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Isico science corner video column

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At Isico we give great importance to research, an integral part of our clinical work.  
Our newsletters always dedicate a space to the presentation and a comment when a new Isico study is published. 
From this issue on, we will go one step further, enriching each presentation with the video commentary of the first author of the research paper. We are pleased that it is just our scientific director Stefano Negrini, the first author of the article, launching the new Isico Science corner video column with a study of such great importance.

Back and neck pain and smartphone: is there a correlation?

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Can being bent over the smartphone too often cause back- and neck pain in younger people? Data coming out of the study Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study, published some time ago by the Journal of Bodywork and Movement Therapies are not confirming this.

The cross-sectional correlational study was conducted in a sample of students selected through convenience sampling between September 2016 and March 2017: the inclusion criteria were university students at the School of Medicine and Surgery, routine/daily use of mobile devices with advanced computing and connectivity capability built on an operating system, and aged 18–30 years. A total of 238 volunteers were recruited.

“The objective of the study – explains Prof. Stefano Negrini, scientific director of Isico and one of the authors of the research – was to determine the impact of smartphone use on neck impairment and functional limitation in university students. Neck pain was assessed using a visual analogue pain score (VAS) and a pain drawing (PD); disability status was measured using the Neck Disability Index (NDI-I); cervical postures while using the phone were captured using the Deluxe Cervical Range of Motion (CROM) device”.

While half of the young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability. “While we wait for future prospective studies – ends Prof. Negrini – there is no reason to recommend a change in smartphone use habits among young adults in the meantime”.

Isico among the attendees of the November SRS webinar

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

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

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

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

To register please visit the page of the SRS website

eSosort2021: ISICO awarded for the third time in a row

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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

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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

Natural History of Scoliosis: the development of a predictive model

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There are two abstracts on the natural history of scoliosis that Isico is going to present at the 56th SRS conference scheduled for next September in the United States: “Predicting Future Curve Severity for Juvenile Idiopathic Scoliosis: A Natural History Study” and “Predicting Future Curve Severity Requires Different Models for Adolescent and Juvenile Idiopathic Scoliosis “.
Abstracts which constitute research carried out by Isico in collaboration with the Canadian University of Alberta and Dr Erik Parent. The preliminary results of this research study will be presented by Prof Stefano Negrini at the Research Grant Outcome Symposium organized by SRS and scheduled for March 6 from 9 to 11 ET US.
Most models to predict future Scoliosis severity have not been validated; many previous samples included treated patients limiting our understanding of the natural history. 

“Our aim was to predict future curve severity at a time point of the clinician’s choice during adolescence using data from x-rays obtained before starting treatment in patients with a diagnosis of Juvenile Idiopathic Scoliosis (JIS) – explains dr Sabrina Donzelli, one of the authors of this research study – we included 2331 patients with a diagnosis of JIS, under age 26, previously untreated.
The data obtained through the radiographs confirm the factors involved in the severity of scoliosis: for juvenile scoliosis the age at onset and the extent of the curve, and for adolescent scoliosis the Risser stage and female gender. The idea is to optimize the use of this data for clinical purposes “.

That is, to be able to validate the model to verify  whether it works for another population with similar characteristics. “During the webinar to which I have been invited – says Prof. Negrini – I will present the preliminary data not only of the two abstracts but also of the other analyses developed by the Canadian university. As a team, we are continuing to validate one model with which we can create an algorithm to predict the cases with the highest development risk.”

Best Practice Guidelines for bracing in AIS

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Which are the guidelines for using a brace in idiopathic scoliosis treatment? The study “Establishing consensus on the best practice guidelines for the use of bracing in adolescent idiopathic scoliosis”, just published by the journal Spine Deformity, collected 38 experts who developed a consensus on 67 items across ten domains of bracing which were consolidated into the final best practice recommendations.
Among the experts, from surgeons to physiatrists and physiotherapists, prof. Stefano Negrini, scientific director of Isico: “Bracing is the mainstay of conservative treatment in Adolescent Idiopathic Scoliosis (AIS), but currently there is significant variability in the practice of brace treatment for AIS and, therefore, there is a strong need to develop best practice guidelines (BPG) for bracing in AIS“.
How did you go about developing a common consensus?
Following a review of the literature, three iterative surveys were administered. Topics included bracing goals, indications for starting and discontinuing bracing, brace types, brace prescription, radiographs, physical activities, and physiotherapeutic scoliosis-specific exercises. A face-to-face meeting was then conducted that allowed participants to vote for or against the inclusion of each item. Agreement of 80% throughout the surveys and face-to-face meeting was considered consensus. Items that did not reach consensus were discussed and revised, and repeat voting for consensus was performed.
 “A common adherence to these BPGs is fundamental for developing common protocols on an international level – ends prof. Negrini – furthermore, this consensus on the guidelines will lead to fewer sub-optimal outcomes in patients with AIS by reducing the variability in AIS bracing practices, and provide a framework for future research”.

Online Master: conclusion of edition 2020

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Our international online Master 2020 edition has reached its last session. It started as usual in January and for the first time in a double edition, English and Chinese. Thanks to the online formula consolidated over the time we have been able to proceed in the best possible way and absolute normality in this particular year. 
The last live lesson has been given together by the 3 teachers who perform the live lessons individually during the year, with the closing of prof Stefano Negrini, scientific director of Isico.
We remind you that registrations are open for the 2021 edition with lessons from January to November. The lectures are organised in modules self-administered by the participants except live lectures delivered two times a month.

Also the first Chinese edition of the online Master course closed its doors, with excellent prospects for the second edition in 2021.


For more infos please visit the website: www.scoliosismaster.org 

Isico involved in an international research project: brace versus plaster cast

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An international project involving clinical centres in 40 countries in the US, Canada, Europe and Asia has just started. Target? A comparison between the use of plaster casts and braces in the treatment of infantile scoliosis.
Isico is one of the centres involved, thus representing Italy, expressly invited given the clinical and research experience gained over the years.

The project manager is Prof. Stuart L. Weinstein, referent Dr Lori A. Dolan, both from the American University of Iowa. The target enrollment is 440 subjects (220 patients and 220 parents). For Isico, the head researcher is Prof. Negrini, while Dr Donzelli is involved as the research referent.

We recall that infantile (early-onset) idiopathic scoliosis (IEOS) is a relatively rare disease affecting 40 out of 100,000 children. Defined as an idiopathic curve measuring > 20 degrees in those less than three years of age, the natural history of IEOS is variable with some curves resolving spontaneously and others quickly progressing to such a degree that severe pulmonary disease and shortened life span may occur. Casting, and less frequently bracing, have been used to treat this condition in hopes of resolving the curve or at least delaying surgical interventions.

The plaster cast is widely used for these early forms of scoliosis, but a plaster requires hospitalization, sedation, and daily handling is much less comfortable for hygiene than a removable brace.

“During the two-year duration of the project, funded by the University of Iowa and The Orthopedic Research and Education Foundation, – explains Dr Donzelli – we will bring between 5 and 10 cases treated at our Institute to research purposes. Isico has several years of experience in the use of braces; our participation will not involve the application of plaster casts; our results will be compared with those of other centres that apply these casts “.

A Brace classification study

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The study Brace Classification Study Group (BCSG): part one – definitions and atlas, published by Scoliosis and Disorders,  represents the first part of the SOSORT consensus in addressing the definitions and providing a visual atlas of bracing.
Prof. Stefano Negrini, Scientific Director of Isico, is one of the authors who belong to a panel of professionals named the Brace Classification Study Group. 
Prof. Negrini explains: “The current increase in types of scoliosis braces defined by a surname or a town makes scientific classification essential. Currently, it is a challenge to compare braces and specify the indications of each brace. A precise definition of the characteristics of current braces is needed“. 
As such, the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) mandated the Brace Classification Study Group (BCSG) to address the pertinent terminology and brace classification.
The BCSG introduced several pertinent domains to characterize bracing systems.
The domains are defined to allow for analysis of each brace system. The BCSG has reached a consensus on 139 terms related to bracing and has provided over 120 figures to serve as an atlas for educational purposes. 
During the annual meeting of the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) in Athens in 2008, Prof. Negrini presented a new classification under the acronym BRACE MAP.
BRACE MAP derives from the following terms: Building, Rigidity, Anatomical classification, Construction of the Envelope, Mechanism of action, and Plane of action. Each item was composed of two to seven classificatory elements defined using one or two letters in order to refer specifically to the characteristics of the brace throughout the classification.  
“A visual atlas of various brace types is provided – ends prof. Negrini – This is the first clinical terminology tool for bracing related to scoliosis based on the current scientific evidence and formal multidisciplinary consensus”.