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

Sforzesco course: starting with participants from 12 countries around the world!

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It is a bit as if an appointment had been made from all over the world for the launch of the Sforzesco online course, which started last May 18 with the first module, given that there are 12 countries from which the various participants are coming.
From Brazil to Cambodia, from Singapore to Malaysia passing through Morocco, Syria, Turkey, Japan, United States, Italy, Latvia and Bosnia-Herzegovina: a world of multi-layered experiences.
The starting point of the Course is the presentation of the Sforzesco brace in its evolution from the first years of application to the current relevant innovations, accompanied and supported by the results of research in ISICO, published in indexed international literature.
These lectures are presented by Isico physiatrists Prof Stefano Negrini and Dr Fabio Zaina, in addition to the orthopaedic Isico doctor, dr Monia Lusini accompanied by several lectures held directly by CPOs who collaborate with ISICO in the realization of the Sforzesco braces, on the various technical and practical aspects to be taken into account during the design and the fabrication.
The course is divided into 3 modules, each module ends with a live session to make the point on what has been shown and explained.
The first live lecture will be held on June 8th.

Isico’s research wins the SOSORT Award

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For the fourth consecutive year, Isico has obtained the most prestigious award for those involved in rehabilitative treatment of the spine, winning the SOSORT Award with the study Prediction of Future Curve Angle using Prior Visit Information in Previously Untreated Idiopathic Scoliosis: Natural History in Patients under 26 Years Old with Prior Radiographs.

The research, which involved 2317 patients with idiopathic scoliosis between 6 and 25 years old, was developed by our researchers (the Isico authors are Prof. Stefano Negrini, together with Dr Giulia Rebagliati, Dr Fabio Zaina, Dr Sabrina Donzelli and Dr Alberto Negrini) in collaboration with Dr Erik Parent of the University of Alberta, Canada. This project was funded by a Standard Research Grant from the Scoliosis Research Society.

“Understanding natural history helps inform the treatment selection for modifying the course of the disease or to avoid overtreatment – explains prof. Stefano Negrini, Isico Scientific Director- Previous models predicting curve progression lacked validation, did not include the full growth spectrum or included treated patients. Our aim was to develop and validate models to predict future curve angles using clinical data collected only at, or both at and prior to, an initial specialist consultation in idiopathic scoliosis”. 

Scoliosis-specific exercises are recommended in small curves in skeletally immature patients, exercises and progressively more aggressive brace treatments are recommended for moderate and severe curves in 10% of growing children and adolescents and invasive corrective surgery is recommended in severe curves at risk of continued progression in adulthood for 0.1-0.3% of cases. 

“Patients were previously untreated and provided at least one prior radiograph prospectively collected at first consult – continues prof. Negrini – We excluded those previously treated”.

 Radiographs were remeasured blinded to the predicted outcome: the maximum Cobb angle on the last radiograph while untreated. Linear mixed-effects models with random effects and maximum likelihood estimate were used to examine the effect of data from the oldest visit (age, sex, maximum Cobb angle, Risser, and curve type) and from other visits while untreated (Max Cobb angle), and time (from oldest radiograph to prediction) on the Cobb angle outcome.

“Predictions models were proposed which can help clinicians predict future curve severity expected in patients not receiving treatment –ends prof. Negrini – Predictions can inform treatment prescription or show families why no treatment is recommended. Our models offer the flexibility to predict at a future timepoints over the full growth period. These validated models predicted future Cobb angle with 80% of predictions within 100 in non-treated idiopathic scoliosis over the full growth spectrum. Improved prediction ability may help clinicians inform treatment prescription or show families why no treatment is recommended”.