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Long-term stability in PWS scoliosis without surgery

It is rare for a single case to so clearly demonstrate the power of a conservative approach. This is what emerges from the article published in the Journal of Clinical Medicine (Effective Conservative Management of Severe Scoliosis in a Girl with Prader–Willi Syndrome: A 20-Year Case Study Follow-Up, MDPI, 2024).

Prader–Willi syndrome (PWS) is a rare genetic disorder characterized by muscle hypotonia, obesity, and cognitive difficulties, often associated with severe scoliosis.
“In many of these cases, surgery is considered the only possible solution,” explains Dr. Francesco Negrini, author of the study. “In contrast, we present the clinical case of a young patient followed for twenty years with a conservative approach, based on scoliosis-specific exercises and customized braces, from Milwaukee to Sforzesco.”

Despite an initial curve exceeding 50° Cobb, the patient avoided surgery, maintaining long-term stability of the deformity and a good quality of life.

“This case highlights the potential of a well-organized, long-term conservative approach to managing scoliosis in PWS,” adds Negrini. “It suggests that, under specific conditions, surgery may be avoided or postponed. Most importantly, it underscores the need for further research to establish standardized protocols and to support clinical decision-making in the conservative treatment of scoliosis in PWS patients. We are already working on specific protocols for ambulatory patients with scoliosis secondary to neurological diseases,” concludes Negrini. “These protocols are urgently needed, as at present they do not yet exist.”

Artificial intelligence and rehabilitation medicine: the revolution has begun

Artificial intelligence (AI) is already a concrete reality at ISICO, where it is actively used in daily clinical practice, as a research tool in studies published in scientific journals, and as part of the European PREPARE project, in which our institute is a partner. AI is fundamentally transforming the work of rehabilitation professionals, opening up new possibilities in early diagnosis, patient monitoring, treatment personalisation, and therapeutic education.

The potential of AI is immense. In a context where the volume of clinical, instrumental and functional data is growing exponentially, intelligent algorithms enable the rapid and efficient analysis of this information, turning it into tangible support for clinical decision-making.

We are only at the beginning of a transformation that will become increasingly far-reaching” – explains Francesco Negrini, physiatrist at ISICO and Associate Professor at the University of Insubria – “Just as the first computers revolutionised our work in the 1980s, AI is set to become an indispensable tool in the daily work of clinicians”.

In recent years, research on AI in the medical field has experienced a dramatic acceleration. Between 2022 and 2023 alone, funding in this sector increased eightfold, reaching $25 billion. Applications range from imaging diagnostics and outcome prediction to motor rehabilitation support and functional assessment.

ISICO has contributed to this evolution. One example is a 2023 study on the use of AI to improve scoliosis screening. The team developed an algorithm capable of combining multiple variables (ATR, age, sex, BMI, family history, prominence height, curve location) to detect the condition early — going beyond the limitations of traditional tools like the scoliometer.

But AI’s applications in rehabilitation go far beyond scoliosis. Through data collection from wearable sensors, surface electromyography, and robotic devices, it is now possible to analyse patients’ movements in real time, support the monitoring of gait and speech disorders, classify levels of motor dysfunction, and adapt treatment plans in a truly personalised way.

At ISICO, AI is also used to enhance the patient experience through projects such as ISAIA (ISICO AI Assistant) — a virtual assistant designed to improve communication between clinicians and patients, answer frequently asked questions, and support the management of emails and FAQs. This approach helps maintain an informative and educational dialogue beyond the consultation, responding to patients’ ongoing concerns during treatment.

Another promising frontier is the integration of AI into telerehabilitation. Smartwatches and dedicated apps now make it possible to monitor home exercises with precision, optimising therapeutic pathways remotely. One recent study, for instance, demonstrated that AI could automatically recognise post-stroke rehabilitation exercises with over 99% accuracy.

Of course, with opportunity comes challenge. The handling of sensitive data, the lack of transparency in algorithms (often still “black boxes”), the risk of over-reliance on automated solutions, and the quality of training data are all critical issues requiring careful oversight and regulation. A responsible adoption of AI must be grounded in strong clinical supervision, ongoing human oversight, and the scientific quality of the sources used.

In conclusion, artificial intelligence will not replace clinicians — it will support them, helping them become more accurate, more efficient, and better equipped to offer truly personalised care.
At ISICO, that revolution has already begun.

SOSORT Award: Isico is back on the podium!

And once again, the winner is… Isico! For the fifth consecutive year, our institute has been awarded the prestigious SOSORT Award, recognising our innovative and cutting-edge research focused on Artificial Intelligence in the rehabilitation treatment of the spine. The winning research, titled “Developing a new tool for scoliosis screening in a tertiary specialist setting using artificial intelligence: a retrospective study on 10,813 patients,” was one of the eight Isico studies presented at the Sosort conference held in Melbourne, Australia, a few weeks ago.

This prize shows the quality of research conducted at Isico, combining scientific evidence with daily clinical practise to enhance rehabilitation treatment for patients worldwide. Dr. Francesco Negrini, a physiatrist and author of the study, explains the motivation behind the research: “We sought to explore ways to reduce the need for radiographs while ensuring accurate and timely scoliosis screening. Through collaboration with engineers in Zurich, we employed advanced analysis methods using artificial intelligence to develop a model that accurately identifies cases warranting X-rays.”

This international collaboration enabled Isico to harness innovative technologies and present research able to achieve this prestigious recognition. Dr. Negrini further emphasises the significance of the prize, stating, “I am immensely satisfied with this achievement. It reaffirms the validity and excellence of Isico’s scientific dedication, paving the way for a reduction in the number of X-rays prescribed to patients while maintaining optimal care.”

https://en.isico.it/isico/ricerca/pdf/ID00665.pdf