Posts

ISSLS Milan: a success with 500 participants

/0 Comments/in /by

“It was a bit as if the world, that of research and clinics in the field of spinal pathologies, had gathered in Milan — this is the comment of Dr. Greta Jurenaite, physiatrist specialist at ISICO — on her first participation in the ISSLS international conference, held between the end of May and the beginning of June. The congress was huge, with around 500 participants, most foreigners, coming from everywhere from Japan to Australia to South America. The few Italians were mostly from our institute.”

We would like to remind you that on the occasion of the conference, the 50th anniversary of its foundation was also celebrated, and Prof. Stefano Negrini, ISICO scientific director, and Dr. Fabio Zaina, physiatrist at ISICO, acted as local guests.

Dr. Jurenaite continues: “The days often began at 7:30 and the presentations continued until dinner, a commitment that makes us understand how much new there is in this sector and how essential it is to keep up to date. I’ll give you an example. On the last day, we participated in a session dedicated exclusively to rehabilitation before back surgery. It was a moment of discussion and comparison, and we reflected on what is still missing to “educate and make the patient as aware as possible, concluding that it is necessary to provide as much information as possible. This is what we do at ISICO when we dedicate time to explaining what scoliosis is, the therapy steps, and the objectives, because every therapeutic choice must be shared with the patient. The discussion was so interesting that we proposed the topic as the subject of a possible scientific article, whose co-authors could be some of us ISICO doctors.” 

Green June: Arianna, a karate champion

/0 Comments/in /by

Since I was a child, I have always loved sports, so much so that I started practising karate at the age of 4. I certainly never imagined that just three years later I would find myself facing something bigger than myself: scoliosis.

I remember very well the first day I wore the brace; I wasn’t sad, I was just very confused. Initially, wearing a corset at school and in the gym didn’t bother me, but as I grew up, I started to feel the weight of other people’s judgement. Going to karate classes with a brace became increasingly difficult, especially because I felt limited and unable to give my all.

Despite this, my passion for karate was stronger than anything else, and despite being a child, I didn’t let scoliosis get me down.

The first satisfaction came from agonism competitions: at 12 years old, I won my first title as an Italian Karate champion, and, from that moment on, my motivation to train grew more and more. Shortly afterwards, however, as I entered adolescence, I began to feel embarrassed about having to wear the brace. I fell into a period of sadness that I couldn’t overcome: the races were going badly, and so was my mood. I got out of it thanks to my family and my karate teacher, who always supported me.

Karate was the strongest motivation that helped me overcome these difficulties and allowed me (and still allows me) to express myself. Once I got over that dark moment, I started winning again, but above all, I had fun during training and races. The results, in fact, did not take long to arrive, so much so that I won two more Italian championships in 2022 and 2024.

After seven years of sacrifices and sometimes difficult moments, my scoliosis has taught me how essential it is to get involved in life, not give up in the face of difficulties, and be tenacious and determined to achieve small and large goals.

Even if the path is not at all easy, I want to tell all the kids who, like me, are “braced” to never give up on their dreams.

I sincerely thank ISICO and, in particular, Dr. Zaina and my physiotherapist, Lorenza Vallini, who have taken care of me over the years. With their attention and professionalism, together with my sacrifices, today I can say that I am proud of my back.

Green June: Gaia, an artistic gymnastics champion

/0 Comments/in /by

Often, a diagnosis of scoliosis leads to despair and the fear of not being able to live one’s daily life as a “braced.” It is not so.
We don’t want to say that it is easy or doesn’t require many sacrifices, but that despite the brace or wearing it, you can continue, for example, to practice sports. Even at a high competitive level, even with champion results, as in the case of the three stories we offer you this month dedicated to scoliosis.

Will you also wear green in June and share it with the hashtag #weargreenforscoliosis!

Gaia, a passion for artistic gymnastics
In November 2023, Gaia was diagnosed with scoliosis with primary right thoracic and left thoracic lumbar curves. A diagnosis that sounds like a condemnation of her passions. In fact, Gaia loves sports; she is very competitive and has been practicing artistic gymnastics since she was 5 years old. She trains for several hours, three times a week.
There’s no denying that her first thought was: Will I be able to practice gymnastics again? Will I be able to keep my habits the same? At the ISICO Centre, where she is being treated, the doctor who looks after her reassures her, telling her that she shouldn’t have to give up anything, especially gymnastics.

So it was: she continued to practice gymnastics, wearing her now faithful friend for 20 hours a day and training in the 4 hours of freedom, so much so that she won gold on the balance beam and placed second on the trampoline and third on floor exercise. “Our doctor was right—says Gaia—nothing has changed; sports, friends, habits… determination, perseverance, and sacrifice are needed, and, in a few years, I will be able to enjoy a healthy back, better posture, and bearing without having to give up my passions at the same time!”.

Modular Italian Brace works just as well as the Sforzesco

/0 Comments/in , /by

A modular brace that has the same practicality and comfort of wearing and the same proven effectiveness, even on the most severe curves, of the Sforzesco corset but with significantly reduced costs. It is the Modular Italian Brace (MIB), the latest corset developed by our institute, after the Sforzesco and the Sforzesco Free Plevis.
Its effectiveness is demonstrated by the data of one of our studies recently published in the Journal of Clinical Medicine, The New Modular Sforzesco Brace (Modular Italian Brace) Is as Effective as the Classical One: A Retrospective Controlled Study from a Prospective Cohort. “A research of considerable importance,” comments Dr. Francesco Negrini, physiatrist and author of the study. “We recently developed a new Sforzesco brace based on modularity (the Modular Italian Brace—MI brace) that could allow standardisation, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life”.

We remind you that the Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS), which revolutionised rehabilitation treatment years ago by replacing the cast but guaranteeing the same results. Recently, the “Free Pelvis” (FP) innovation has been introduced. It consists of semi-rigid material on the pelvis connected to the main rigid body of the brace on the trunk.
It was found that it does not change the in-brace and short-term results of classical very rigid braces and, consequently, can be safely applied.

The MI brace, even if built in a different way, keeps the main characteristic of the Sf brace, that is, the overall symmetry (with some asymmetries inserted in specific areas). In fact, it is the symmetry that allowed the development of the MI brace, where it is possible to recreate the asymmetrical needs of the SF brace through internal pads.

The MIB can be built and fully personalised directly for the patient, modifying the classical procedures of brace construction through CAD-CAM or casting. Moreover, the MIB can be continuously adapted during treatment, giving full adaptability to the patient during changes due to growth or treatment.

The MIB is an evolution of the SF-FP. The two braces share the semi-rigid material on the pelvis, a novelty that improves comfort and patient acceptability. On the other hand, Sf FP is built in a more traditional way, without the MIB modularity and the possibility to adapt the brace during treatment. With Sf FP, if the patient changes due to growth, the brace must be changed altogether.

“The braces considered in this paper share the same action; the question is if they also share the same results. We aimed to compare the short-term results of the two braces,” explains Dr. Negrini. “We compared in this retrospective study 231 patients with scoliosis, between 10 and 16 years old, 53 treated with a MI brace, and 178 treated with a Sforzesco brace. Both braces reduced the Cobb angle (−6◦ out-of-brace; −16◦ in-brace) without differences between groups. The results of the present study suggest that the SfB and MIB can have similar positive short-term results on moderate-to-moderate, moderate-to-severe, and severe curve brace treatment with modular braces. that could lead to easier diffusion worldwide, even where there are reduced economic means and expertise in brace treatment. Before suggesting a generalised use of the MIB as a first-line rigid brace treatment, the results should be confirmed in studies with longer follow-ups”.

SOSORT 2024 : presented studies, news and comments

/0 Comments/in /by

“This 2024 edition of the annual SOSORT conference, held in Boston, was also an opportunity for discussion, involvement, and growth. Every year, the level of research presented at SOSORT continues to rise, and we at ISICO are always at the forefront, commented Professor Stefano Negrini, Scientific Director of our Institute. SOSORT is undoubtedly the congress that brings together the most important specialists and the most significant research at an international level on the rehabilitation treatment of scoliosis. There was lots of news and great satisfaction for our specialists, who enlivened the conference with nine research projects presented both with posters and oral presentations. Dr. Fabio Zaina presented a study on the ability of the ODI and the SRS 22 to distinguish adult patients with or without scoliosis. At the moment, neither of the two questionnaires is able to make the distinction; in the ODI, subjects with scoliosis have greater difficulty lifting weights and standing compared to those who don’t have it, but the difference is not significant. Our physiotherapy director, Michele Romano, led two ongoing studies on curves; instead, our physiotherapist, Alessandra Negrini, in addition to animating the pre-conference by talking about Telemedicine, presented a review study on sagittal measurements among healthy children and adults, up to 40 years of age, to collect and, if possible, arrive at an average overall data measurement of kyphosis, lordosis, and other sagittal parameters.

“I myself presented two studies on adherence to brace treatment measured with sensors: one is a review study that demonstrated that both the use of sensors and counselling, i.e., the support given to patients during the course of treatment, can increase adherence to therapy, while the second study identified sex and age as the main variables that influence patient compliance,” explains Prof. Negrini.

There are also three posters signed by ISICO. Dr. Greta Jurenaite has prepared a poster on a case report of patients with lumbar Scheuermann, which demonstrates that exercises and a corset can effectively treat the pain caused by this pathology and that the brace also improves spinal growth by reducing the deformity. Dr. Giulia Fregna instead presented a review in the field of trunk neurophysiology in a poster; finally, the European Prepare project was also discussed with a poster by Dr. Carlotte Kiekens, already present at other SOSORT conferences but at her first as an ISICO specialist with her own research. “The congress was really interesting and informative! We were pleased to note that the PREPARE poster attracted a lot of attention – comments Dr. Kiekens – I was surprised that many professionals still do not have a clear understanding of the fact that rehabilitation treatment requires a multi-professional approach, involving the patient in a collaborative process and including diverse components such as brace therapy, exercises, cognitive behavioural therapy (CBT), psychological support, education, and much more. ISICO stands out for its advanced approach in this field.”. As introduced by Dr. Kiekens, there has been much discussion about artificial intelligence and its applications in the assessment of scoliosis, the development of therapeutic strategies, and the prediction of treatment outcomes, added Professor Negrini. Our participation in the PREPARE project positions us at the forefront of these new applications, thanks to our constant commitment to research, which is fundamental for the improvement of therapies. To the specialists present in Boston, we must add those who worked on this research, from therapists Bruno Lionelli, Serena Quaggio, and Sara Rossi Raccagni to Dr. Giulia Fregna. Finally, a moment from the conference that we are pleased to share: the appointment of Dr. Sabrina Donzelli, part of the ISICO staff for many years, as SOSORT president for the next two years. The first woman in the history of this society: congratulations to Dr. Donzelli, a great professional.

 We look forward to seeing you again at SOSORT 2025 in Dubrovnik!

Leaving for Boston

/0 Comments/in /by

In a few days, our specialists will attend the international annual SOSORT conference, which will be held in Boston, USA, from May 1 to 4 (please visit the website to register for the event or to learn more about it).  

ISICO will present a remarkable number of nine abstracts during the conference, two of which are Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis and Influence of Specific Interventions on Bracing Compliance in Adolescents with Idiopathic Scoliosis — A Systematic Review of Papers Including Sensors’ Monitoring.

Both abstracts focus attention on the treatment of idiopathic scoliosis with braces, the factors that determine patient compliance, and its objective measurement. Bracing is, in fact, an effective treatment for medium-degree curves, and thermal sensors help monitor patients’ adherence (compliance), a critical issue in bracing treatment.  

Influence of Specific Interventions on Bracing Compliance in Adolescents with Idiopathic Scoliosis—A Systematic Review of Papers Including Sensors’ Monitoring underlines that high adherence to brace prescription is fundamental to gaining the maximum benefit from adolescent idiopathic scoliosis (AIS) treatment approach. Having an objective measure of compliance provided by the sensors allows the clinician to make informed decisions and prescribe therapy in a personalized and sustainable manner, balancing therapeutic efficacy with the patient’s daily needs and difficulties, but the use of wearable sensors is poorly investigated.

“Wearable sensors are available that objectively monitor the brace-wearing time, but their use, combined with other interventions, is poorly investigated.- explains prof. Stefano Negrini, ISICO Scientific Director and one of the authors of the research – We conducted a systematic review of the literature published (466 articles and included examples articles) to summarize the real compliance with bracing reported by studies using sensors; to find out the real brace wearing rate through objective electronic monitoring; to verify if interventions made to increase adherence to bracing can be effective according to the published literature”. 

The research Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis‘ performed a cross-sectional study of 514 adolescent patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year.

“Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts – tells Dr. Giulia Fregna, one of the authors of the research  – We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We have identified gender, age (considered alongside bone age), and the “bracing hours prescription” as critical determinants of adherence behaviour. These findings underscore the importance of tailoring interventions to address the specific needs of different patient populations”.

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”.

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”.