Paola has scoliosis: her back is twisted on itself. Therefore, she has been given a brace to wear — a nice plastic “jacket” that she is actually going to have to wear for some years to come. But why? Well, to straighten her back, of course!

This, of course, is a logical train of thought, but unfortunately logic and medicine don’t always go hand in hand.

A similar logical train of thought leads many people to think that surgery can eliminate the problem of scoliosis, but the reality is that surgery simply fixes a section of the spine with screws and bolts, blocking the curve in order to stop it from worsening. And even in those instances when the surgeon manages to almost straighten the patient’s back, we have to ask ourselves whether a surgically treated scoliotic spine can ever possibly be the same as before.

The answer is that, obviously, it can’t – the fixation devices (screws and bolts) used to arrest the progression of the curve are constraints that will prevent single segments of the spine from moving.

In reality, many, if not all, treatments used in medicine don’t solve, erase or even fix the problem they are addressing. Therapy gives us the instruments we need to manage, as well as possible, our condition and all the problems it brings.

Take diabetes, for example. You have diabetes? No problem, just take a drug before each meal: it will control your blood sugar level. What it won’t do, however, is get rid of your diabetes.

The same goes for scoliosis. Scoliosis can’t be erased; it can’t be eliminated. If you have it, the first thing you have to do is accept that you have a totally manageable health problem.
Then you simply have to roll up your sleeves and get on with the business of taming it. Try thinking of it like a wild horse, but one that we can certainly tame and keep under control. Just don’t expect to be able to transform it into a fluffy little pet — it will always retain some of its wild spirit!

Receiving a diagnosis is always a difficult moment: it doesn’t matter what disease you are being told you have. Therefore, accepting the presence of  imperfection is hard, both for patients and for their parents.

Sometimes it seems easier to pretend that the problem is not there, and with scoliosis it is certainly easy to do this: first of all, being “behind us”, it is harder to see. Also, at the outset it is not particularly noticeable, or may even be almost invisible, externally. Unfortunately, however, scoliosis, is sneaky and very insidious, and sooner or later it forces us to face reality. That’s when we find ourselves, once again, weighing up the treatment options. There will always be more than one treatment option, but as time goes by the possible outcomes change, and therefore so, too, do the objectives of the treatment!

The ultimate objective in scoliosis treatment is to ensure that the patient has a healthy and functional back by the time they have finished growing, and that does not mean a straight back. A healthy back is one capable of withstanding the stresses and strains of daily life for the 70 or so years that we can, on average, expect to live once we have finished growing. It is also a back that will do its job without giving us pain, and without developing a major worsening of the curves.

Science has taught us that this objective is realistic, providing the curves are still under 30°-35° at the end of growth, which is hardly straight!

In pursuit of this ultimate objective, strongly supported by the SOSORT guidelines, medical prescriptions can differ between patients, even ones whose situation is apparently similar.

In some families, there will be more than one sibling affected by scoliosis, and even though these youngsters have the same disorder, its morphology may well vary. For example, one might have a dorsal curve and another a lumbar one. Similarly, the severity of the curves can differ: you might find one girl who can be treated with exercises alone, while her older sister has to wear a brace full time.

In these situations, misunderstandings can often arise! Let me give you an example.

Laura has scoliosis, an approximately 30° curve that was discovered when she was 14 years old. After examining her, the physician prescribed a rigid brace, to be worn 23 hours out of 24. By the end of the treatment her curves had improved considerably, her trunk was perfectly modelled and symmetrical, and her scoliotic curve had decreased to under 20°!

Laura has a sister, four years younger. From the time of Laura’s first examination, the physician caring for her began monitoring her sister, too. When she was 11 years old, the younger sister began treatment involving exercises alone. By the time she finished growing, however, her curve measured between 25 and 30 degrees!

At the end of the treatment, the mother was disappointed and worried about the younger daughter’s outcome. The family, at a considerable personal sacrifice, had done everything according to the physicians’ instructions, for years bringing both daughters along for examinations and exercise sessions, only to end up with one daughter with worse curves than her sister.

In these situations, comparisons are inevitably made and the straight back misunderstanding arises! Nowadays braces aren’t as alarming as they once were and patients might well be tempted to think, why not wear one anyway, if it means I will end up with a nice straight back?

Because the fact is that a person whose back is straight by the end of growth will enjoy the same level of function and the same quality of life as someone whose back is slightly curved (under 30º). That’s why, as patients start out on their long and tiring therapeutic journey, we urge them to remember the motto: “let’s function and not straighten up!”

Isico, too, will be present at the forthcoming SRS (Scoliosis Research Society) Annual Meeting, which is taking place in Montreal, Canada, from 18th to 21st September. In fact, a study conducted by Isico has been chosen among the more than one thousand abstracts submitted from all over the world, and we are hugely satisfied about this, given the prestige of this society. Isico will be represented at the event by Prof. Stefano Negrini and Dr Sabrina Donzelli, physiatrist at Isico, who will be participating, as active members, in the conference proceedings, and in the Educational Committee and Non-operative Committee meetings.
Prof. Negrini will be speaking about the  study Idiopathic Scoliosis Cobb Angle Prediction from Clinical Measures. A Geometrical Study of a 7591 Subjects Cohort. As its name indicates, this is an angle prediction study that involves combining two complementary measures of the prominence, namely the angle of trunk rotation (ATR – degrees) and the hump height (HH – mm).  Clinical measurements in a large sample of subjects at high risk of scoliosis were good predictors of the Cobb angle, in particular if HH greater than 10 mm and ATR above 7 in subjects with curves over 20 degrees.
Future studies will verify the diagnostic accuracy of these clinical measures and their combination to predict Cobb degrees during the follow-up of patients under treatment.

Prof. Negrini will also be taking along the preliminary results of SRS-funded research aimed at identifying a predictive model of the evolution of scoliotic curves in untreated patients. Isico has completed the initial verification step and sent a preliminary sample to the Canadian statisticians, who are collaborating on the project. Towards the end of this year our specialists will have the complete sample, therefore, in the first months of next year the Canadian statisticians will be able to develop the predictive models.

The Italian Spine Youth Quality of Life questionnaire (ISYQOL) is an instrument that measures the health-related quality of life of adolescents with spinal deformities.

It was developed by Isico in a setting devoted to conservative treatment of all types of spinal deformities, including surgical curves. It is based on concerns expressed by patients and has been shown to be particularly appropriate in patients with adolescent idiopathic scoliosis (AIS) who have not been treated surgically.

This questionnaire (a brief test comprising just over a dozen questions) is now available online and anyone can access it in order to evaluate their well-being with regard to their back problem (scoliosis, kyphosis or other). Once you have completed the test, you are given a result, to be interpreted following the indications on the site itself. 

The site, which is simple and clear, was created in order to make it easy for professionals, but also lay people, to access the test. At present the test is available in Italian and in English, but versions in other languages will also be added. 

Visit: www.isyqol.org

Teenagers with scoliosis are not necessarily at greater risk of developing anorexia or bulimia; indeed, in some cases, scoliosis therapy, conducted in a certain type of environment and in strongly motivated patients, could actually be an element helping to avoid possible eating disorders.

This is what emerges from an Isico study entitled “Adolescent idiopathic scoliosis and eating disorders: is there a relation? Results of a cross-sectional study”, published in the journal Research in Developmental Disabilities.  
The study involved nearly 300 adolescents, including 187 adolescent girls with idiopathic scoliosis being treated with exercises and bracing; 93 participants did not have scoliosis.
“Until now, eating disorders (anorexia and bulimia) have always been thought to be more frequent among adolescents with idiopathic scoliosis” explains Dr Fabio Zaina, physiatrist at Isico “In actual fact, even though we found an association between scoliosis and lower body mass index, and thus between scoliosis and being thinner (which may probably be due to hormonal differences), otherwise the data we collected differ [from those published in the literature]. Using the screening questionnaire Eat 26, which is one of the most accredited for this type of analysis, we found eating disorders in 1.6% of our sample”.
“Obviously, the particular setting of our study and the probably different background of our patients  has to be taken into account” Dr Zaina goes on. “This was certainly a population characterised by high  levels of parental interest and adherence to the treatment. We can therefore conclude that the existence of a connection between scoliosis and eating disorders must be strongly questioned, particularly in a setting like ours where scoliosis treatment was found to reverse the trend of the data presented in the literature to date, producing lower rates [of eating disorders] than in the rest of the population”.

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.

Changing schools when you wear a brace?

Every year, when September comes round, we get asked the same question: “I’m changing school. I’m going to have new classmates and teachers. How should I tell them that I wear a brace?”
Well, the best thing is probably to start by telling the student who sits next to you, and then gradually tell the others. Don’t forget, it’s only a treatment, just like braces to treat teeth or glasses for eye problems.
It can be stressful trying to hide, and there’s absolutely no reason why you should! If your brace is well made it shouldn’t be noticeable under your clothes, although obviously if someone tries to tickle you or give you a hug, then they are going to feel your “shell”. 

Tell your friends about it: some of them might be a bit curious to begin with, others will want to help you with your backpack, and you will probably get teased a bit, but if you treat it as something quite normal then they will soon do the same!
It’s important to think carefully about what to wear for your first days at school. It’s best to choose clothes that make you feel good, and make sure you “wear” a big smile, too. Because even though a new school, like all new experiences, can be a bit scary, it will be exciting and interesting too!

What about those who tease you about your brace? Some classmates will tease you in a nice way, and if that’s the case, there’s no need to get offended. Of course, we all know that there can be some rather stupid people in this world, and wearing a brace is one way of working out who they are. Once you know, you will also know not to take any notice of them.

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!