Rastereography vs 3D ultrasound imaging system: when should we choose one instead of the other?

/0 Comments/in , /by

Let’s start with the thing they have in common: to lower radiation exposure. Indeed, these two methods, although unable to accurately reproduce the Cobb angle, were both created to reduce the radiation exposure of patients being monitored for spinal disorders, especially during pubertal growth.

Non-invasiveness and absence of radiation exposure are huge advantages of these methods, used for evaluating the curves of the spine, physiological and otherwise; combined with clinical measurements and evaluations, they allow the specialist to decide on the course of the patient’s treatment. And in many cases without the need for a follow-up X-ray. 

We have already explored the features and peculiarities of these methods in one previous post and another one

THE ROLE OF 3D ULTRASOUND IMAGING IN THE CLINICAL DIAGNOSIS AND MONITORING OF SCOLIOSIS DURING GROWTH

So, when should we opt for one as opposed to the other?

Rasterstereography: In clinical practice, this method is mainly used to study changes in the patient’s sagittal plane since it appears to be much more reliable in this plane than in the frontal plane. 

Moreover, current scientific evidence has failed to show the reliable correlation between diagnostic measurements between radiography (Cobb angle) and rasterstereography (1,2). We use rasterstereography to evaluate and monitor, over time, postural and structural problems affecting the sagittal plane, such as various forms of hyperkyphosis, long kyphosis, hyperlordosis, and so on.

This method is also very useful for evaluating the effectiveness of bracing or specific exercises over time.

3D ultrasound imaging system: This is the first ultrasound imaging system capable of detecting and evaluating scoliosis. The only one currently available in Italy is at the Isico offices in Milan. 

Even though research (3) has shown very good correlations and agreements between ultrasound and radiographic measurements (respectively UCA – Ultrasound Curve Angle  and Cobb angle), the reliability of the system is not yet sufficient to allow the 3D ultrasound imaging system — and the same goes for rasterstereography — to replace radiography, which remains the diagnostic tool of reference for diagnosing scoliosis and for confirming its evolution.  

Based on our experience to date, we use the 3D ultrasound imaging system as a valuable ally in the frequent monitoring (every 3-4 months) of patients at increased risk of scoliosis progression, as it allows prompt detection of any worsening of the curves.

It should be recalled that this examination is suitable in patients with certain characteristics: e.g., for patients with a Risser sign of 0-1 who are undergoing either bracing or exercise-based treatment, for patients who are only being monitored for a possible scoliosis diagnosis, and finally for children over 5 years of age to reduce (annual) radiation doses/exposure.

Even though, according to current guidelines, standing anteroposterior and lateral-projection radiographs are the most reliable method for diagnosing scoliosis and sagittal deformities, both rasterstereography and 3D ultrasound imaging system can be considered valid and useful tools for monitoring the clinical condition over time, the first being used for more extensive assessments (of sagittal problems) and the second for targeted assessments (of scoliosis). Some authors suggest that they could be used for carrying out early screening in large populations (e.g., in schools) (2). 

1. Multicenter Comparison of 3D Spinal Measurements Using Surface Topography with Those From Conventional Radiography
DOI: 10.1016/j.jspd.2015.08.008

2. Is rasterstereography a valid noninvasive method for the screening of juvenile and adolescent idiopathic scoliosis?  DOI: 10.1007/s00586-018-05876-0

3. 3D ultrasound imaging provides reliable angle measurement with validity comparable to X-ray in patients with adolescent idiopathic scoliosis 10.1016/j.jot.2021.04.007

Full-time treatment: no stress!

/0 Comments/in , /by

We talk of “full-time treatment” whenever a brace needs to be worn round (or almost round) the clock, i.e., for 23 or 24 hours a day.  When patients with scoliosis are treated using a brace, it is not unusual to have to wear the device full time in order to effectively address severe curves (those measuring more than 40 Cobb degrees) or high-risk situations (a pubertal growth spurt).  

Full-time treatment is a tough challenge, especially if you consider that it usually begins at between 11 and 15 years of age, in other words, just before or during adolescence, which is a notoriously tricky time that already brings plenty of changes. Youngsters of this age no longer see the world through children’s eyes. Instead, they begin to experience all kinds of doubts and insecurities, and sometimes they are unhappy about the changes in their appearance, or about having to wear dental braces or glasses. It is therefore entirely understandable that being prescribed bracing treatment can be upsetting for them, and also for their parents who would do anything to spare their child any suffering.

In the literature, it is suggested that the start of bracing treatment (the first 6 months) can negatively affect the patient’s quality of life.
Even though there is no scientific proof of this — on the contrary, research tells us that treatment, ultimately, does not negatively impact quality of life —, there can be no denying that the early stage of bracing is hard and must be overcome. In particular, it is crucial to avoid poor adherence to the treatment that might potentially lead to its early and total abandonment and thus expose the patient to all the risks, in terms of progression and consequent severity of the condition, that are associated with scoliosis in childhood and adolescence. 

“This is a very important issue for us at Isico”, remarks physiotherapist Lorenza Vallini. “We have long been aware of the difficulties youngsters face at the start of this experience, which we liken to a marathon rather than a sprint: our youngsters have to get to the finish line on their own two feet, but we healthcare professionals are alongside them all the way, guiding and helping them and their families.”

And what about friends? Well, friends are like fans on the terraces; if they feel involved, they will cheer the patient on.

All this is perhaps easy for us to say because the fact is that when full-time bracing is prescribed, which means 23 or even 24 hours a day, the patient can feel like their world is falling apart. That is why we at Isico like to make sure we always have a chat with the family and the youngster after their appointment.

“We know very well that this is a key moment, a watershed moment that needs to be addressed together”, Vallini continues. “Our therapists are trained to listen to doubts, answer a thousand questions, and provide all the necessary explanations. We try to get the youngsters involved, showing them videos of other young “brace wearers” doing all kinds of everyday activities, including sports, with their brace on. They are often visibly surprised to see their counterparts happily taking a dip in the sea or swimming pool.”

It is also important not to overlook the aesthetics of brace-wearing!

We at Isico are always careful never to overlook the aesthetic aspect. Many of our patients are girls who are of an age at which comparing yourself with others is a normal part of growing up: “We always stress that braces are hardly visible under clothes, and we give patients tips and advice about their appearance”, Vallini says. “This moment is an opportunity to start building an alliance with the patient. Obviously, our work and involvement don’t end with that one chat, which on the contrary is the starting point for a process that will continue over the monthly sessions we have with these youngsters thereafter. The first session after delivery of the brace is particularly important, as it is when we try to present this “intruder” as a friend, not the easiest to be sure, but a friend nonetheless.”

That is why this particular session is designed to be motivating as well as technical, an opportunity to tackle any issues or doubts that have arisen and gather the patient’s reactions – both the tears and the laughter. 

As soon as the brace arrives, it is tested by an Isico doctor, who provides a series of explanations in order to get the treatment off to a good start. As a rule, whenever possible, a meeting with the therapist is also arranged so that youngsters are not left to face their fears and doubts alone. When this is not possible, a telephone contact is offered and, after the first session, the patient is also contacted by email to find out if there have been any difficulties.

Availability, care and assistance are the cornerstones of our approach: “We never underestimate any request, from the simplest to the most complicated”, Vallini says. “We make sure patients realise we are always there for them, as we want them to be reassured that there is always someone available for them.”

The importance of listening
The Isico team includes all the specialists necessary to support and monitor young brace wearers, so not only doctors and orthopaedic technicians, but also therapists and a psychologist (who sees patients directly on the rare occasions when this is felt to be necessary, but usually intervenes through the other professionals). All the team members will accompany the patient for a part of their journey, to support them and ensure that the therapy is going as it should, particularly at the start.

Will there be any other particular crisis moments? Undoubtedly! In the course of a long and demanding treatment process, undertaken in the midst of a thousand other emotional interferences from the outside, this is only to be expected: “The main thing for us is to remain vigilant so that we know when a family might be needing extra help”, Vallini says. “Everyone is ready to add the right input at the right time to help patients reach the finish line. And when they do, the smiles and hugs we get from them are quite wonderful, as is their tangible sense of pride”.

Let’s find out who is Giacomo Rizzolatti, the one who holds the Presidential Lecture at the next ISLLS conference.

/0 Comments/in /by

“In every action, beyond what you do, the intention counts; the reason you do it— I take the glass—is the action. How I take it is crucial to understanding the intention. Whether to drink, to toast, or to throw it against my interlocutor”: These words are by Prof. Giacomo Rizzolatti, discoverer of mirror neurons and one of the leading figures in the field of neuroscience.

Prof. Rizzolatti, one of the greatest Italian neuroscientists, will speak for a keynote lecture at the 50th ISSLS conference taking place from May 27 to May 31 in Milan, the city of the ISICO headquarters. We remind you that Dr. Fabio Zaina, an ISICO physiatrist, and our scientific director, Prof. Stefano Negrini, will be local hosts for the event.

A short premise before we go into it. Following the discovery of Rizzolatti between the 1980s and 1990s, Professor Vilayanur Subramanian Ramachandran, an Indian neuroscientist who later developed the “Mirror Therapy”, said: “I predict that mirror neurons will do for psychology what DNA did for biology,” 

Rizzolatti’s discovery of mirror neurons had an enormous impact on present thinking, on brain-mind relations, and on “naturalising” cognitive functions. (description of the neurophysiological mechanisms underlying the actions, intentions, and emotions of others).

About Prof. Rizzolatti
Born in Kyiv in 1937, after graduating with a degree in medicine and surgery from the University of Padua, Rizzolatti has devoted his career to the study of the brain and the neural mechanisms underlying human behaviour. 

During his career, Rizzolatti has worked at several prestigious academic institutions, including the University of Parma, where he currently holds the role of Professor Emeritus of Neuroscience.  

Rizzolatti is a member of the National Academy of Lincei, the American Academy of Arts and Sciences, the Académie des Sciences, the Institut de France, and an honorary member of the Italian Society of Neurosciences. He has also received numerous international awards and recognitions, such as the Giuseppe Occhialini International Award in 2011 and the election as a Foreign Member of the Royal Society, the most prestigious scientific academy in the UK, since 2021.

About mirror neurons
It was thanks to observing the behaviour of some monkeys and how their brains worked that the team of researchers led by Prof. Rizzolatti discovered a particular type of neurons that were named “mirror neurons”.
“Mirror neurons are a class of neurons that modulate their activity both when an individual executes a specific motor act and when they observe the same or similar act performed by another individual...” (ref. Understanding motor events: a neurophysiological study).

According to the published study, What We Know Currently about Mirror Neurons “The discovery of mirror neurons was exciting because it has led to a new way of thinking about how we generate our own actions and how we monitor and interpret the actions of others. This discovery prompted the notion that, from a functional viewpoint, action execution and observation are closely related processes, and indeed that our ability to interpret the actions of others requires the involvement of our own motor system.”

So let’s say that neurons can reflect just like a mirror. What? Emotions, for example, by activating the ability to empathise with and understand the emotions of others.
When I observe the gestures or facial expressions of my interlocutor, these neurons are activated, affecting my ability to understand and respond to other people’s emotions. The possible implications in the field of psychology, for example, are then natural.

And in the field of medicine? Mirror neurons have different applications, also because recent studies in several species, from birds to humans, suggest that the ‘mirror mechanism’ is more intricate and adaptable than previously believed, extending beyond traditional mirror neurons to encompass a broader network of neural components.

“It’s obvious and incredible the application they can have in the field of motor rehabilitation, for example, following a stroke, an orthopaedic trauma, or a brain injury. The activation of mirror neurons not only in execution but also in simple observation, somewhat like, as if that movement was actually being done, is useful for promoting the recovery of compromised motor functions, explains Prof. Negrini. 
Think of “Action Observation Therapy,”  a treatment that promotes observing and imagining an action before performing it so as to speed up and improve motor recovery processes.
Or think of “Mirror Therapy”: the physiotherapist usually uses mirrors or special boxes placed in front of the patient, which, for a few years, are going to be replaced by digital technology.”

Through the use of virtual reality technology, patients can be immersed in environments where they observe themselves performing movements, thereby stimulating the activation of mirror neurons. “An incredible and innovative approach that can improve motor relearning and facilitate functional recovery in individuals undergoing rehabilitation,” concludes Prof. Negrini

SOSORT Conference: Isico in the front row

/0 Comments/in /by

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

/0 Comments/in /by

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

/0 Comments/in /by

“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

/0 Comments/in /by

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?

/0 Comments/in /by

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

/0 Comments/in /by

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.