SOSORT Conference: Isico in the front row

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Once again, ISICO receives the acceptance, in the form of an oral presentation or a poster, of all nine abstracts submitted for the next annual international conference SOSORT that will be held from May 1 to May 4 in Boston, United States.

This is a reconfirmation with full marks for Isico, among the best researchers in the world in the rehabilitation treatment of spinal pathologies.
The following abstracts will be presented, where the first authors Dr. Fabio Zaina, Dr. Greta Jurenaite and Dr. Carlotte Kiekens, physiatrists, Michele Romano, director of physiotherapy, Giulia Fregna, physiotherapist, are from Isico further to Claudio Cordani, a physiotherapist.

– Normative data for radiographic sagittal parameters in asymptomatic population from childhood to adulthood: a systematic search and review (oral presentation)

– Lessons learned on trunk neurophysiology and motor control from adolescent idiopathic scoliosis. A scoping review (poster)

– Influence of specific interventions on bracing compliance in adolescents with idiopathic scoliosis. A systematic review of the literature including sensors’ monitoring (oral presentation)

– Can currently used questionnaires like ODI (and SRS-22) discriminate patients with scoliosis in a population with chronic back pain? (oral presentation)

– Personal and clinical determinants of brace wearing time in adolescents with idiopathic scoliosis (oral presentation)

– Convexity orientation of single scoliotic curves. Are they as we have always been taught? Verification of 4470 single curves (oral presentation)

– Suspected high prevalence and gender difference of scoliotic curves with the apex at T12 (poster)

– PREPARE: Personalized rehabilitation via novel AI patient stratification strategies – the case for idiopathic scoliosis during growth (poster)

– Case series report of atypical lumbar Scheuermann’s disease treated with braces and physiotherapeutic specific exercises (poster)

One of the 9 abstracts presented is linked to the European project PREPARE, in which ISICO takes part.

PREPARE Rehab aims to provide healthcare professionals with valuable insights and tools to predict better and stratify patients, ultimately leading to more personalized and effective rehabilitation interventions. Artificial Intelligence (AI) may help predict treatment outcomes and improve rehabilitation strategies for Idiopathic Scoliosis.

“By combining different factors that influence treatment success, AI-based models can provide a better understanding of the natural progression of the disease and the factors that determine the effectiveness of treatments. This allows us to personalize therapies better and avoid both over-treatment and under-treatment  – explains Dr. Carlotte Kiekens, one of the researchers of this project. With its ability to analyze large amounts of data and utilize deep learning techniques, AI offers a comprehensive approach to predicting functional prognosis and setting goals in Individual Rehabilitation Projects (IRPs)”.
In this study, data from over 21 thousand patients were taken into consideration. What do we expect to achieve?
“Three results: a clinical decision support system to be used by clinicians to make shared decisions with their patients and families, integrating big data and thus providing real-time insights; the development of innovative methods and models for categorizing patients into different groups based on specific criteria – ends Dr. Kiekens – and a roadmap that outlines the steps and requirements for ensuring compliance with medical device regulations.  These expected results indicate a comprehensive approach to improving healthcare through the integration of advanced technology, data analytics, and regulatory compliance measures”.

Isico: our research on the roof of the world

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ISICO specialists, starting with Prof. Stefano Negrini, scientific director, and Michele Romano, physiotherapy director, are at the top of the world’s research rankings with research on SEAS – Scientific Exercise Approach to Scoliosis, and the revolutionary Sforzesco brace, which has proven its efficacy in replacing plaster casts in the treatment of scoliosis.

The data from three studies (Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualization study, Exercise therapy for adolescent idiopathic scoliosis rehabilitation: a bibliometric analysis, A bibliometric review and visual analysis orthotic treatment in adolescent idiopathic scoliosis from the Web of Science database and CiteSpace software) says so.

These studies have just been published and are the first to map the scientific knowledge of research on scoliosis conservative treatment using visual research techniques by examining its hotspots, frontiers, and evolutionary trajectories, aiming to give an in-depth overview of the research status and developments in this subject, serving as a reference for researchers. 

Alan Pritchard introduced the scientific approach known as bibliometrics in 1969, monitoring data relevance and projecting future limits are aided by it. Researchers may comprehend the breadth of pertinent studies and efficiently promote information integration with the help of bibliometric analysis and its visualisation.

“These are the first three bibliometric analyses and visual analyses of orthotic treatment in adolescent idiopathic scoliosis that were taken into account from 1990 to 2023. In total, over a thousand articles and a total of 1005 records were included,” explains Prof. Stefano Negrini. “In Isico, we have 283 publications indexed in the last twenty years; 71 have dealt with scoliosis and braces and 37 with our SEAS approach. Numbers that, together with these recent bibliometric analyses, photograph the commitment and quality of years of constant and constantly growing scientific research”.

Scoliosis and conservative treatment: what we know
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that develops in teenagers for unexplained causes. The guidelines of the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), are presently the treatment recommendations and the basis for available treatment choices.

For children with a Cobb angle between 26° to 45°AIS, bracing is the suggested nonoperative treatment option; for those with Cobb angles larger than 40° to 45°, surgery is advised. On the other hand, some parents and children with AIS insist on wearing a brace instead of having surgery performed. According to recently published meta-analyses, bracing can also reverse the progression of scoliosis curves from 40° to 60°. 
Nevertheless, no bibliometric investigation has yet been done in this area.

Top of the class
1) The countries
China and Turkey are the only two of the ten countries with the greatest publishing output, categorised as developing; the other eight are categorised as developed. With 1,261 citations, the USA’s study was the most referenced, followed by China (977) and Italy (576).
The United States of America has the greatest annual publication volume, the longest length of research in this field, and the earliest start. China has the second-largest yearly publication volume, with a late start but quick development. It has grown remarkably every year, particularly in the last few years, and currently holds the record for the nation’s highest proportion of yearly publications. 
Both are followed by Canada and immediately after by Italy, which comes in fourth place with 47 published articles.

2) The researchers/ High-impact authors
According to the study Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualisation study, of the 3,472 authors included in the visualisation atlas, 15 have published more than 10 articles. And here, too, Italy with Isico is among the top five in the world: three positions are occupied by Canadian authors, one by a Chinese author, and the fifth by Prof. Stefano Negrini, scientific director of our institute, for the number of articles published. In the classification, in the tenth place in the world, we also find Dr. Fabio Zaina, a physiatry specialist at Isico.
Prof. Stefano Negrini is in first place regarding the frequency of citations.
The new SOSORT 2016 guidelines, published by Prof. Stefano Negrini et al. in 2018, had the highest burst intensity among the 25 burst citations with the most co-cited literature, according to an evaluation of the Web of Science database. It focused on the background of idiopathic scoliosis, described conservative treatments for various populations, provided flow charts for clinical practice, reviewed the literature, and made recommendations regarding bracing, PSSE, assessment, and other conservative treatments.
It should be noted that Prof. Negrini is also in seventh place with the 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.
Instead, the study Exercise therapy for adolescent idiopathic scoliosis rehabilitation takes into consideration the top 10 active authors who have published literature on exercise therapy for AIS rehabilitation, and here Isico is on the roof of the world: Prof. Stefano Negrini is in the first place, followed by our physiotherapy director Michele Romano, while in the fourth and fifth places, we find Dr. Fabio Zaina and physiotherapist Alessandra Negrini.
The authors of this latest research write: “With 287 citations overall and an average of 47 citations per manuscript, it shows that the Italian Scientific Spine Institute is placed top in terms of citations per paper. Furthermore, the H-index could fairly represent the author’s academic accomplishments. With the highest ranking on the H-Index, Negrini Stefano is the most influential person in this sector. 172 publications have been published thanks to the efforts of this group of authors, with Negrini Stefano taking the lead. The team focuses on rehabilitating idiopathic scoliosis during growth, particularly through treatment with specific exercises”.

 Monia Lusini comments on a recently published study about patient’s perception of back pain

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“How well can the clinician appreciate the patient’s perception of the severity and impact of their back problem?” was recently published in the European Spine Journal. The study was carried out in two collaborating centres (in Switzerland and Italy) and involved five consultant spine specialists and 108 of their patients who had presented for treatment due to a low back disorder.

This cross-sectional study compares patients’ and physicians’ ratings made on the same day of the consultation for treatment.

Let’s make a premise. Good doctor-patient communication allows patients to share vital information regarding the nature of their problem, which is essential for an accurate diagnosis.

“Effective communication has been associated with improvements in patient satisfaction, greater adherence to treatment plans, better and more appropriate medical decisions, and improved clinical outcomes, ” explains Dr. Monia Lusini, an orthopaedic doctor and one of the research study’s authors. One of the main concerns of patients with back problems is typically their back and/or leg pain (together with its origin) and its impact on their function and quality of life. These subjective data must be considered during the visit so that the specialist can verify their impact on the patient’s daily life and decide on the best treatment path.”.

The study evaluated the agreement between clinicians’ and patients’ independent ratings of patient status on the Core Outcome Measures Index (COMI). The Core Outcome Measures Index for the back (COMI back) is a short, validated, multidimensional outcome instrument with excellent clinimetric properties.

The study shows that doctors could ascertain the location of the main complaint of their patients with good accuracy; however, they systematically underestimated the severity of the patient’s leg pain and dissatisfaction with their current symptom state and overestimated how much the patient’s function was impaired.

This is probably because at the time of the visit, the patient is no longer in the acute phase of pain and functional impotence that he was forced to experience in the previous days, but the memory is still vivid. Often, it is the patient himself who is amazed at how he can move during the visit compared to just a day or two before.
The COMI questionnaire is, however, fundamental for these patients to understand the difference in quality of life and pain before and after the prescribed and performed therapy.

“More detailed or direct questioning on these domains during the consultation might deliver a better appreciation of the impact of the back problem on the patient’s daily life,” concludes Dr. Lusini.”

SEAS in short: quick data, courses and future

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SEAS (Scientific Exercise Approach to Scoliosis) is one of the few approaches to scoliosis treatment based on specific exercises. It has spread worldwide thanks to training events organised for years on all five continents.

What is SEAS, in short? These specific exercises are varied and updated continuously to avoid boredom and stimulate our nervous system and spine more and more with a custom self-correction individualised for each curve.

Some quick data

Since 2010, 272 educational programmes have been implemented, of which 115 in Italy and 157 abroad, which has led to the training of more than 6000 therapists.

“The interest collected, in conjunction with the published scientific evidence that the approach is valid, has prompted us to accept the increasing demands for the training of local teachers who started to programme more capillary courses in different countries,” explains Michele Romano, Director of Isico physiotherapy and head of SEAS courses “This has allowed us to divert efforts even to geographical areas where we were not yet able to bring our approach”.

Participants accredited since 2011 in courses abroad: https://en.isico.it/seas-participants-accredited-since-2011/

SEAS versus Schroth
A primate of diffusion that SEAS shares with another method, the Schroth, born in Germany at the beginning of the last century: both are recognised as reliable by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) but present non-secondary differences. One of these is the ease of learning and performing the exercises, as well as the active correction that patients learn to practice.
In Schroth, the active alignments of the column, which therapists teach the hearing patients, are characterized by considerable difficulties in execution and, above all, the objective and complex execution of the program at home, which the classic protocols provide but which is difficult to perform without the support of the therapist.
In a study published this year, the authors interviewed 173 professionals who treat scoliosis using the Schroth method in Europe and America. 52% of these operators declared to use a different method in combination, and in 37.9% of cases, the different approach is SEAS.

That is why an increasing number of physiotherapists trained with Schroth integrate the classic treatment with SEAS exercises to help the less skilled patients while adhering to a treatment that lasts for years.
One of the main obstacles to continuing these treatments is the boredom caused by the repetitiveness of a small group of exercises, which patients perform throughout the therapy.
The many therapists who apply Schroth try to overcome the weaknesses of the first method by teaching the most straightforward and most dynamic SEAS exercises.
In Isico centres in Italy, SEAS provides learning sessions ranging from 60 to 90 minutes, with monthly, bimonthly, or quarterly frequency, depending on the treatment phase. After these sessions, patients can perform the exercises on their own at home. This significantly reduces costs by combining quality (learned at the Isico Centres) with convenience (exercises at home or close to home).


SEAS: the near future

“In the future, we will anticipate the training of other local teachers that will cover increasingly large areas of the globe,” concludes Romano, “and will spread more and more SEAS treatment.”
Isico will be engaged in the design of rehabilitation facilities in different continents dedicated to the application of SEAS, so that there can be trained specialists on site who take care of an increasing number of patients.

I have surgical scoliosis: should I have surgery or not?

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In the presence of a curve measuring more than 50 Cobb degrees, scoliosis is termed surgical; this is because there is a very high chance that it will worsen even in adulthood, causing pain, disability and reduced quality of life.

What should be done when surgical scoliosis occurs in infantile (0–3 years) or juvenile (3–12 years) cases? 
In the past, infantile and juvenile forms of scoliosis, being typically associated with a high potential for worsening, have always tended to be considered surgical cases regardless. There may be some hope of avoiding surgery, provided the affected individuals adhere to a lengthy period of conservative treatment. This will begin at the onset of the scoliosis and will continue until they have finished growing. Conservative treatment is often recommended in the early stages of scoliosis anyway, even when there is a very high likelihood that the patient will ultimately need surgery. In such cases, this treatment supports the patient until he/she reaches the best age and stage to undergo surgery, and it, therefore, helps to ensure that the surgical treatment will consist of a single and definitive operation.

What should be done when scoliosis is surgical in adolescence (from 10-14 years)?
At this age, the process of bone maturation is not yet complete, and therefore, scoliosis is at a high risk of worsening further. If the patient has never previously tried a valid conservative treatment programme (24-/23-hour bracing combined with specific exercises), then it might be worth trying this approach for a few months, after which, together with the medical specialist, the situation can be reassessed in light of the results obtained. We know that a scoliosis curve classed as surgical but still within 60° can be improved through conservative treatment and get below the surgical threshold in a certain number of cases. While this result cannot be guaranteed, it is worth trying to achieve it.
While this result cannot be guaranteed, it is worth trying to achieve it. It is a very long course of treatment that demands considerable commitment and many sacrifices, but it is essential to remember that it has a beginning and an end: sooner or later, patients are able to get rid of their brace! In any case, young patients and their parents must always be helped to make, as far as possible, an informed choice about the course they wish to follow. To this end, it is important to consider seeking a specialist surgical consultation (which is not the same as deciding to go on a waiting list for surgery!). The decision on whether or not to be treated surgically is a wholly personal one, but in order to make it, patients and families need to be informed of the risks and benefits of the operation; they must also be told about the most innovative surgical techniques available and the post-surgical recovery: how long it will take and what to expect. Given that it is impossible to know beforehand whether the benefits of surgery will be sufficient to justify performing it, only armed with all this information is it possible to make a truly informed decision.

What should be done in the case of surgical scoliosis at 17–20 years of age? 
This is the age at which, as bone maturity is reached, the risk of a growth-related worsening of scoliosis disappears. However, the condition may still worsen due to the instability of the curves. It is important to keep in mind that scoliosis surgery is never a life-saving procedure and therefore should never be treated as an emergency. It is always helpful to seek the opinion of a surgeon, but there is no reason, in this situation, why the patient should not choose to wait, taking the time to verify, through periodic checks with his/her medical specialist, the stability, or otherwise, of the situation. Should an evolution of the curve occur, it will still be possible to undertake a specific course of exercises and assess, over time, whether these are sufficient to stop the curve’s progression, before deciding whether or not to opt for surgery.

How should adults with surgical scoliosis be treated?
 In adults, the extent of the curve, measured in Cobb degrees, is no longer the main parameter when deciding whether to opt for surgery. When examining X-rays taken in adults, attention is paid mainly to the sagittal plane, given that adults (unlike youngsters) are more likely to develop a more forward-bent posture.
The other parameters to be considered are pain, disability and quality of life. Given that the surgery carries risks, and it is not possible to know in advance whether the benefits of the surgery will be great enough to justify choosing this course of action, in adults it tends to be chosen only in the presence of a highly debilitating level of pain that is seriously compromising the patient’s quality of life. In this case, too, it is possible first to undertake a specific conservative treatment, in order to monitor how, over time, it affects the stability of the curve and the level of pain and disability. In this way, the possibility of surgery can be weighed up in the light of its results.

Scoliosis: learning to love yourself and overcome your fears

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Many of our patients receive their scoliosis diagnosis in the midst of what is one of the most intense and turbulent periods in a person’s life, characterised by sudden and profound transformations that can even lead them to question and redefine their very identity. We are talking about adolescence.
During adolescence, the body changes, even quite abruptly, and these changes do not always give us the body we would like to have.
At the same time the sexual organs and secondary sexual characteristics are developing too, leading us to discover a new, previously unexplored, dimension of our body.
Cognitive development continues and sometimes peaks in adolescence. In other words, our cognitive functions gradually reach full maturity, albeit not all at the same rate. In fact, the different areas of our brain have different developmental trajectories and mature at different times. The frontal lobes are a particularly interesting area in this regard, as they constitute the neural substrate of what are termed executive functions, i.e., complex cognitive abilities such as the ability to plan, organise and regulate our behaviours.
Adolescence is also the period of life in which we experience an increasing range and intensity of emotions, but may struggle to regulate them if the brain area involved has not yet reached full maturity.
“Finally, our social relations are also an area of life that changes in adolescence,” explains ISICO psychologist Dr Irene Ferrario. “This is, of course, the period when friendships become increasingly meaningful and important to us, and in which, in some cases, we form our first romantic attachments. In short, it is a time when the demands placed on us by our social environment are becoming ever more complex.”
While all this is going on, some young girls and boys also find themselves having to handle and “digest” a diagnosis of scoliosis and the need to wear a brace, something that some patients find harder to do than others.
“One of the most common reactions in those struggling to accept their scoliosis and its consequences is anger towards a condition that, they feel, limits their freedom, that they perceive as unfair, and that makes them feel embarrassed, given that the brace can be seen under their clothes or felt when others hug them,” Dr Ferrario goes on.

Fear of what others might say or think is something we can experience at any age, although it is particularly frequent and acute in adolescence when we desperately desire to feel accepted by our peers, and to be like them. For some people, though, this fear can be paralysing, leading them to avoid all situations in which they might be exposed to the judgements of others. As a result, they limit their experiences, leading to even greater feelings of isolation and loneliness.
Sometimes it can be enough to talk these feelings over with friends or parents, or it may be sufficient, with the help of the doctor or physiotherapist, to find ways to manage the brace better.
Other times, patients can find it useful to talk with a psychologist about their feelings and the suffering a certain situation is causing them. Scoliosis treatment is a long and arduous process and it is quite normal to experience moments of difficulty due to tiredness or linked to changes in the patient’s life. Changing schools, changing friends, starting new relationships, arguments at home — all these are situations that can become moments of crisis that in turn impact the management of the treatment.
“The word crisis has negative connotations, but in actual fact this word came into being with a very different meaning” Dr Ferrario remarks. “It comes from a Greek word meaning choice or decision. In this light, a moment of crisis can be seen as an opportunity to make a choice that there is no escaping, whether you like it or not — an opportunity to redefine some aspects of yourself. Asking for help in a crisis is not a weakness. On the contrary, it takes courage to question yourself and decide to ask for help!”

At ISICO, it is sometimes families that ask to see the psychologist, and sometimes the doctors or physiotherapists suggest it, if they realise that a youngster is struggling, whether or not it is because of the treatment.
The intervention, at this point, may range from simple identification of the factors underlying the patient’s non-compliance to the structuring of a personalised support or psychotherapeutic pathway based on the youngster’s specific needs. The psychologist can also support doctors and therapists by helping them to understand and manage complex situations.
This collaboration between mental health professionals, doctors and physiotherapists allows us to take care of the whole person and not just their back.

Stanford University has identified the best researchers in the world; ISICO is part of it!

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Isico, with its specialists, is still in the “hall of fame” of the world of researchers: Prof. Stefano Negrini, our scientific director, has risen to 52nd place in the world among those involved in rehabilitation research, first among Italians.
This is to say that Prof. Negrini is among the best researchers and scientists in the world in the field of rehabilitation.
In the general ranking of all branches of scientific research, he is in 37,206th place overall.
How does it work? Every year, a group of analysts from the American University of Stanford, led by Prof. John Ioannidis, in collaboration with the medical publishing house Elsevier and the global research database “Scopus”, collects data relating to indicators of standardised citations, referring to as many as 8.6 million researchers from universities and research centres around the world. The ranking covers the entire career, and all researchers in the world since the 1960s are present. Thanks to the processing of this data on 22 scientific sectors and the related 176 sub-sectors, researchers cited in the top 2% of the ranking are inserted into a database. 

We started by saying “still” because already in the past, Isico, with some of its specialists, had entered the highest places in the “Expertscape” ranking, an American rating agency that identifies the leading experts in the world in various medical disciplines based on an analysis of a series of parameters and variables.
The site refers to the PubMed database to identify the world’s leading experts in more than 27,000 branches of medicine. Isico, as a clinical institute, was placed in 38th place, first among the structures that deal with non-surgical treatment, while in the ranking of global experts for the treatment of scoliosis (both rehabilitative and surgical), Prof. Negrini was among the top twenty (11th, to be precise).  Also present in the ranking at that time were Dr. Fabio Zaina, physiatrist, and our physiotherapy director, Michele Romano. 

A new confirmation of Isico’s high level of research and scientific experience in the rehabilitation treatment of spinal pathologies aimed at improving daily clinical practice with verified data. 

Do youngsters with scoliosis walk differently ?

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In recent years, many studies have been conducted analysing gait and postural control during walking. Some of these have included gait analysis in youngsters affected by scoliosis.

The first thing to emerge from the literature is that the type of scoliosis does not influence gait. Indeed, no differences in the variables analysed were found between patients with adolescent idiopathic scoliosis and those with congenital scoliosis. Therefore, the gait disturbance in scoliosis is secondary to its existence and not related to its onset or aetiology [1].

In general, study results indicated that patients with scoliosis produced an asymmetrical rotation pattern in the frontal and transverse planes [2] and therefore, when walking, shifted their body to the side and rotated on themselves.

The position of the curve actually influences the motor pattern: in adolescent idiopathic scoliosis, patients with a single thoracic curve showed asymmetrical trunk movement in the transverse plane, whereas those with a single lumbar curve showed asymmetrical trunk movement in the coronal plane. These results suggest that the postural control strategy of patients with scoliosis differs according to the curve pattern [3].

Contrary to what X-rays deceptively show, scoliosis is not solely a deformity in the frontal plane but rather a fully three-dimensional deformity that X-rays can show only in two dimensions. This is confirmed by the findings of several analyses in which postural adjustments during walking were observed in all three space planes [4].

Scoliosis reduces the physiological curves in the sagittal plane, mainly due to loss of dorsal kyphosis. One study has, in fact shown that patients with scoliosis “may lean backwards and have posterior postural sway, which may be associated with hypokyphosis during walking” [5].

It has also been observed that adolescents with scoliosis have difficulty maintaining smooth bodyweight transfers during strides and that this difficulty increases with increasing severity of the spinal deformity. Gait parameters, namely the loading response, midstance phase and propulsion phase, were not found to differ between the left and right sides. However, patients with moderate and severe scoliosis had asymmetrical gait periods in both limbs,  suggesting abnormal asymmetrical gait patterns [6].

Given all this information, we were drawn to a recently published meta-analysis in which reduction of the stance phase and restriction of frontal pelvic motion was found to lead to prolonged activation timing of the quadratus lumborum, erector spinae and gluteus medius muscles [7].

A final question was whether these differences in walking might affect youngsters’ daily lives. In this regard, one study, using a pedometer installed on smartphones, showed no difference in daily walking distance between adolescents with and without scoliosis [8].

References

[1] Garg B, Gupta M, Mehta N, Malhotra R. Influence of Etiology and Onset of Deformity on Spatiotemporal, Kinematic, Kinetic, and Electromyography Gait Variables in Patients with Scoliosis-A Prospective, Comparative Study. Spine (Phila Pa 1976). 2021 Mar 15;46(6):374-382. doi: 10.1097/BRS.0000000000003796. PMID: 33620181.

[2] Yang JH, Suh SW, Sung PS, Park WH. Asymmetrical gait in adolescents with idiopathic scoliosis. Eur Spine J. 2013 Nov;22(11):2407-13. doi: 10.1007/s00586-013-2845-y. Epub 2013 Jun 4. PMID: 23732766; PMCID: PMC3886502.

[3] Nishida M, Nagura T, Fujita N, Hosogane N, Tsuji T, Nakamura M, Matsumoto M, Watanabe K. Position of the major curve influences asymmetrical trunk kinematics during gait in adolescent idiopathic scoliosis. Gait Posture. 2017 Jan;51:142-148. doi: 10.1016/j.gaitpost.2016.10.004. Epub 2016 Oct 11. PMID: 27764749.

[4] Wu KW, Wang TM, Hu CC, Hong SW, Lee PA, Lu TW. Postural adjustments in adolescent idiopathic thoracic scoliosis during walking. Gait Posture. 2019 Feb;68:423-429. doi: 10.1016/j.gaitpost.2018.12.024. Epub 2018 Dec 18. PMID: 30594870.

[5] Horng J, Liu XC, Thometz J, Tassone C, Duey-Holtz A. Evaluation of plantar pressures and center of pressure trajectories in Adolescent Idiopathic Scoliosis. Stud Health Technol Inform. 2021 Jun 28;280:131-135. doi: 10.3233/SHTI210451. PMID: 34190074.

[6] Zhu F, Hong Q, Guo X, Wang D, Chen J, Zhu Q, Zhang C, Chen W, Zhang M. A comparison of foot posture and walking performance in patients with mild, moderate, and severe adolescent idiopathic scoliosis. PLoS One. 2021 May 17;16(5):e0251592. doi: 10.1371/journal.pone.0251592. PMID: 33999943; PMCID: PMC8128255.

[7] Kim DS, Park SH, Goh TS, Son SM, Lee JS. A meta-analysis of gait in adolescent idiopathic scoliosis. J Clin Neurosci. 2020 Nov;81:196-200. doi: 10.1016/j.jocn.2020.09.035. Epub 2020 Oct 13. PMID: 33222916.

[8] Gaume M, Pietton R, Vialle R, Chaves C, Langlais T. Is daily walking distance affected in adolescent idiopathic scoliosis? An original prospective study using the pedometer on smartphones. Arch Pediatr. 2020 Aug;27(6):333-337. doi: 10.1016/j.arcped.2020.04.002. Epub 2020 Jun 17. PMID: 32563619.

Will the prominence disappear once the brace is on?

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This question, together with others linked to aesthetic concerns, is often asked by parents and by youngsters about to start wearing a brace. After all, scoliosis is characterised by variable and sometimes marked clinical signs at the level of the trunk. The scoliotic prominence, linked to the spinal rotation component of the disease, becomes evident on bending forwards, but in some individuals it is also visible when standing. Changes in scoliosis have been found to be correlated with changes in the prominence, although this is not to say that a given degree of change will necessarily be proportional to a worsening or improvement of the hump; that said, a modification of the prominence can usually be taken as a sign that the scoliosis has changed.

Clinical monitoring of the prominence at medical checkups is therefore essential during brace treatment to establish whether there has been any reduction.

Bracing is a treatment that has two equally important objectives:

  • to stabilise or (when possible) improve the radiographic picture
  • to improve the appearance of the back

Essentially, the corrective force applied by the brace to the trunk reduces the rotation of the vertebrae, limits this particular contributing factor, and shapes the ribs and lumbar musculature to minimise the aesthetic impact of the curve. All these aspects will vary according to the type of brace, the experience of the orthopaedic technician who built it, the specific characteristics of the single spine and, last but certainly not least, the patient’s compliance with the treatment.

As we have said, clinical monitoring of the prominence at medical checkups is necessary, but the importance attached to this aspect should not be taken to mean that vertebral rotation always has an aesthetic impact and therefore constitutes an “enemy” to be fought at all costs.

In reality, in most cases, the problem is visible only to the trained eye of expert clinicians (doctors and physiotherapists), and parents and youngsters learn to see only it after the condition has been diagnosed and pointed out to them.

This is borne out by the fact that parents at the first consultation will often admit that, until then, they had never been aware of their child’s scoliosis and the associated aesthetic changes. For this reason, they usually have the impression that “the whole problem sprang up overnight”.