In adult scoliosis patients with back pain, brace treatment reduced the pain at 1 month, and the improvement was found to be stable at 6 months. This is what emerged from the first prospective study on this topic. The research, by Isico, was published in Prosthetics and Orthotics International and entitled “Can bracing help adults with chronic back pain and scoliosis? Short-term results from a pilot study”.  

“We included 20 patients, all with severe scoliosis” explains Dr Fabio Zaina, physiatrist at Isico. All had back pain secondary to scoliosis and were treated with the Tri-Point brace, which they wore for 1-2 hours a day. Our aim was to establish whether bracing in adults can reduce pain and improve quality of life”.

Developed in the USA, the Tri-Point is a prefabricated device that, however, can be adjusted to the single patient. 

“This is the first time we have conducted this kind of research in adults” Dr Zaina goes on, “and the results were very positive: improvements are seen very early on, with the pain diminishing and quality of life remains constant. What is more, considering the brace wearing time (1-2 hours a day), it is possible that wearing it for a longer time each day might produce even greater benefits”. 

In the presence of a curve measuring more than 50 Cobb degrees, scoliosis is termed “surgical”. Unfortunately, the likelihood of surgical scoliosis worsening, even in adults, and giving rise to pain, disability and reduced quality of life, is very high.

What to do when scoliosis occurs in young children (0-3 years) and in cases of juvenile scoliosis (3-12 years)

Being typically associated with a high potential for worsening, infantile and juvenile scoliosis have, in the past, always tended to be considered surgical cases from the outset. Today, though, we know that there may be some hope of avoiding surgery in these cases,  provided the affected individual adheres to a lengthy course of conservative treatment that begins with the onset of the scoliosis and ends only when he/she has finished growing. Conservative treatment is often recommended in the early stages of scoliosis in any case, even when there is a very high likelihood that surgery will eventually be required.
In such cases, this initial conservative treatment is a means of supporting these young patients until they reach the moment deemed most opportune for performing the surgery, which, in this way, will consist of a single and definitive operation.

What to do when scoliosis is already surgical in adolescence (12-14 years)

 In early adolescence, when the process of bone maturation is not yet complete, a scoliotic curve is at very high risk of worsening. If the affected youngster has never previously tried an appropriate conservative treatment programme (full-time bracing and specific exercises), it may well be worth considering pursuing this avenue and then, together with the medical specialist, re-assessing the situation in the light of the results achieved after the first few months of treatment.

We already know that a scoliotic curve classed as surgical can often be stabilised, and sometimes even improved, through conservative treatment.

Conservative treatment is, as we constantly stress, very protracted and demands considerable commitment and many sacrifices. But it is also a treatment with a beginning and an end, which means that, sooner or later, the brace will become a thing of the past! When young patients, together with their parents, decide to go down this route, it is crucial that their decision is, as far as possible, an informed choice.
For this reason, it is important that they consider speaking to a specialist surgeon (which is not to say that they will automatically be put on a waiting list for the operation!). The decision on whether or not to be treated surgically remains an entirely personal one, but, in order to make it, patients and families need to be informed of the risks and benefits of the operation, and informed about the most innovative surgical techniques available, and about 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 the surgery will ultimately justify this course of action, only armed with all this information is it possible to make a truly informed decision.

What to do about surgical scoliosis in 17-20 year olds

Young people reach bone maturity by late adolescence/early adulthood. At this age, therefore, the risk of growth-related worsening of scoliosis disappears.
Conversely, there is still a risk that the condition may worsen as a result of likely instability of the curves, which remains.

Scoliosis surgery is never a life-saving procedure, and therefore should never be treated as an emergency.

It is always useful to seek the opinion of a surgeon, but there is no reason why the patient, having done so, 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 further progression of the curve, before deciding whether or not to opt for surgery.

What to do about surgical scoliosis in adults

In adults, the extent of the curve, measured in Cobb degrees, is no longer the main parameter considered when deciding whether or not 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 taken into consideration 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.

Isico offers those taking its ONLINE MASTER COURSE “Principles and Practice of Scoliosis Conservative Treatment“, which it has now been running for three years, the chance to see clinical practice in operation at our institute’s Milan headquarters.
Registrations are still open and participants registering by 15 December will benefit from a reduced rate.

Rosemary Marchese, one of the 2019 course participants, decided to take advantage of this opportunity and flew over from Australia specially. While she was here, we decided to ask her about her experience as one of our “students”. Thank you for the chat, Rosemary!

Could you tell us about your studies?

This course has been an amazing opportunity to learn from world experts in scoliosis! What a great opportunity to have access to some of the finest educators in this field. The course is well organised with comprehensive modules on topics useful for my work. The modules ran over two weeks, which allowed time for listening to lectures, reading of literature and involvement in discussions with other course participants from around the world. I thought each module finishing with a live lecture was just a perfect way to consolidate learning in a collaborative fashion.

What is your profession?

I am a physiotherapist, specialising in scoliosis management. 

Why you did register for the World Master course?

I wanted to learn from world leaders and consolidate and update my education following my SEAS and Schroth training.
 
What makes the World Master different from other educational courses and masters programmes? 

It is ALL applicable to my day-to-day work: every single module, lecture, all the content, and every discussion has been relevant. I really enjoyed and valued the ability to manage my own time in the two-week modules, but that there was also an end point to each module to keep the momentum going.
 
Are you satisfied with what you have learned?

Yes! I have found it to be a great learning opportunity!
 
If you were asked to recommend the course, what would you say?

I would highly recommend this course to medical professionals and allied health professionals wanting to further extend their fundamental knowledge in scoliosis management. If you are looking for course 100% dedicated to scoliosis, and designed and delivered in a modern format, then I highly recommend this course.

Prof. Stefano Negrini, scientific director of Isico as well as director of the Cochrane Rehabilitation Field, will be leading a symposium entitled “Cochrane Rehabilitation, the new international body to spread and strengthen evidence in rehabilitation medicine” and the workshop Evidence Based Multidisciplinary Approach to Adolescent Idiopathic Scoliosis at the 96th Annual American Congress of Rehabilitation Medicine in Chicago, running from 5th  to 8th November.

The American Congress of Rehabilitation Medicine (ACRM) is an association that was created to improve the lives of individuals with disabling conditions by supporting research that promotes health, independence, productivity, and quality of life, and by meeting the needs of rehabilitation clinicians and people with disabilities. Given that this event is the world’s largest rehabilitation conference, Prof. Negrini’s participation is an important milestone for Isico, and may be seen as recognition of the significant role that he himself plays within the Cochrane network. As far as the workshop presenters of this introductory course will include 4 professions (MD, PT, CPO, PhD/PA-C), and 3 SOSORT past presidents, one of them is prof. Negrini. Topics: what AIS is, evaluation, current evidence, bracing and exercises schools, clinical cases: medical, physiotherapeutic and orthotic approach, Q&A.
For more information and to register, visit: https://acrm.org/meetings/2019-annual-conference/