Over the past 13 years or more, we have published dozens of posts and thousands of comments on our forum dedicated to scoliosis.
The Isico forum is a dedicated space where patients can ask questions and swap experiences, but it is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and also engage with patient.  Here is one of our published posts.

Will the hump disappear once the brace is on?

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 hump, 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 hump, 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 hump can usually be taken as a sign that the scoliosis has changed.

Clinical monitoring of the hump at medical checkups is therefore important during brace treatment, in order 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 serves to reduce the rotation of the vertebrae, in an effort to limit this particular contributing factor, and shape the ribs and/or lumbar musculature, in order to reduce 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 hump at medical checkups is important, 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 often have the impression that “the whole problem sprang up overnight”.
In fact, wearing a brace is a great way of learning not to care about how others may judge you. It will help you to make sure you only spend time with real friends, those who you know you can always count on! Unfortunately, nothing comes easy in life, and making friends takes time and effort, but you have to be prepared to persevere in order to see the results, just like with your brace!

The people who stick up for you and support you when things are tough are your real friends. As for the rest, take no notice of them. They are just people you happen to know! 

In September, the Scoliosis Research Society (SRS) held its 54th annual conference in Montreal, and Isico was there! The SRS annual conference is one of the most important international meetings devoted to scoliosis, and every year over 1700 research studies are submitted to the organisers for consideration. Despite this level of “competition”, one of the papers presented by Isico was, for the fourth year running, selected as the topic of an oral presentation, which was given by Prof. Stefano Negrini.

“Our research was very well received; in fact, interest in conservative treatments is growing all the time among surgeons” Prof. Negrini  remarked. “What our study showed was that degrees of curvature can be accurately predicted by combining clinical measurements of the hump: this not only reduces the number of X-rays patients have to undergo, but also the number of affected individuals who  go undiagnosed”.

During the conference, there was also discussion of mini-invasive surgical techniques. However, since there is, as yet, no short- or long-term evidence of the efficacy of these methods, their use is currently restricted to highly selected cases.

“This scientific society is ready to invest in research into the use of braces in children and adults” added Prof. Negrini. “The non-operative management committee suggested holding a course in Athens during IMAST, which is the second annual international congress organised by SRS, where Dr Sabrina Donzelli (an Isico physiatrist) and I will both be taking part as lecturers”.
Finally, this year’s SRS annual conference also saw Prof. Alberto Ponte, one of the world’s top ten scoliosis experts, presented with a Lifetime Award for his achievements, and this recognition was a source of great pride for us Italians! It was Prof. Ponte, of course, who developed an important technique for the surgical treatment of kyphosis (the Ponte osteotomy), which continues to be used in scoliosis surgery to preserve or restore the sagittal balance of the surgically treated spine.

“We couldn’t possibly have asked for a better piece of news than this to mark June, which is World Scoliosis Awareness month” commented Prof. Stefano Negrini, scientific director of Isico. “This recognition from Expertscape is a source of huge satisfaction not only for me but for the entire organisation I represent”.

Because while Prof. Negrini features among the world’s top 20 experts in the rehabilitation and surgical treatment of scoliosis (he is listed 11th to be precise: http://www.expertscape.com/ex/scoliosis), Isico finds itself in 38th place in the classification of clinical institutes. What is more, Prof. Negrini is not the only Isico specialist to appear in the classification: Drs Fabio Zaina (24th), Michele Romano and Sabrina Donzelli are also included.

Negrini’s ranking is based on 55 articles published since 2008.

What is Expertscape? It is an American rating agency that classifies the world’s leading experts in the various medical disciplines on the basis of the   analysis of a series of parameters and variables. With reference to the past 10 years, the site uses the National Institutes of Health PubMed database to identify and rank medical expertise across more than 27,000 topics.

The site was created to make it easier to find top specialists in any field of medicine. The site managers specify that they evaluate “scientific knowledge”; other criteria clearly cannot be taken into account in their evaluation, given that some of the top experts might be involved solely in research, and not in daily clinical practice with patients.

In the case of Isico, and its specialists, this recognition reflects the constant research and scientific publishing activity that accompanies their daily clinical involvement with thousands of patients.

Learn more about Expertscape’s methodology and how to increase your ranking.

“Ever since 2010, we at Isico have been using Thermobrace, a heat sensor that is applied to the brace in order to establish how much it is actually being worn. We see this as a way of fostering a better doctor-patient relationship, as well as a means of collecting real-life data that can be used to optimise the use of the brace”

explains Dr Sabrina Donzelli, Isico physiatrist and author of a study entitled “In defense of adolescents: They really do use braces for the hours prescribed, if good help is provided. Results from a prospective everyday clinic cohort using thermobrace”, published in the journal Scoliosis. “Our implementation of this heat sensor, which is the most suitable of those currently available on the market, has been a gradual process” she says. “Initially, we applied it to the braces of just a handful of patients, precisely because until recently literature opinion on the use of this kind of instrument was divided. We have actually found that it helps to strengthen the doctor-patient relationship, as it allows us to make therapeutic choices on the basis of real-life data obtained from the sensor, and these data can thus be used to optimise the use of the brace”.

The most surprising finding was that the patients who have the highest number of prescribed brace-wearing hours were the ones who showed the best compliance with the treatment. It emerged that 45% of the patients used the brace for the number of hours prescribed, or for just an hour less,  while 55% claimed to be wearing the brace for a number of hours that was very close to the actual number (a difference of 1 hour at most), and 60% showed 90% compliance.

Patients and parents tend to overestimate compliance, hence the reason for developing an objective assessment based on the use of heat sensors.

Whereas the authors of other studies set out only to verify actual compliance with the prescribed number of brace-wearing hours, our aim was to test the sensor as a tool for improving clinical practice. Accordingly, we have never used the sensor without a patient’s knowledge. We do not see Thermobrace as a means of “checking up” on patients, but rather as a tool for collecting real-life data that can be used to optimise treatments.

Indeed, these sensors enable doctors to be more precise as they endeavour to make the best clinical decisions. Along with brace quality and some disease factors, compliance is a key element in the efficacy of brace treatment: “In patients known to comply reliably with the treatment, we should be able to get a much more accurate idea of the true effectiveness of braces” added Dr Donzelli.

From 14 to 16 June, Michele Romano, our director of physical therapy, held a SEAS I course in Novi Sad. The event was our first in Serbia and it attracted over 20 participants, coming not only from Serbia, but also from Croatia, Israel, the Netherlands, North Macedonia and Montenegro.

Novi Sad was also the venue, on 29 June, for the ScoSym International Symposium on “Current Trends in Research on Scoliosis and Other Spinal Deformities”, where Romano was an invited speaker and gave a talk on the topic of sport and scoliosis.

Finally, at the end of July, Romano will be on the move again, flying to China to lead the last SEAS courses before the summer break. These will be held in Shanghai and Zhenzhou.