi held a SEAS course in Cairo, Egypt. We took the opportunity to ask him about his experience, as it was the first time he had conducted an international course on his own. 

We also remember that the local organiser, Essam Rashad, physiotherapist and owner of the “Scoliofix” centre in Cairo (pictured with Selmi), was one of the first partners of ISICO Alliance.

● Was it the first time you held a SEAS course?

No, I started working as a SEAS trainer in both national and international contexts about 2 years ago, initially alongside our Head of Physiotherapy, Michele Romano, and later independently. However, this was my first course as the sole instructor at the international level.

● And in Cairo, was it your first time?

Yes, I had never been to Egypt, although in some way, I didn’t feel it was so far away since I have a close friend with Egyptian roots.

● How did it go?

Very well, I’d say even better than expected. I was confident about doing a good job, but in these situations, teaching success is closely tied to participant feedback. Fortunately, the feedback was very positive. Additionally, on the day of departure, I was lucky enough to spend a few hours as a tourist, and the grandeur of the Pyramids left me speechless!

● How many participants?

There were 21, all physiotherapists.

● What were they most interested in?

The academic path to a physiotherapy degree differs in Egypt compared to Italy. It lasts six years, and a medical prescription does not bind the physiotherapist. They can work independently, prescribe X-rays, and, in the case of patients with scoliosis, even braces. I sensed great interest in the comprehensive management of patients, with obviously more focus on the physiotherapy approach, as it was their first exposure to SEAS. Only a few had experience with scoliosis patients, but they used other treatment methods. So, it was an excellent opportunity for exchange and mutual learning.

● What kind of questions did they ask?

I’d say I’ve never received so many questions in the courses I’ve held before. Since it was a very practical course, I sensed a strong desire for “one-on-one” interaction on how to teach corrective movements. They even practiced directly with their hands on my torso, as if I were the patient, so I could give them feedback.

● What would you focus on in future courses?

From what I’ve seen, there’s a lot of interest in high-quality information and training. I was told that the first option for patients in the region is “wait and see,” possibly leading to surgery. Conservative treatment has not yet offered a sufficient alternative, from the medical personnel’s perspective.

In the coming years, having a growing number of therapists trained and updated based on the latest scientific evidence, and therefore able to offer patients an alternative to just hoping things don’t get much worse, while also being a valuable team ally for doctors, will be a great achievement.

● What are your next appointments?

My next course will be in Italy in early November, and I will return to Cairo in early April 2025.

Your brace, an “accessory” that makes you unique

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Every era has its own fashion corset, you might say, if you think of the various ways, in which this particular garment has been used over the years.

First created in the sixteenth century, it has always been intended to enhance the female silhouette by the aesthetic canons of the times. Worn under clothes, it modified the shape of the body. It has undergone a continuous process of evolution to the point of becoming, nowadays, an actual item of clothing—a fashion garment that, again for aesthetic reasons, is deliberately left visible.

The well-known TV series Bridgerton, which features women in Regency-style corsets, has brought them back into vogue, so much so that, in the name of gender equality, male models are now even wearing them on catwalks. And, as we saw on the red carpet at the Oscars, corsets appeal both to Gen Z and over-60s celebrities, with Halle Bailey and Jamie Lee Curtis both appearing in Dolce & Gabbana ones.

Although the orthopaedic braces used in the rehabilitation treatment of scoliosis are created with a completely different function in mind, they, too, are worn to achieve a better silhouette. Indeed, one of their purposes is undoubtedly to improve the appearance of the patient’s back, as well as its health, of course.

Whenever we mention corrective braces, the initial response is always one of fear and dismay because the first image that springs to mind is that of some object that is impossible to disguise under clothes. We might think, for example, of the Milwaukee brace (now hardly ever used anywhere in the world), which even has a kind of chin rest that clearly can’t be concealed under clothing. However, thanks to research and continuous efforts to develop treatments that are the least invasive possible, the braces being produced nowadays are not only more and more effective as corrective devices, but also increasingly close-fitting and therefore impossible to see under clothes. One example is the Sforzesco brace, developed by ISICO, which is just as effective as casting.

Familiarity with these somewhat “awkward accessories” has grown in recent years as people are encouraged to regard them (whatever type they are) as objects that are just a part of everyday life and don’t need to be covered up. Actually, plastic braces now even exist that can be customized with different Thermo adhesive designs.

It’s a bit like the situation with glasses: frames have increasingly evolved, following fashion, and today the variety available is so great that there is something for all tastes, particularly eccentric styles. In this way, a person’s glasses are now a fundamental part of their style and identity. Their purely medical function has been combined with a strong aesthetic component, turning them into true accessories.

Similarly, dental braces have become increasingly customisable, and limb prosthetics, in part thanks to athletes, are now part of everyday life too. Indeed, many of those who wear them are happy to show them off as they are part of what makes them unique.

All these are examples of “awkward accessories” that are now a part of everyday life. And why shouldn’t this also be true of the corrective braces worn by young scoliosis patients?  

My next comments are aimed directly at those who wear braces or are about to start doing so.

Just like glasses, dental braces or limb prosthetics, a scoliosis brace should be seen, and treated, as something that sets you apart, but in a positive way, as something that is peculiar to you — something that makes you special, stronger and more self-confident, while also caring for your back. Although this might initially sound impossible, over time you really will come to see it as a strength.

You might think, “it’s easy for the physiotherapist to talk. They haven’t actually gone through this. We patients are the ones who have to wear these things, and only we can really know what it feels like.” 

Well, this is where, as a physiotherapist, I am able to draw on my own experience as a former patient. I lived with a brace for 7 years, wearing it full-time to begin with. And on the basis of that experience, I feel compelled to urge all youngsters who are embarking on, or about to embark on, this journey to use their brace and see it as a distinguishing feature, something to joke about with friends, something that makes you unique and will help you in your adult life (even though I realise that when you’re young it’s hard to think that far ahead).

Erica, former ISICO patient and now ISICO therapist

Isico Alliance, excellence in spine

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Isico’s goal has always been to promote the best therapies for the treatment of scoliosis in the world, and it is precisely from this idea and to give proper answers to the requests we periodically receive that we founded the Isico Alliance.

“ISICO stands alongside the ISICO Alliance Centres to support applying proper braces, organising new activities, and providing better care to their patients—explains Fabio Zaina, physiatrist and one of the project coordinators — taking advantage of the experience and ongoing innovations ISICO realises day by day. In fact, ISICO services mean excellent care for patients and an excellent approach for the centre.” 

There are several advantages from which an Isico Alliance centre can choose, from brace delivery, ISICO takes care of the entire production cycle of the prescribed brace in the workshops in Italy, to brace design, ISICO gives its assistance in designing the brace that will be produced on-site, from the training of a local orthotist to equip them with the skills necessary to manage the entire process of SPoRT (Symmetric, Patient-oriented, Rigid, Three-dimensional, active) braces production, to the opportunity to organise periodically SEAS courses in the local area, up to the use of the best technology for best care thanks to ScoliosisManager, the software developed by ISICO providing a uniform data collection protocol. Other optional services available are the ISICO iOS-Android app featuring specific functions for patients and ISICO practitioners, and Telemedicine services delivered to local patients directly by ISICO for complex or particular cases.

Do you wish to join the Alliance, or do you want to ask for more information? Please visit the website: https://isicoalliance.com

Happy summer: Enza’s thoughts

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Enza was a patient of ours. Back in 2019, she shared her thoughts as a former brace wearer. Despite being shy, she knows that it can be good to talk about yourself and say thank you. The encouraging things she has to say here are a testament to the power of courage.

She agreed to let us republish her letter on this blog.  

Thank you, Enza!

Here’s wishing you a happy summer and a wonderful life!

Hi everyone, 

It is already nearly a year since I stopped wearing a brace. But I wore one for the 9 years before that. Although I call it a “cage”, it should not be seen as a prison, more as a device designed to prepare us for the freedom that will follow. It was clear from the start that my scoliosis, which came to light unexpectedly when I was 12 years old, was severe. I was too scared to entertain the idea of ​​surgery, even though, for years (during which I tried bracing and casting), I continued to be told, by different doctors, that surgery was the only viable option for me. Then, after a series of fortuitous events, I came across ISICO.

They didn’t tell me anything I didn’t already know: my scoliosis was severe and warranted surgery. However, they also said there was a new possibility I could try. To begin with, I didn’t feel too happy about that, because once you have resigned yourself to something you didn’t want, hope is the last thing you need: it means you have to find the courage to roll up your sleeves again and decide: “OK, let’s go back to the beginning, and try again. I’m still willing to give it a go”. But that’s exactly how it was. I decided to have a go with a new brace, embarking on a new course of treatment that involved daily exercises. And even though I no longer felt optimistic, for the first time ever, I actually started to see an improvement and realise that my efforts were paying off. This is why, after many years — many moments of sadness, many hot, sweaty summers, countless t-shirts three sizes too big, as well as all the itching, irritation, annoying questions, and the need to wear my hair very long to try and disguise the shape of the brace at the back — I am now sitting in my room here at university, taking time out between exams to write to you.

A few years ago, I wrote a post urging you to face your treatment with all the strength and spirit you could muster. Today, many months on, my message is still the same, except that this time I am saying it as someone for whom wearing a brace for 23 hours a day is a memory, something from the past. As far away and impossible as it may seem now, this moment will come for you, too, as long as you work towards it with perseverance and determination, despite the difficulties involved. Every time you think you can’t do it, and want to tear off that plastic shell that makes you feel so unnatural and awkward alongside everyone else, try to remember that brace wearing just a moment in time.

If you live it in a positive way, a moment that can even become something to smile about, a personal victory won through courage and perseverance, and a reason to feel even better about yourself in the future.

Today, I am not miraculously healed. However, for the moment at least, my back has stopped getting worse. I don’t know what the future holds for me, but I do know that, right now, I feel happy about the battles I have won, proud of how I overcame the heat and also the feeling (which lasted until I after I turned 19) that I was somehow inadequate. And every sign that remains, every asymmetry or defect, is like a prize left over from a battle that I know I waged well (with the support of the best possible allies: my family, friends, doctors, and physiotherapists).

I do not use the word “battle” lightly; after all, let’s not kid ourselves, bracing is not easy. It doesn’t even really help to think of those who are worse off than you, because when you are going through something, it does become a personal battle, even if you know that there are worse things you could be facing.

But what I want to say to you is this: make the best of your life and fight with gritted teeth, because the day will come when you feel super proud of everything you have managed to do.

And even if, when you’re in the midst of it all, it seems like the end of the world, the good thing is that that is certainly not true, and you are actually far stronger than you thought. Don’t be discouraged, keep pedalling away and try to make the journey unforgettable, because you will reach the descent and, I promise you, that part is a blast.

Big hugs to you all, and many thanks to ISICO. Have a great summer!

Enza

Margherita, sport, and scoliosis: a possible pairing

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What distinguishes ISICO in the treatment of scoliosis is a therapeutic approach that allows you to combine treatment with exercises and brace with sporting passions, even high-level competitive ones. This happened to Margherita, 14 years old, from the Marche region in Italy, who is an aerobic gymnastics champion.
We asked our young patient to share her experience while she prepares for an important sporting event: the Aerobic Gymnastics World Championships, scheduled for Pesaro, Italy, in September. Let’s discover with her how it is possible to reconcile sport and a brace.

How did your passion for aerobic gymnastics arise? 
It all started as a game with physical gymnastics. I was only 4 years old. Then my coach suggested the aerobics course to me, and from then on I became passionate about this sport.

When were you diagnosed with scoliosis?
I was 8 years old, it was in 2018…

What has been the impact of scoliosis on your daily life, at school and with friends?
At the beginning, I was monitored periodically and did specific exercises with my physiotherapists, who were special people for me, helping me to understand my condition better. As I grew up, my curve got worse, so I started the journey with ISICO and I found myself very well.

Do you wear a brace? For how many hours a day?
I started wearing the brace one year ago; it wasn’t easy because initially I had to wear it 20 hours a day; after a few months, it was decreased to 18 hours.

How do you reconcile the brace with sporting activity? How many hours do you train?
When I wore the brace for 20 hours, I only took it off for workouts. Now, my ISICO physiatrist, Fabio Zaina, has reduced the hours I wear it. I generally train between three and four hours a day, six days a week. In the summer, however, the hours increase. There are also double workouts.

What would you recommend to a peer who is starting corset therapy and playing sports?
Sport, like brace wearing, requires consistency, continuity, and tenacity. The first few weeks in a brace are not easy, but then everything improves, and you get used to it. My back has improved, and that’s the most important thing.


What are your next goals and competitions?
During this period, I am training for the World Championships, which will be held in Pesaro, Italy, in September.

Good luck, Margherita!

We remind you that ISICO’s innovative approach includes:

•  SEAS: specific exercises for scoliosis

•  Personalized Therapy: each patient receives a tailor-made treatment plan, which takes into account specific individual needs and conditions

•  Multidisciplinary Approach: the therapeutic team consists of physiotherapists, spine specialists and orthotist, who work together to offer a complete physical and psychological approach to treating scoliosis.

Sanders staging: the pros and cons?

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The progression of idiopathic scoliosis is related to skeletal growth, peaking during the adolescent growth spurt. Subsequently, once skeletal maturity has been reached, the pathology usually stabilises or slows down.

Knowing the predictors of skeletal maturity allows physicians to predict the risk and timing of curve progression, and therefore choose the most suitable treatment for their patient’s scoliosis.

Several indicators of skeletal maturity are closely linked to the progression of scoliosis. They include chronological age, height and weight, development of secondary sexual characteristics, and menarche.
However, skeletal maturity is known to be the most sensitive indicator of both the speed of skeletal growth and its completion. (1)

Numerous staging systems for evaluating skeletal maturity, in addition to the Risser sign, have been developed and used in patients with scoliosis. In the scientific community, particularly in the USA, the Sanders staging system is becoming increasingly popular.

Unlike the Risser method, which evaluates the degree of ossification of the iliac crests, the Sanders approach is based on the assessment of the ossification of the epiphyses of the wrist and hand bones, and it divides bone growth into 8 stages. Stage 3 corresponds to the pubertal growth peak when the risk of scoliosis worsening is greatest, while stage 8 corresponds to full skeletal maturity, and thus to the absence of a risk of worsening (in the case of curves measuring less than 50°) (2).

So, what are the pros and cons of this method of assessing skeletal maturity?

PROS:

1. It accurately predicts the skeletal growth peak: the Sanders classification system offers the possibility of dividing the relevant growth periods of patients who are still skeletally immature into multiple categories and would all be grouped as stage 0 using the Risser system. Essentially, some Risser stage 0 patients are at higher risk and more developmentally immature than others who are more skeletally mature but still classified as Risser 0 (1). 

2. It more reliably predicts residual growth: the Sanders classification can help doctors to predict residual growth in scoliosis patients more accurately than is possible with other assessment methods, and this allows them to plan better treatment (such as when to “wean” patients off their braces) and better monitor the evolution of the disease. (1)

3. It is a support tool: like other methods, the Sanders staging system, combined with clinical and radiographic parameters, allows doctors to make more informed decisions on the treatment of scoliosis, such as the decision to opt for a conservative approach (based on specific physiotherapeutic exercises and bracing) as opposed surgery, and vice versa (3).

CONS:

1. Its ability to predict skeletal growth may be limited: the Sanders staging system estimates skeletal maturity and residual growth, but it is not 100% accurate and may be limited in its ability to predict this type of growth.

2. It involves radiation exposure: to perform Sanders staging, radiographs have to be taken of the wrist, but this would mean increasing the radiation exposure of young patients, an aspect we always pay close attention to, and something we try to avoid as much as possible. as much as possible. In some places they experimented performing the classical spinal x-rays with specific hand positions to be able to see also the Sanders, but this is still experimental, and we don’t know yet if and how it changes the spinal posture. It could be a solution. In fact, we recommend that our patients have X-rays taken using EOS, a tool that allows their radiation exposure to be reduced. Of course, modern X-rays are nothing like the X-rays of the past, but it is nevertheless always better to have as few as possible.

3. Issues of cost and availability of resources: Sanders staging requires radiographic/logistical resources and specific expertise to interpret the images, which may not always be available in all healthcare settings. Furthermore, using the Sanders system can result in additional costs for patients or for the healthcare system.

Finally, our scientific director, Prof. Stefano Negrini, has explained an important reason why Sanders staging is not currently used at Isico: “We have a very pragmatic approach to the problem, that is based on adding further radiation only if necessary and if it would change our clinical behaviour. The reality is that scoliosis is still highly unpredictable: it can progress unexpectedly at any bone staging or it can stay stable at the highest risk phases. Consequently, the only clinical change when we are at a high-risk phase is seeing the patients more often, and intervening if needed because of progression. Would that change with more precise knowledge of bone maturity? Bone age is correlated with the risk, but not precise enough to rely on that alone – there are too many other unknowns… To explain all this, I often tell my patients that scoliosis treatment is rather like driving a car on a foggy night. We have some significant landmarks, but we never know exactly where we are. Increasing the precision of external reference points may perhaps help us, but it does not take away the fog or the night, which are the two factors that most determine our risk of having an accident, more than the road signs. In other words, we might well manage to obtain a more accurate assessment of the patient’s skeletal growth. Still, if the disease ends up following this indication only partially and behaving in a way we can’t control, then in reality we have not actually obtained any extra information that is really useful for treating our patient. For this reason, we don’t ask patients to have an additional X-ray if it is not really going to change their treatment significantly”.

References

1 – Prediction of Curve Progression in Idiopathic Scoliosis

2 – Maturity Indicators and Adolescent Idiopathic Scoliosis: Evaluation of the Sanders Maturity Scale

3 – Managing the Pediatric Spine: Growth Assessment

4 – Is there a skeletal age index that can predict accurate curve progression in adolescent idiopathic scoliosis? A systematic review

ISSLS Milan: a success with 500 participants

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“It was a bit as if the world, that of research and clinics in the field of spinal pathologies, had gathered in Milan — this is the comment of Dr. Greta Jurenaite, physiatrist specialist at ISICO — on her first participation in the ISSLS international conference, held between the end of May and the beginning of June. The congress was huge, with around 500 participants, most foreigners, coming from everywhere from Japan to Australia to South America. The few Italians were mostly from our institute.”

We would like to remind you that on the occasion of the conference, the 50th anniversary of its foundation was also celebrated, and Prof. Stefano Negrini, ISICO scientific director, and Dr. Fabio Zaina, physiatrist at ISICO, acted as local guests.

Dr. Jurenaite continues: “The days often began at 7:30 and the presentations continued until dinner, a commitment that makes us understand how much new there is in this sector and how essential it is to keep up to date. I’ll give you an example. On the last day, we participated in a session dedicated exclusively to rehabilitation before back surgery. It was a moment of discussion and comparison, and we reflected on what is still missing to “educate and make the patient as aware as possible, concluding that it is necessary to provide as much information as possible. This is what we do at ISICO when we dedicate time to explaining what scoliosis is, the therapy steps, and the objectives, because every therapeutic choice must be shared with the patient. The discussion was so interesting that we proposed the topic as the subject of a possible scientific article, whose co-authors could be some of us ISICO doctors.”