Leaving for Boston

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 eight 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?

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

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/

Full-time treatment: no stress!

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

Once again, ISICO receives the acceptance, in the form of an oral presentation or a poster, of all eight 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 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).

One of the 8 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

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”.

I have surgical scoliosis: should I have surgery or not?

In the presence of a curve measuring more than 50 Cobb degrees, scoliosis is termed surgical; this is because there is a very high chance that it will worsen even in adulthood, causing pain, disability and reduced quality of life.

What should be done when surgical scoliosis occurs in infantile (0–3 years) or juvenile (3–12 years) cases? 
In the past, infantile and juvenile forms of scoliosis, being typically associated with a high potential for worsening, have always tended to be considered surgical cases regardless. There may be some hope of avoiding surgery, provided the affected individuals adhere to a lengthy period of conservative treatment. This will begin at the onset of the scoliosis and will continue until they have finished growing. Conservative treatment is often recommended in the early stages of scoliosis anyway, even when there is a very high likelihood that the patient will ultimately need surgery. In such cases, this treatment supports the patient until he/she reaches the best age and stage to undergo surgery, and it, therefore, helps to ensure that the surgical treatment will consist of a single and definitive operation.

What should be done when scoliosis is surgical in adolescence (from 10-14 years)?
At this age, the process of bone maturation is not yet complete, and therefore, scoliosis is at a high risk of worsening further. If the patient has never previously tried a valid conservative treatment programme (24-/23-hour bracing combined with specific exercises), then it might be worth trying this approach for a few months, after which, together with the medical specialist, the situation can be reassessed in light of the results obtained. We know that a scoliosis curve classed as surgical but still within 60° can be improved through conservative treatment and get below the surgical threshold in a certain number of cases. While this result cannot be guaranteed, it is worth trying to achieve it.
While this result cannot be guaranteed, it is worth trying to achieve it. It is a very long course of treatment that demands considerable commitment and many sacrifices, but it is essential to remember that it has a beginning and an end: sooner or later, patients are able to get rid of their brace! In any case, young patients and their parents must always be helped to make, as far as possible, an informed choice about the course they wish to follow. To this end, it is important to consider seeking a specialist surgical consultation (which is not the same as deciding to go on a waiting list for surgery!). The decision on whether or not to be treated surgically is a wholly personal one, but in order to make it, patients and families need to be informed of the risks and benefits of the operation; they must also be told about the most innovative surgical techniques available and the post-surgical recovery: how long it will take and what to expect. Given that it is impossible to know beforehand whether the benefits of surgery will be sufficient to justify performing it, only armed with all this information is it possible to make a truly informed decision.

What should be done in the case of surgical scoliosis at 17–20 years of age? 
This is the age at which, as bone maturity is reached, the risk of a growth-related worsening of scoliosis disappears. However, the condition may still worsen due to the instability of the curves. It is important to keep in mind that scoliosis surgery is never a life-saving procedure and therefore should never be treated as an emergency. It is always helpful to seek the opinion of a surgeon, but there is no reason, in this situation, why the patient should not choose to wait, taking the time to verify, through periodic checks with his/her medical specialist, the stability, or otherwise, of the situation. Should an evolution of the curve occur, it will still be possible to undertake a specific course of exercises and assess, over time, whether these are sufficient to stop the curve’s progression, before deciding whether or not to opt for surgery.

How should adults with surgical scoliosis be treated?
 In adults, the extent of the curve, measured in Cobb degrees, is no longer the main parameter when deciding whether to opt for surgery. When examining X-rays taken in adults, attention is paid mainly to the sagittal plane, given that adults (unlike youngsters) are more likely to develop a more forward-bent posture.
The other parameters to be considered are pain, disability and quality of life. Given that the surgery carries risks, and it is not possible to know in advance whether the benefits of the surgery will be great enough to justify choosing this course of action, in adults it tends to be chosen only in the presence of a highly debilitating level of pain that is seriously compromising the patient’s quality of life. In this case, too, it is possible first to undertake a specific conservative treatment, in order to monitor how, over time, it affects the stability of the curve and the level of pain and disability. In this way, the possibility of surgery can be weighed up in the light of its results.

Scoliosis: learning to love yourself and overcome your fears

Many of our patients receive their scoliosis diagnosis in the midst of what is one of the most intense and turbulent periods in a person’s life, characterised by sudden and profound transformations that can even lead them to question and redefine their very identity. We are talking about adolescence.
During adolescence, the body changes, even quite abruptly, and these changes do not always give us the body we would like to have.
At the same time the sexual organs and secondary sexual characteristics are developing too, leading us to discover a new, previously unexplored, dimension of our body.
Cognitive development continues and sometimes peaks in adolescence. In other words, our cognitive functions gradually reach full maturity, albeit not all at the same rate. In fact, the different areas of our brain have different developmental trajectories and mature at different times. The frontal lobes are a particularly interesting area in this regard, as they constitute the neural substrate of what are termed executive functions, i.e., complex cognitive abilities such as the ability to plan, organise and regulate our behaviours.
Adolescence is also the period of life in which we experience an increasing range and intensity of emotions, but may struggle to regulate them if the brain area involved has not yet reached full maturity.
“Finally, our social relations are also an area of life that changes in adolescence,” explains ISICO psychologist Dr Irene Ferrario. “This is, of course, the period when friendships become increasingly meaningful and important to us, and in which, in some cases, we form our first romantic attachments. In short, it is a time when the demands placed on us by our social environment are becoming ever more complex.”
While all this is going on, some young girls and boys also find themselves having to handle and “digest” a diagnosis of scoliosis and the need to wear a brace, something that some patients find harder to do than others.
“One of the most common reactions in those struggling to accept their scoliosis and its consequences is anger towards a condition that, they feel, limits their freedom, that they perceive as unfair, and that makes them feel embarrassed, given that the brace can be seen under their clothes or felt when others hug them,” Dr Ferrario goes on.

Fear of what others might say or think is something we can experience at any age, although it is particularly frequent and acute in adolescence when we desperately desire to feel accepted by our peers, and to be like them. For some people, though, this fear can be paralysing, leading them to avoid all situations in which they might be exposed to the judgements of others. As a result, they limit their experiences, leading to even greater feelings of isolation and loneliness.
Sometimes it can be enough to talk these feelings over with friends or parents, or it may be sufficient, with the help of the doctor or physiotherapist, to find ways to manage the brace better.
Other times, patients can find it useful to talk with a psychologist about their feelings and the suffering a certain situation is causing them. Scoliosis treatment is a long and arduous process and it is quite normal to experience moments of difficulty due to tiredness or linked to changes in the patient’s life. Changing schools, changing friends, starting new relationships, arguments at home — all these are situations that can become moments of crisis that in turn impact the management of the treatment.
“The word crisis has negative connotations, but in actual fact this word came into being with a very different meaning” Dr Ferrario remarks. “It comes from a Greek word meaning choice or decision. In this light, a moment of crisis can be seen as an opportunity to make a choice that there is no escaping, whether you like it or not — an opportunity to redefine some aspects of yourself. Asking for help in a crisis is not a weakness. On the contrary, it takes courage to question yourself and decide to ask for help!”

At ISICO, it is sometimes families that ask to see the psychologist, and sometimes the doctors or physiotherapists suggest it, if they realise that a youngster is struggling, whether or not it is because of the treatment.
The intervention, at this point, may range from simple identification of the factors underlying the patient’s non-compliance to the structuring of a personalised support or psychotherapeutic pathway based on the youngster’s specific needs. The psychologist can also support doctors and therapists by helping them to understand and manage complex situations.
This collaboration between mental health professionals, doctors and physiotherapists allows us to take care of the whole person and not just their back.

Stanford University has identified the best researchers in the world; ISICO is part of it!

Isico, with its specialists, is still in the “hall of fame” of the world of researchers: Prof. Stefano Negrini, our scientific director, has risen to 52nd place in the world among those involved in rehabilitation research, first among Italians.
This is to say that Prof. Negrini is among the best researchers and scientists in the world in the field of rehabilitation.
In the general ranking of all branches of scientific research, he is in 37,206th place overall.
How does it work? Every year, a group of analysts from the American University of Stanford, led by Prof. John Ioannidis, in collaboration with the medical publishing house Elsevier and the global research database “Scopus”, collects data relating to indicators of standardised citations, referring to as many as 8.6 million researchers from universities and research centres around the world. The ranking covers the entire career, and all researchers in the world since the 1960s are present. Thanks to the processing of this data on 22 scientific sectors and the related 176 sub-sectors, researchers cited in the top 2% of the ranking are inserted into a database

We started by saying “still” because already in the past, Isico, with some of its specialists, had entered the highest places in the “Expertscape” ranking, an American rating agency that identifies the leading experts in the world in various medical disciplines based on an analysis of a series of parameters and variables.
The site refers to the PubMed database to identify the world’s leading experts in more than 27,000 branches of medicine. Isico, as a clinical institute, was placed in 38th place, first among the structures that deal with non-surgical treatment, while in the ranking of global experts for the treatment of scoliosis (both rehabilitative and surgical), Prof. Negrini was among the top twenty (11th, to be precise).  Also present in the ranking at that time were Dr. Fabio Zaina, physiatrist, and our physiotherapy director, Michele Romano. 

A new confirmation of Isico’s high level of research and scientific experience in the rehabilitation treatment of spinal pathologies aimed at improving daily clinical practice with verified data. 

Do youngsters with scoliosis walk differently ?

In recent years, many studies have been conducted analysing gait and postural control during walking. Some of these have included gait analysis in youngsters affected by scoliosis.

The first thing to emerge from the literature is that the type of scoliosis does not influence gait. Indeed, no differences in the variables analysed were found between patients with adolescent idiopathic scoliosis and those with congenital scoliosis. Therefore, the gait disturbance in scoliosis is secondary to its existence and not related to its onset or aetiology [1].

In general, study results indicated that patients with scoliosis produced an asymmetrical rotation pattern in the frontal and transverse planes [2] and therefore, when walking, shifted their body to the side and rotated on themselves.

The position of the curve actually influences the motor pattern: in adolescent idiopathic scoliosis, patients with a single thoracic curve showed asymmetrical trunk movement in the transverse plane, whereas those with a single lumbar curve showed asymmetrical trunk movement in the coronal plane. These results suggest that the postural control strategy of patients with scoliosis differs according to the curve pattern [3].

Contrary to what X-rays deceptively show, scoliosis is not solely a deformity in the frontal plane but rather a fully three-dimensional deformity that X-rays can show only in two dimensions. This is confirmed by the findings of several analyses in which postural adjustments during walking were observed in all three space planes [4].

Scoliosis reduces the physiological curves in the sagittal plane, mainly due to loss of dorsal kyphosis. One study has, in fact shown that patients with scoliosis “may lean backwards and have posterior postural sway, which may be associated with hypokyphosis during walking” [5].

It has also been observed that adolescents with scoliosis have difficulty maintaining smooth bodyweight transfers during strides and that this difficulty increases with increasing severity of the spinal deformity. Gait parameters, namely the loading response, midstance phase and propulsion phase, were not found to differ between the left and right sides. However, patients with moderate and severe scoliosis had asymmetrical gait periods in both limbs,  suggesting abnormal asymmetrical gait patterns [6].

Given all this information, we were drawn to a recently published meta-analysis in which reduction of the stance phase and restriction of frontal pelvic motion was found to lead to prolonged activation timing of the quadratus lumborum, erector spinae and gluteus medius muscles [7].

A final question was whether these differences in walking might affect youngsters’ daily lives. In this regard, one study, using a pedometer installed on smartphones, showed no difference in daily walking distance between adolescents with and without scoliosis [8].


[1] Garg B, Gupta M, Mehta N, Malhotra R. Influence of Etiology and Onset of Deformity on Spatiotemporal, Kinematic, Kinetic, and Electromyography Gait Variables in Patients with Scoliosis-A Prospective, Comparative Study. Spine (Phila Pa 1976). 2021 Mar 15;46(6):374-382. doi: 10.1097/BRS.0000000000003796. PMID: 33620181.

[2] Yang JH, Suh SW, Sung PS, Park WH. Asymmetrical gait in adolescents with idiopathic scoliosis. Eur Spine J. 2013 Nov;22(11):2407-13. doi: 10.1007/s00586-013-2845-y. Epub 2013 Jun 4. PMID: 23732766; PMCID: PMC3886502.

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