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ISSLS 2022: Fabio Zaina’s take

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.

Isico’s research wins the SOSORT Award

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”.

Ready for SOSORT

There are just a few days and the SOSORT  International Conference finally, after two years from the start of the pandemic, is back in person in San Sebastian, Spain from the 4th to the 7th of May.
It will be the usual pre-course, scheduled for May 4, to kick off the event: three of our specialists will participate in the round table, Dr Fabio Zaina, with a session on Overview of Adult Spinal Deformity classification, and how it is differing from AIS, Dr Sabrina Donzelli with  ASD prevalence and Dr Michele Romano, director of Isico Physiotherapy, with Standardized presentations describing assessment, clinical decision making process and treatment.

In the following days, Isico will be present again with three presentations: Dr Fabio Zaina will present on May 6th “Night-time bracing improves back pain in patients with painful scoliosis: six months results of a retrospective controlled study“, Dr Michele Romano on May 7th “Exercises for adolescent idiopathic scoliosis: Updated Cochrane Review”  and finally, Prof. Stefano Negrini, scientific director of Isico, will compete for the SOSORT Award with his research Splitting Growth into 3 Phases with Cut-offs at Pubertal Spurt and Risser 3 Facilitates Prediction of Progression. A Study of Natural History of Idiopathic Scoliosis Patients from age 6 to End of Growth”.

For more info: https://sansebastian2022.sosort.org

Isico among the attendees of the November SRS webinar

A new webinar for professionals is scheduled for November 7, part of the cycle of those organized in recent months by the SRS (available on the pages of the society’s website).

Two specialists from Isico, our scientific director, Prof. Stefano Negrini and Dr. Fabio Zaina, Isico physiatrist will be taking part in this online event titled Current Status of Bracing in Adults and Adolescents:An SRS-SOSORT Collaboration.

Join the SRS Non-Operative Committee and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) for a webinar analyzing the current evidence and practice guidelines for bracing for adolescent and adult patients with spinal deformity.

This webinar will provide a systematic analysis of the current evidence and best practice guidelines for bracing management of patients with spinal deformity in both adolescents and adults. With variations in brace design and documentation of long-term benefits, use the consensus discussed to clarify your current practice and brace selections.
There will be an update on the current training of Orthotists, including specialization, fabrication, fitting and deformity correction.

To register please visit the page of the SRS website