How long before having an X-ray should I remove my brace?

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During bracing for scoliosis, doctors want to see X-rays every 6-12 months in order to check how well the treatment is working and also verify the patient’s growth stage in order, over time, to adapt the prescription accordingly. 

This obviously begs the question: “How long before having an X-ray should I remove my brace?”

Let’s see what the scientific literature has to say. 

According to one study, it takes around 2 hours to reach the maximum correction that can be obtained using a brace; after removing, it the correction obtained is gradually lost over around 2 hours, after which the curve/spine stabilizes (https://pubmed.ncbi.nlm.nih.gov/24859575/). 

Another study suggested that subjects who leave their brace off for longer than they would normally do are more prone to this loss of correction (https://pubmed.ncbi.nlm.nih.gov/18810041). 

Because the patients in these studies were not assessed on the basis of repeat X-rays — it would not be ethical to expose patients to so much radiation —, but rather using other (less reliable) examinations, and the patient samples investigated were small, these data are only able to show a trend, which will need to be confirmed by more robust studies.  

So, what happens when you remove your brace? Does the spine remain corrected? And, if it does, for how long? In other words, when you need to have an X-ray, how long beforehand should you remove your brace?

Given the absence of reliable data to rely on, what we find, if we look at what happens worldwide, is that there exists no universally accepted criterion to guide this choice. This means that doctors can decide according to their own beliefs. Accordingly, some doctors ask their patients to remove their brace up to 2 days before having an X-ray, in order to get, even in those who normally wear it full time, a picture that can be considered to reflect the “real” situation, independent of the effect of the brace. Some instead want their patients to be X-rayed immediately after removing it, while others do not give precise instructions.

In our view, it is important to ensure consistency between X-rays taken in the course of bracing treatment, so that they can be compared and the effects properly understood. For this reason, whatever the doctor decides, it is a good idea to apply the same criterion for all X-rays performed during the treatment.

The approach of our doctors at ISICO is to ask patients to do X-rays after they have been out of their brace for the same number of hours they leave it off in real life. So, if a patient is prescribed 20 hours of brace wearing per day and 4 hours of brace-off time, then they will have their X-ray 4 hours after removing their brace.

Why this choice? Because the ISICO doctor wants an X-ray that shows the “worst” scenario, so as to be able to establish how well the spine is holding up during the hours of freedom and, on this basis, whether the brace-off period needs to be shortened.

There are two ways you can achieve optimal maintenance of the correction and, therefore, good results on follow-up X-rays. The first is to adhere scrupulously to the doctor’s prescription every day, rather than some days keeping the brace on for more hours than prescribed, and others for fewer; this constancy allows gradual and targeted strengthening of the muscles that support the spine. The second is to do specific physical exercises designed to increase your ability to practice self-correction of the spine during your everyday activities. 

If you can do this, you will end up with a kind of natural muscular brace that can be activated as necessary during your brace-off hours. This ability to support the spine can be further enhanced by regular sporting activity. 

In short, while there is no clear answer to the question asked at the start, we have here offered some considerations to help you to interpret your specialist’s requests, and also some tips on how to get good results from your treatment.  

Chronic back pain: how pain reprocessing can help

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Back pain is one of the most frequent musculoskeletal diseases: low back pain is estimated to affect about 80% of the population at least once in their lifetime, and 20% once a year; the rates are higher among working people. 

Acute pain generally disappears spontaneously within a month; however, in a small percentage of people, this does not happen and the pain tends to become chronic, i.e., to last for more than 3 months, even following the resolution of the underlying condition.

Tissue injury can cause acute (“immediate”) pain. In this type of pain, termed nociceptive, pain signals are transmitted from the peripheral nervous system to the central nervous system areas responsible for pain processing.
This is what happens, for example, if we burn ourselves or sustain a traumatic tissue injury. In such cases, the pain usually disappears once the injury causing it heals.

Chronic pain, on the other hand, is a complex sensory and emotional experience.
We talk of chronic pain in situations where biological, psychological and social changes taking place after an injury or illness complicate the clinical picture so much that it becomes difficult to establish the initial cause of the pain and identify clearly the different mechanisms underlying it. 

In such cases, pain thresholds are lowered and even non-painful stimuli are perceived as painful. At the same time, more and more brain areas begin receiving pain signals from the periphery. The whole body goes into a state of high alert, becoming rather like an oversensitive alarm system that “goes off” at the slightest thing, even when there is no real danger present.

Pain that has become chronic is also accompanied by symptoms of anxiety and depression: affected individuals struggle to tolerate their condition, often thinking about their pain all the time, and believing that nothing can be done to solve the problem. This “catastrophising”, rather like when you are unable to see anything positive in a situation, itself plays a part in making pain chronic, i.e., a habitual state, something that is there all the time. 

So how can we help these patients? “The best way, also according to the evidence in the literature, is active physiotherapy, in other words, specific exercises” says ISICO physiatrist Dr Giulia Rebagliati. “The important thing is for the specialist to evaluate, together with the patient, the mechanisms and factors that favour the maintenance of the pain. The aim, through a cognitive behavioural approach, and by working together, is to replace recurrent thoughts and erroneous ideas with more functional pain and movement processing patterns.”

Absolutely, because, as remarked by our physiotherapist Martina Poggio, “without evaluating biopsychosocial factors that can contribute to the maintenance of pain, it is difficult for the therapist, together with the patient, to work out a long-term and truly effective treatment”.

An interesting article was recently published on this complex topic (Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022). In it, the authors examined the efficacy of psychological pain reprocessing therapy (PRT) that sought to change patients’ beliefs about the causes and maintenance of pain. 

The researchers studied 151 individuals aged 21 to 70 years who had suffered from back pain for at least half the days in the previous 6 months, and had an average pain intensity score of at least 4 out of 10 (where 0 is painless and 10 is the maximum bearable). The participants were then randomly divided into three groups.

The participants randomised to PRT each underwent a 1-hour telehealth evaluation and education session, in which they were introduced to the concept of “chronic pain as a brain-generated false alarm”.
These patients then had eight individual 1-hour sessions with a therapist who had extensive experience in PRT. During these sessions, “pain sensations while seated and while engaging in feared postures or movements” were reappraised, and techniques were used to increase positive emotions and address psychosocial threats that potentially amplify pain. 

The subjects in the placebo group watched two videos describing how placebo treatments can relieve pain (e.g., how they can automatically trigger the body’s natural healing response). The subjects then received a subcutaneous injection of saline administered by a physician at the site of greatest back pain.

Finally, the third group continued to follow their usual care without any additions (they were simply given a chronic pain workbook after the end of their treatment).

What emerged? Chronic pain intensity was greatly reduced in the subjects in the PRT group compared with the two control groups, with 73% reporting no pain or nearly no pain post-treatment. The benefits of the treatment were still evident at 1-year follow-up. 

How can we explain these differences and benefits? 

“The treatment used in this study targeted pain, with the aim of helping patients reassess their ideas on its causes and significance” explains ISICO psychologist Dr Irene Ferrario. “It allowed the participants in the treatment group to reconceptualise their pain, enabling them to see it as a reversible phenomenon that can be controlled centrally, and not a genuine threat caused by peripheral tissue injury or disease. The PRT technique is based on existing psychological treatment models such as cognitive-behavioural interventions and interventions based on acceptance and mindfulness (self-awareness). It makes for better management or acceptance of pain: the specialist helps the patient to realise that painful activities are not necessarily harmful, and to better understand pain sensations and what causes them”. 

In the physiotherapy rehabilitation setting, it is essential for the doctor and patient to evaluate together the mechanisms involved in pain, in order to manage the factors, such as erroneous beliefs, fear of movement or catastrophisation, that could lead it to become chronic. Sometimes, in more complex situations, it can be important to have the support of a psychologist, too, who will work in a team with the physician and physiotherapist in order to identify the causes of the pain and help the patient to overcome it.

SRS Meeting in Stockholm: Isico is there!

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In September Isico will be at the forefront of the 57th Scoliosis Research Society Annual Meeting, scheduled from 14 to 17 September in Stockholm, Sweden, where our experts will present several studies.
The 57th Annual Meeting is a hybrid event that draws over 1500 attendees and includes a robust in-person program live from the Waterfront Congress Center in Stockholm, and the virtual component allowing delegates who are unable to attend in-person to enjoy the SRS Annual Meeting from the comfort of their home or office.
Faculty-led instructional course lectures, case discussions and abstract papers will be presented on an array of topics, including adolescent idiopathic scoliosis, growing spine, kyphosis, adult deformity, minimally invasive surgery, machine learning, and mental health considerations.

On September 16, prof. Stefano Negrini, scientific director of Isico, will present two works “Prediction of Future Curve Severity in Idiopathic Scoliosis Between Age 6 and Skeletal Maturity Without Treatment: A Validated Natural History Model” and “Natural History of Idiopathic Scoliosis: Validated Models of Curve Progression for Three Group Ages (Pre, At and Post Growth Spurt) “; while the following day he will be the moderator of the presentation of other papers.
Instead, Dr Sabrina Donzelli, physiatrist at Isico will present the study “Bracing Improves Curves and Aesthetics in Risser 3-4 Adolescents With 30 to 45 ° Curves. Retrospective Results From a Cohort of 1104 Consecutive Patients“.

For more information or to register for the event, visit the website dedicated to the conference https://www.srs.org/am

Brace: a drawing on cyberbullying

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The brace accompanied Valentina for five long years: due to a scoliotic curve that in the worst period exceeded 60°; a scoliosis form challenging to be contained but faced with great determination thanks also to the support of a wonderful family. From the parents to her sister, Sofia, who wanted to somehow tell about Valentina’s courage, a few months ago participated in a school project that asked for a drawing on cyberbullying.

“We started from reading a story – Sofia writes – the protagonist Camilla wore a corset and suffered from her condition. I understood that I could best represent what Camilla was feeling because my sister Valentina had worn the brace for almost five years. Of course, Valentina was lucky and has never been bullied, indeed, her friends and companions have always been close to her, but I knew that I could best represent the rebirth one feels in overcoming this difficult path. I then asked my sister if I could take one of her old corsets to draw on it. On the one hand, I decided to draw a group of dark-coloured butterflies to represent the sadness and loneliness you feel when you are bullied, while on the other I have drawn colourful flowers and butterflies to describe the sense of rebirth you feel when overcoming a bad situation, like that of being bullied.
Wearing a corset is not something to be ashamed of or to be made fun of, on the contrary, it helped my sister to grow up and overcome the most difficult moments with courage and strength “.

Alessia’s story: a champion who dances

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Alessia has dancing in her heart. For years she has been treated with a back brace and exercises due to a challenging scoliotic curve and her path has always been a struggling uphill ride, during which she never lost sight of her passion, dancing! 
She never stopped dancing, even wearing her corset and never gave up until recently she won the title of 5th Italian champion in the category of Modern/Contemporary dance at the 2022 Italian championships. Here are the words she wanted to share.
“My name is Alessia Mancini, and I am a dancer. At the age of 6, I was diagnosed with very important scoliosis: my curve was greater than 40 °. At the age of 11, I came to Isico, where I made my first visit with Dr Sabrina Donzelli, who followed me for the duration of my therapeutic path. After a few months, I was wearing the first corset of a long series. For two long years, it accompanied me for 23 hours a day; I wore it when sleeping, going to school and playing sports. The only hour of freedom available was dedicated to dancing.
Over the years, the wearing hours have decreased to 18 in the last six months of therapy: I was now 18 years old.
Therapy has accompanied me through the most complicated and changing years of my life, forcing me to sacrifice aspects of adolescence that were taken for granted by my peers.
All this without ever compromising the one thing I already understood, when I was only 11 years old, was essential for me: dancing. Although I could have felt inferior to my pathological condition, I always thought, on the contrary, that I had something more and that I was somehow special.
I had to work on many technical things subjectively compared to my fellow dancers since my body’s levers and balances are shifted compared to an “aligned” person! But now I thank the little girl that was me, who has always believed in this dream because thanks to her that I am today’s Alexia; she pushed me to get to where I am right now.
Finally, I would like to thank my doctor again, Sabrina Donzelli: she was and will be my doctor of life!”

Can scoliosis get worse while you are waiting for a brace?

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It may happen that between the prescription of a brace and its actual application, some time can elapse, may this be due to bureaucratic issues, issues linked to the orthopaedic shop or simply to personal reasons.

Considering that a brace is prescribed precisely to prevent scoliosis from getting any worse, it is legitimate to wonder what happens while you wait for it to be delivered. Could your scoliosis get worse?

Well, there’s really only one way to find out, which is to have another X-ray taken just before starting to wear your brace. At ISICO, our doctors always ask for a new X-ray whenever, for whatever reason, 3-4 months or more elapse between prescribing and fitting a brace. From these X-rays, we have seen that the condition remains substantially stable in some patients, whereas in others scoliosis worsens by a few degrees. 

Patients going through a growth spurt are at risk of their scoliosis worsening in the space of just a few weeks. 

There is another reason why it is a good idea to have an X-ray not long before receiving the brace: by comparing subsequent X-rays with previous ones, it is possible to assess the effectiveness of the treatment. 

Many specialists, for example, ask their patients to have an X-ray with their brace on quite soon after starting to wear it. By comparing this “brace-on” X-ray with the previous one, they are able to see how the device is working and evaluate how well the patient’s spine is responding to the correction.

So, what can be done to reduce the risk of your curve worsening while you are waiting for your brace to arrive? First of all, you can try and speed up, as far as possible, the bureaucratic process. It is also crucially important to start doing, straight away, your specific self-correction exercises, as these are able to slow down the progression of scoliosis.

Since, for some patients, timely intervention can be crucial in managing the condition, the specialist prescribing the brace will carefully explain what has to be done while waiting for it.

Green June: The tin man tale

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June is the month of scoliosis and during this #scoliosisawarenessmonth  we are sharing images, videos and testimonials on our social networks to remember the importance of it.
Today is the time for a story that years ago won our Concorsetto in 2019. A text written by a young patient, Leonardo Vener, entitled “The tin man”.
Below is an excerpt, you can read the full text on the site www.concorsetto.it

Tin Man (excerpt)

Leonardo Vener

“It was June when I started wearing a back brace. The day of the first fitting was a total disaster, although that’s the way I saw it. When I put it on and left the waiting room to try it out, I was struck by two kinds of pain. One was physical; it was clear that some adjustments were called for. The other was a different kind of pain. As I went outside, I caught sight of myself reflected in a window. For the first time, I saw myself in a brace. In the reflection, I looked different. And I mean different in a wrong way. After all, I liked the way I looked before. Staring at my image, I became aware of another change in myself: a tear raced down my cheek, chased by another, the second seeming to want to catch up with the first. After that, they came thick and fast, one after the other. A dreadful river of tears. Perhaps that was the first time I ever really cried with abandon, and I still feel somewhat ashamed of those wasted tears. Also, because I absolutely hate crying.

[…] Initially, wearing a brace wasn’t at all easy. First, I had to get used to doing everyday things in a new way. That’s not to say I was impeded, even though that’s what it felt like to begin with. The second problem was the heat because the summer two years ago was the hottest and stickiest I can ever remember. I really couldn’t stand being hot, and I was suffering even before the treatment started. Let’s say that it really doesn’t help to have a plastic brace hugging your back, not to mention that extra layer of fabric between your back and the brace, to prevent the plastic from sticking to the skin. It doesn’t help one bit!

Scoliosis is a bit like when a kid comes across a jigsaw puzzle on the floor: unexpected and catastrophic. Just as I was putting all the pieces together, and starting to see the complete picture, I suddenly found myself back at square one, only now I felt tired, which made it all the harder. I was so wrapped up in myself that I couldn’t see this new beginning as anything other than a drama and a tragedy, completely failing to realise that with puzzles, the challenge of putting them together is the fun part, not just completing them. Each piece is important, and finding exactly where it fits is like finding the key to life itself.

My brace quickly taught me that even the easy pieces of my life now needed to be reappraised and turned this way or that.

“It’s just a question of getting used to it, don’t worry”.

Up to a point, that’s true. In time, you do get used to doing up your shoes without bending over. You even find a way of picking up pencils that drop off your desk. You also get used to having to carefully plan your hours of freedom, when you can leave your brace off, to maximise that time and make the very most of it. The thing that’s hardest to get used to is the very idea of wearing one.

People can’t all be expected to see things in the same way. After all, we all look at things with our own eyes and process them with our own minds. Some manage to look to the future even in the midst of misfortune; others find that success can trigger fear. It’s like when an icy mantle envelops winter roads. Some people are nervous and fearful of slipping, whereas others just strap on their skates. Doctors belong to this second category — people who, when faced with a problem, will start to look for a possible solution.

In fact, as soon as they had my back X-rays in their hands, my doctors were already thinking about how to try and solve the problem, clinging to that one crumb of hope that, with incredible effort on my part, might turn out to be well placed. But, of course, it was up to me to seize that crumb. So, I decided to put on my skates and try out the ice. To begin with, the doctors skated alongside me, helping me along, before finally allowing me to strike out on my own. I am still skating today, even though I sometimes wobble a bit. Every so often, I look over my shoulder towards the exit, and feel tempted to give up and come off the ice. But I know that that’s not what I really want. I want to carry on wobbling until I can finally skate confidently, because once you have learned how, it’s like riding a bike — something you never forget how to do.

The first time I wore my brace in front of friends, especially my classmates, I felt very unsure. I didn’t know what to expect. I didn’t want them to see me differently somehow, because of this change in my appearance. “So, you’ve got it on then. How long have you got to wear it for? Do you have to keep it on all day? Does it hurt? …”

Well, they didn’t! Obviously, they were full of questions, and I just answered them, no problem. After that, I found that nothing had changed. Thanks to them, I realised that even with a piece of plastic around me, I am still Leo, the kid who laughs a lot, loves football, tries hard at school, thinks deeply about things. In short, I am still me! Lots of people lose touch with themselves when things happen to them. It’s easy to forget you are a good student when you get your first bad mark. When a relationship ends, you forget how happy and in love you were at the start of it. And sometimes, even knights in shining armour don’t feel so brave once they have saved their princess and are leading a normal life. But I haven’t forgotten anything about the way I was before, because simply erasing things isn’t always the way to start afresh. And I was starting afresh.

The start of my treatment was like a bump in the road of my life journey. And it took me unawares. As any driver knows, you need to slow down as you approach a bump. On the other hand, confused and angry, I pressed down on the accelerator, sacrificing some shock absorbers as a result! Looking back, I was probably going so fast that hitting the bump made me fly into the air, like a rally car off a ramp. In other words, I Iet go of reality, letting my imagination soar. But, of course, I had to come back down to earth again, which meant standing in front of a mirror and starting to do the exercises that the physiotherapist had prescribed. But that flight of fancy was what got me over that first bump, and as soon as I saw the next one ahead of me, I approached it in exactly the same way, and once again took flight. After that, with each bump it got better and better, and the crash down to earth less devastating. 

Every night I go to sleep looking up at the ceiling.

I stare at it, wanting it to fall in and let me look at the stars.  

I pray that tomorrow will be better than today has been, and that the sun will banish the last clouds.

I hope that the night time will cancel my fatigue, so that I can simply feel proud of myself.

I may be waiting to be grown up, so that I can put away my soft toys.

But in the meantime, I can smile and clean a bit of rust off my body.

Go for it, tin man! Tomorrow is another day”.

Dress green with us in June

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As every year, Isico dresses in green throughout June with a particular initiative. 
During the four weeks of the month, we will release dedicated posts on our social networks where each time we will share something different: a video, a testimony or an image to talk about scoliosis and how it is possible to live your daily life and overcome the difficulties of a demanding therapy.

Isico will be also part of an initiative organised by Tratando Escoliose/Brazil who realised together with the Associação Brasileira de Tratamento da Escoliose (ABTE), the First Scoliosis Event exclusively for patients and families.
Concerned about the quality of the information that reaches those who are in search of adequate scoliosis treatment for their kids, ABTE and “Tratando Escoliose” want to facilitate the meeting between national and international health professionals, renowned in the field of scoliosis, clearing doubts and insecurities.
Isico will be represented with a short video given by our physiotherapy director Michele Romano on the importance of patient education, through informative material, to better understand the how and why of treatment and the importance of a strong team following the path.
Follow us too, wear green and share our posts with the hashtag for the event ##scoliosisawarenessmonth

ISSLS 2022: Fabio Zaina’s take

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Finished SOSORT Meeting, ISICO physiatrist Fabio Zaina headed to Boston where the 48th ISSLS Annual Meeting, another international event that, following the hiatus due to the pandemic, could finally be staged in the normal way again.

Dr Zaina represented ISICO by giving a presentation which was one of the 8 selected for presentation to the general assembly at the ISSLS, the fourth in order of importance (in fact, the reports have been presented in order of choice of the scientific committee). Further to this great achievement, Dr Zaina also presented a poster.

We asked him three questions, to get his brief take on the event.

1) How did it feel to finally get together with so many colleagues from all over the world?

It felt absolutely great, because it is three years since the last time, and they have been difficult for everyone. Added to that, ISSLS is like a big family and the aim of its members is not just to do research, but to work together and nurture the good human relations that are essential if you want to produce quality scientific work.

2) What were the major scientific developments at this 48th Annual Meeting?

A number of the studies presented focused on type 1 and 2 Modic changes. Efforts were made to interpret this sign, which seems to be related to low back pain, and also to consider the possible causes, which might be mechanical, autoimmune or infectious. All this seems to suggest that although Modic 1 and 2 are two separate entities, there could exist intermediate and nuanced forms lying somewhere between the two.

3) In five lines, which would you say was the study of most relevance to your daily clinical and scientific work?  

I would say it was the AWARD-  winning “Progression of spinal degenerative changes in a group of chronic low back pain patients and patients 11-14 years after discography evaluation” by Swedish authors Hanna Hebelka, K. Lagerstrand, V. Gunterberg, and H. Brisby.
I say this because it threw into question the findings of a previous paper published in 2009, which took an ISSLS Prize that year, namely, “Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study“ reached the opposite conclusion to the previous study, which had found that discography techniques resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal, and the development of reactive endplate changes compared with the findings in matched controls.

Even though the two study populations are not perfectly overlapping, the result is interesting and a starting point for further studies.

SOSORT 2022: a feedback by dr Sabrina Donzelli, the next president of SOSORT

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We asked physiatrist Dr Sabrina Donzelli, one of our doctors at ISICO, to tell us about the highlights and significance of SOSORT, the international conference held at the start of May in San Sabastian.
We knew that the event would be an important occasion for the specialists in attendance, as they had not been able to meet in person for two years. Little did we imagine, though, when we approached Dr Donzelli, that we were asking the very person who, in the course of the event, would be named as the next President of SOSORT. The presidency of this association is a highly prestigious role. This is the fourth time an ISICO member has been chosen for the position, and Dr Donzelli is the first woman to have the honour.

We therefore begin this interview by extending our congratulations to Dr Donzelli.

1) Wow! Well, this was great news on two levels: first, because the position will once again be held by an ISICO member, and second, because this is the first time a woman has been chosen. The International Society has grown considerably over the years and now has a large membership with a good balance of men and women, even though this is not so true of the single professions. There aren’t many doctors in SOSORT; most of its members are physiotherapists. If you aspire to be President of SOSORT, you have to serve the organisation, putting in years of voluntary work. For some years now, I have been committed to doing all I can for SOSORT because I share its vision and its mission: to ensure that patients with scoliosis always receive the best treatment based on the scientific evidence. It is therefore important to be committed to research and to spreading knowledge. In other words, the mission is also to educate. My commitment and willingness have helped me become widely appreciated within the society, allowing me to join the executive board in 2019, and to be made President Elect this year. 

2) What did it mean, after three years, to finally be meeting in person, with colleagues all in one place rather than scattered around the world?

SOSORT, which dates back to as long ago as 2004, was created to bring together the world’s leading experts in the field of rehabilitation treatment for spinal disorders, to allow them to “compare notes” and increase the level of scientific evidence in the field, as well as improve the treatments available to patients. Over time, its missions and aims have been and continue to be updated, because medicine is a constantly evolving science. The last proper congress was held in San Francisco in 2019, after which the event moved online for a couple of years. It was therefore fantastic finally being able to get together in person again. We were able to talk face to face and really share, all together, our passion for what we do and our everyday challenges. All this is reflected in the slogan that was used to announce and promote the event: SOSORT 2022 – More than a congress: an experience in San Sebastian. You will never forget it! 

3) What are the main scientific developments you were able to take away with you? 

Epigenetics appears to be the future when it comes to improving understanding of scoliosis and trying to identify individuals at risk of developing it. Obviously, there is still a huge amount of work to be done, but at present this seems to be the way to go. 

Second, ultrasound is the future of radiation-free diagnostics, albeit perhaps not so much when applied to the spine as when used to estimate residual growth. In this regard, I should mention an interesting study by  Sanders based on ultrasound of the hand, Bracing outcomes in end-of-growth patients. Evidence to support the use of braces even towards the end of growth: it’s not too late to wear a brace.
Indeed, other studies similar to ours have shown that good results can be obtained even at the end of growth. There is also promising scientific evidence in patients who have finished growing: we at ISICO were the first to present these findings, and now other groups, too, are showing that good results are possible even in individuals with advanced bone growth. 

It is worth considering that three of the six studies in the running for the SOSORT Award dealt with outcome prediction: they ranged from Dr Lori Dolan’s study with 10-year follow up after the end of bracing treatment to our research conducted in collaboration Dr Eric Parent of the University of Alberta, in Canada, in which we attempted, in patients observed over time, to predict future curves solely on the basis of X-rays performed before they started treatment with braces or exercises. 

4) SOSORT Award: were there any surprises?

Not at all. The winning study was the strongest methodologically. The paper, on which we collaborated with the University of Alberta, illustrated a prediction model developed on the whole sample: it has some limits related to the heterogeneity of the data, which reflects that of scoliosis itself. Each patient has their own clinical history and this makes it difficult to predict how the disease will evolve in relation to age, time since onset, and residual bone growth estimated using the Risser classification. 

The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), on the other hand, is a fundamentally important study: it has demonstrated the therapeutic effectiveness of braces and shown that follow up over time is essential in order to advance the study of scoliosis. The monitoring of the patients observed and treated by these researchers will continue to give us important information, while the methodological rigour of their study is a guarantee of very reliable scientific evidence.  

Pictured, Sabrina Donzelli, together with organiser (SOSORT 2022 local host) Garikoitz Aristegui, and Judith Sanchez Raya, co-Chair of the SOSORT 2022 Scientific Committee