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SOSORT 2022: a feedback by dr Sabrina Donzelli, the next president of SOSORT

We asked physiatrist Dr Sabrina Donzelli, one of our doctors at ISICO, to tell us about the highlights and significance of SOSORT, the international conference held at the start of May in San Sabastian.
We knew that the event would be an important occasion for the specialists in attendance, as they had not been able to meet in person for two years. Little did we imagine, though, when we approached Dr Donzelli, that we were asking the very person who, in the course of the event, would be named as the next President of SOSORT. The presidency of this association is a highly prestigious role. This is the fourth time an ISICO member has been chosen for the position, and Dr Donzelli is the first woman to have the honour.

We therefore begin this interview by extending our congratulations to Dr Donzelli.

1) Wow! Well, this was great news on two levels: first, because the position will once again be held by an ISICO member, and second, because this is the first time a woman has been chosen. The International Society has grown considerably over the years and now has a large membership with a good balance of men and women, even though this is not so true of the single professions. There aren’t many doctors in SOSORT; most of its members are physiotherapists. If you aspire to be President of SOSORT, you have to serve the organisation, putting in years of voluntary work. For some years now, I have been committed to doing all I can for SOSORT because I share its vision and its mission: to ensure that patients with scoliosis always receive the best treatment based on the scientific evidence. It is therefore important to be committed to research and to spreading knowledge. In other words, the mission is also to educate. My commitment and willingness have helped me become widely appreciated within the society, allowing me to join the executive board in 2019, and to be made President Elect this year. 

2) What did it mean, after three years, to finally be meeting in person, with colleagues all in one place rather than scattered around the world?

SOSORT, which dates back to as long ago as 2004, was created to bring together the world’s leading experts in the field of rehabilitation treatment for spinal disorders, to allow them to “compare notes” and increase the level of scientific evidence in the field, as well as improve the treatments available to patients. Over time, its missions and aims have been and continue to be updated, because medicine is a constantly evolving science. The last proper congress was held in San Francisco in 2019, after which the event moved online for a couple of years. It was therefore fantastic finally being able to get together in person again. We were able to talk face to face and really share, all together, our passion for what we do and our everyday challenges. All this is reflected in the slogan that was used to announce and promote the event: SOSORT 2022 – More than a congress: an experience in San Sebastian. You will never forget it! 

3) What are the main scientific developments you were able to take away with you? 

Epigenetics appears to be the future when it comes to improving understanding of scoliosis and trying to identify individuals at risk of developing it. Obviously, there is still a huge amount of work to be done, but at present this seems to be the way to go. 

Second, ultrasound is the future of radiation-free diagnostics, albeit perhaps not so much when applied to the spine as when used to estimate residual growth. In this regard, I should mention an interesting study by  Sanders based on ultrasound of the hand, Bracing outcomes in end-of-growth patients. Evidence to support the use of braces even towards the end of growth: it’s not too late to wear a brace.
Indeed, other studies similar to ours have shown that good results can be obtained even at the end of growth. There is also promising scientific evidence in patients who have finished growing: we at ISICO were the first to present these findings, and now other groups, too, are showing that good results are possible even in individuals with advanced bone growth. 

It is worth considering that three of the six studies in the running for the SOSORT Award dealt with outcome prediction: they ranged from Dr Lori Dolan’s study with 10-year follow up after the end of bracing treatment to our research conducted in collaboration Dr Eric Parent of the University of Alberta, in Canada, in which we attempted, in patients observed over time, to predict future curves solely on the basis of X-rays performed before they started treatment with braces or exercises. 

4) SOSORT Award: were there any surprises?

Not at all. The winning study was the strongest methodologically. The paper, on which we collaborated with the University of Alberta, illustrated a prediction model developed on the whole sample: it has some limits related to the heterogeneity of the data, which reflects that of scoliosis itself. Each patient has their own clinical history and this makes it difficult to predict how the disease will evolve in relation to age, time since onset, and residual bone growth estimated using the Risser classification. 

The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), on the other hand, is a fundamentally important study: it has demonstrated the therapeutic effectiveness of braces and shown that follow up over time is essential in order to advance the study of scoliosis. The monitoring of the patients observed and treated by these researchers will continue to give us important information, while the methodological rigour of their study is a guarantee of very reliable scientific evidence.  

Pictured, Sabrina Donzelli, together with organiser (SOSORT 2022 local host) Garikoitz Aristegui, and Judith Sanchez Raya, co-Chair of the SOSORT 2022 Scientific Committee

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”.

SOSORT 2022: the AWARD winners and a fourth ISICO President

This year’s SOSORT meeting, held in San Sebastian, Spain in the wake of two editions forced online by the pandemic, was a double success for ISICO, which had two studies shortlisted for the SOSORT Award.
One of them, Prediction of Future Curve Angle using Prior Visit Information in Previously Untreated Idiopathic Scoliosis: Natural History in Patients under 26 Years Old with Prior Radiograph, conducted in collaboration with the University of Alberta in Canada, came first, making this the fourth consecutive year that ISICO has taken home the prestigious award. But this was not the only high point. Our Dr Sabrina Donzelli, physiatrist, was named as the next President of the International Society. This is the fourth time that ISICO has had this has honour since SOSORT was founded in 2004,  and it is the first time a woman has been appointed to the role.

“This prestigious appointment is an acknowledgement of Dr Donzelli’s scientific standing, hard work and commitment, as well as a recognition of our institute, which now provides a benchmark for clinical and research activity worldwide” remarked Prof. Stefano Negrini, Scientific Director of ISICO as well as one of the ISICO authors — the others being De Giulia Rebagliati, Dr Fabio Zaina and Dr Alberto Negrini — who collaborated with Dr Eric  Parent, first author of the study that won the SOSORT AWARD. The congress was hugely stimulating and we can’t wait for 2023 and next year’s meeting in Melbourne, Australia”.

The winning study of the SOSORT Award 2020 has been published

Two years after winning the SOSORT AWARD, the study “Predicting final results of Brace Treatment of Adolescents with Idiopathic Scoliosis: First Out-of-Brace are Better than In-Brace-radiographs” has finally been published in the European Spine Journal.

 A total of 131 patients were included in the study, the researchers aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph). In fact, the in-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient’s ability to maintain the correction.

The first out-of-brace radiograph predicts end results better than the in-brace radiograph.

“Our research has highlighted – explains Dr. Sabrina Donzelli, author of the research – how important the first x-ray taken without the brace is in predicting end-of-care results. The first out-of-brace radiograph should be considered an essential element of future predictive models and offers an excellent clinical reference for clinicians and patients. The collection of clinical data that occurs routinely during all visits to ISICO has allowed in recent years to be able to develop the so-called predictive models, i.e. we can use the characteristics of the patient to understand how the final results can be predicted or to understand if there are risk factors more important than others to consider when deciding what type of therapy to prescribe “.

eSosort2021: ISICO awarded for the third time in a row

And the winner is: Isico! For the third consecutive year, our Institute has been awarded the highest international recognition for those involved in the rehabilitation treatment of vertebral pathologies. On Saturday, May 1st, on the occasion of the annual SOSORT conference, this year in online mode due to the pandemic, our studio “Efficacy of bracing in infantile scoliosis. A 5.5 years prospective cohort shows that idiopathic respond better than secondary” was awarded the SOSORT Award. 

It is not the first time, because only in the last two years Isico has won the coveted international recognition for the best research by SOSORT, to which is added, in 2019, the award won as co-authors of a research study in collaboration with the University of Hong Kong. A truly unique continuity.
“An award that once again certifies the high quality achieved by the scientific research carried out in our Institute at an international level – explains Prof. Stefano Negrini, scientific director of Isico and first author of the awarded research (the other authors are Dr Sabrina Donzelli, Dr Greta Jurenaite, Dr Francesco Negrini and Dr Fabio Zaina) – through this research the main goal was we have set ourselves the goal to check the results in the medium term of bracing of infantile scoliosis, comparing the two groups: idiopathic and secondary scoliosis.”
According to Mehta results, casting is considered the gold standard conservative treatment for infantile scoliosis, still casting requires repeated general anaesthesia, and recently doubts have been raised that this could cause potential brain damages in the long term. 

“In our Institute, we have been using bracing for a long time to reduce invasivity for the patient – says Prof. Negrini – Moreover, the results of the Sforzesco brace have shown to be similar to casting in adolescents. Thanks to the clinical and research experience gained over the years, we have developed a retrospective study in a prospective cohort. We have been using braces since 2004 and have been able to present the largest case history on braces to date (34 patients), with an average follow-up of 5 years, documenting excellent results in idiopathic scoliosis (success in 50% of cases – only one failure), while in those secondary to other pathologies it is possible to delay surgery over time even in the face of more frequent failures (surgery inevitable in 20% of cases)”.
We remind you that infantile scoliosis is very rare, about 1 case in 10,000 children, and for this reason, it must be treated by very expert and dedicated specialized clinics with specialists who  have been managing spine deformity for long and have a rich clinical experience
“In this context, we are also the only Italian structure that is participating in an international multicentre study, which involves clinical centres in 40 countries around the world, to verify the effectiveness of braces compared to casts – concludes prof. Negrini – During the two-year duration of the project, we will bring about 5 cases treated at our Institute for research purposes. Isico has several years of experience in the use of braces, our participation will not include the application of casts, but our results in bracing will be compared with those of other centres that apply casts”.

eSosort2021: Isico competes for the AWARD

Isico, too will be present with several presentations at the annual international conference Sosort, online from April 29th to May 1st.
A presence, albeit virtual, characterized by the possibility of competing again for the SOSORT Award. We recall that Isico has been awarded already in the last two years the prestigious international recognition given by SOSORT for the best research, to which is added, in 2019, the Award won as co-authors of a research study in collaboration with the University of Hong Kong.

“In this online edition, our study Efficacy of bracing in infantile scoliosis. A 4-years prospective cohort shows that idiopathic respond better than secondary scoliosis will compete for the Award along with six other studies – explains Prof Stefano Negrini, scientific director of Isico and first author of the research – an important result that recognizes the high quality of the research we are performing in Isico. Also, the study Adults with idiopathic scoliosis: progression over 5 Cobb degrees is predicted by menopause and metabolic bone disease, which sees as first author Dr Sabrina Donzelli (who won the Award in 2020) was nominated among the 7 best research studies: Dr. Donzelli will hold the presentation but will not compete for the Award this year.”
In addition, another study, Increasing Brace Comfort, Durability and Sagittal Balance through Semi-rigid Pelvis Material does not change Short-Term Very-Rigid Sforzesco Brace Results, is among those selected for the Podium presentation and will be presented during the event by Dr Francesco Negrini, an Isico physiatrist.

Isico also distinguished itself for the works accepted as Posters, available to subscribers to the event in an on-demand session, and they are three: Can the tilt-differences of limiting vertebrae be a prognostic factor for the worsening of the scoliosis curves treated with specific exercises? A pilot study using a series of matched patients, edited by our director of physiotherapy, Michele Romano, Reducing the pelvis constriction changes the sagittal plane in the brace. A retrospective case-control study of 37 free-pelvis vs 336 classical consecutive very-rigid Sforzesco braces and The modular MI-brace is as effective as the classical custom-made Sforzesco brace. A matched case-control study of 120 consecutive high-degree female AIS, both from Prof Stefano Negrini.

This year’s virtual meeting will begin with synchronous (live) presentations on Thursday, April 29th and Friday, April 30th, from 9 am to 11 am Eastern Time, and on Saturday, May 1st, from 9 am to 1 pm Eastern Time.

All the presentations will be recorded and be made available on-demand for a duration of 1 year on the SOSORT conference website for registered participants. For more information and registration, visit the event website https://esosort21.sosort.org

And the Sosort Award winner is… Isico!

At the International Sosort Meeting in June, this year held for the first time ever entirely online, Isico recorded another great success.

Dr Sabrina Donzelli, Isico physiatrist, won the Sosort Award, the event’s top prize, for her research entitled: “Predicting final results of Brace Treatment of Adolescents with Idiopathic Scoliosis: First Out-of-Brace are Better than In-Brace-radiographs”. Her study was chosen over the work of 7 other researchers in the running for the award.

Among eight studies selected as oral presentations, the Scientific Committee picked out, as the two finalists, Dr Donzelli’s research study and a study on the genetics of scoliosis by the Montreal-based research group led by Prof A Moreau. “After the initial selection we were asked to submit a complete article to be entered for the Sosort Award” explains Dr Donzelli. “The prize, for the winning study, is a sum of money allowing it to be published in any magazine, as an open-access article, in other words in a format accessible, free of charge, to anyone who might be interested in reading it”.

The other studies running for the award included a long-term follow up of patients with scoliosis, presented by Dr AG Aulisa, a cost analysis of conservative versus surgical treatment, and two studies on Scolioscan©, the ultrasound equipment present as well at Isico’s Milan clinic. 

“Our winning research underlines how important patients’ first out-of-brace radiographs are for predicting the results at the end of their course of treatment,” Dr Donzelli goes on. “The accuracy of the model we developed and tested, is the key factor that won us this prestigious award, which will allow us to publish our work in the coming months.” 

In the course of the online meeting, several of our specialists gave presentations: Alessandra Negrini, Isico physiotherapist, asked “Is swimming helpful or harmful in adolescents with idiopathic scoliosis?”, Dr Fabio Zaina, Isico physiatrist, gave a presentation entitled “ISYQOL, a Rasch consistent tool for quality of life evaluation in scoliosis patients during adulthood: comparison with the gold standard”, while our director of physiotherapy, Michele Romano, spoke about “The effect of dance performance on idiopathic scoliosis progression in adolescents”.

This is the second year running that Isico has not only been among the finalists but also gone on to win the award. 

In 2019, Isico also won an award with a study concerning scoliosis and sport. “The quality of our research has increased not only as a result of our acquisition of increasingly high-level methodological skills, but also thanks to the growing availability of systematically collected data,” explains Dr Donzelli. “In recent years, the data we routinely collect from patients visiting our facilities have allowed us to develop so-called predictive models. In other words, we consider the characteristics of large groups of patients to try and understand whether they allow us to predict their final results, or whether certain risk factors are more important to consider than others when deciding what type of therapy to prescribe. Our growing clinical and research expertise has led to international collaborations. Many others now look to us to provide expert support. We are also seeing an increase in our collaborations with international partners that want to analyse and compare their clinical and radiographic data with our database”.