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Idiopathic scoliosis is common in adulthood and can impact patients' physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from adolescence to adulthood. More recently, the Italian Spine Youth Quality of Life (ISYQOL) international questionnaire was developed, which performs better than SRS-22 in adolescent spinal deformities. However, the ISYQOL questionnaire has never been tested in adults. This study compares the construct validity of ISYQOL and SRS-22 with the Rasch analysis (partial credit model). We recruited 150 adults and 50 adolescents with scoliosis (≥30° Cobb). SRS-22, but not ISQYOL, showed disordered categories and one item not fitting the Rasch model. A 21-item SRS-22 version with revised categories was arranged and further compared to ISYQOL. Both questionnaires showed multidimensionality, and some items (SRS-22 in a greater number) functioned differently in persons of different ages. However, the artefacts caused by multidimensionality and differential functioning had a low impact on the questionnaires' measures. The construct validity of ISYQOL International and the revised SRS-22 are comparable. Both questionnaires (but not the original SRS-22) can return measures of disease burden in adults with scoliosis.

Background: Adolescent idiopathic scoliosis and its treatments can severely impact health-related quality of life. The Italian Spine Youth Quality of Life (ISYQOL) questionnaire, initially developed in Italian and tested on Italian people, was created to measure quality of life in young persons with spine changes. ISYQOL was created using the Rasch analysis, a modern psychometric technique for questionnaires' assessment and development, which showed that the ordinal scores of the ISYQOL Italian version provide sound quality of life measures., Aim: The current work aims to evaluate the cross-cultural equivalence of the ISYQOL questionnaire in seven different countries., Design: Cross-sectional, international, multi-centre study., Setting: Outpatient clinic., Population: Five hundred fifty persons with adolescent idiopathic scoliosis from English Canada, French Canada, Greece, Italy, Spain, Poland, and Türkiye., Methods: The ISYQOL Italian version was translated into six languages with the forward-backwards procedure. The conceptual equivalence of the items' content was verified, and any inconsistency was resolved by consensus. The Rasch analysis was used here to evaluate that ISYQOL translations retained the good measurement properties of the Italian version of the questionnaire. In addition, the Differential Item Functioning (DIF) was checked to assess the psychometric equivalence of the ISYQOL items in patients from different countries., Results: Four items of the translated ISYQOL were dropped from the questionnaire since they did not contribute to measuring due to their poor fit to the model of Rasch. Seven items were affected by DIF for nationality, a finding pointing out that these items do not work the same (i.e. are not equivalent) in the different countries. Thanks to the Rasch analysis, the DIF for nationality was amended, and ISYQOL International was eventually obtained., Conclusions: ISYQOL International returns interval quality of life measures in people with adolescent idiopathic scoliosis with high cross-cultural equivalence in the tested countries., Clinical Rehabilitation Impact: Rigorous testing showed that ISYQOL International ordinal scores return quality of life measures cross-culturally equivalent in English and French Canada, Greece, Italy, Spain, Poland, and Türkiye. A new, psychometrically sound patient-reported outcome measure is thus available in rehabilitation medicine to measure health-related quality of life in idiopathic scoliosis.

Competing Interests: One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms.

Background: We need good outcome predictors to maximize the treatment efficiency of adolescents with idiopathic scoliosis (AIS). The in-brace correction has shown an important predictive effect on brace failure, while the influence of other variables is still debated. We aimed to identify new outcome predictors from a big prospective database of AIS., Methods: Design: Retrospective analysis of prospectively collected data., Inclusion Criteria: AIS between 21 and 45°, Risser 0-2, brace prescription during the observation, treatment conclusion. All of the participants followed a personalized conservative approach according to the SOSORT Guidelines., Outcomes: End of growth below 30°-40°-50°. The regression model included age, BMI, Cobb angle, ATR, TRACE score, real brace wear (RBW), and in-brace correction (IBC)., Results: A total of 1050 patients, 84% females, ages 12.1 ± 1.1, 28.2 ± 7.9° Cobb. IBC increased by 30%, 24%, and 23% the odds of ending treatment below 30°, 40°, and 50°, respectively. The OR did not change after the covariate adjustment. Cobb angle and ATR at the start also showed a predictive effect., Conclusions: The systematic evaluation of IBC in clinics is useful for individuating the patient response to brace treatment more accurately, even in relation to the Cobb angle and ATR degrees at the start. Further studies are needed to increase the knowledge on predictors of AIS treatment results.

Background: In clinics and the literature, there are doubts about the indications and contraindications of sports to support rehabilitation treatment for adolescents with idiopathic scoliosis (IS)., Aim: The aim of the study is to assess sports activities' effect and frequency in a large population of adolescents with idiopathic scoliosis (IS)., Design: Retrospective observational cohort study., Setting: Tertiary referral institute specialized in the conservative treatment of scoliosis., Population: consecutive patients in a clinical database of age ≥10, with juvenile or adolescent IS diagnosis, 11-25° Cobb curve, Risser Bone Maturity Score 0-2, no brace prescription, radiographic follow-up radiographs at 12±3 months., Methods: At 12-month follow-up, radiograph, we considered progression an increase of scoliosis curve ≥5° Cobb and failure an increase to ≥25° Cobb - need of a brace. We calculated the Relative risk (RR) to compare the outcome of participants performing sports (SPORTS) or not (NO-SPORTS). We run a logistic regression with covariate adjustment to assess the effect of sports participation frequency on the outcome., Results: We included 511 patients (mean age 11.9±1.2, 415 females). Participants in the NO-SPORTS group showed a higher risk of progression (RR=1.57, 95% CI: 1.16-2.12, P=0.004) and failure (RR=1.85, 95% CI: 1.19-2.86, P=0.007) than participants in SPORTS. Logistic regression confirmed that the more frequent the sports activities, the less probable progression (P=0.0004) and failure (P=0.004) were., Conclusions: This study shows that sports activities have a protective role against progression at 12-month follow-up in adolescents with milder forms of IS. Excluding high-level sports activities, the risks of progression and failure decrease with the increase in sports frequency per week., Clinical Rehabilitation Impact: Albeit non-specific, sports can help in the rehabilitation of patients with idiopathic scoliosis and reduce brace prescription.

There is a common agreement that bracing is appropriate for curves between 20 and 40° for the Cobb angle during growth, but for larger curves, the experts' opinions are not consistent. We designed this systematic review to report the updated evidence about the effectiveness of bracing in scoliosis patients with curves ≥40° and a residual growth period. We included randomized controlled trials, non-randomized controlled trials, prospective and retrospective observational studies, and case series addressing the effect of bracing in patients with idiopathic scoliosis during growth with curves ≥40° for the Cobb angle, published from 2000 onwards. Outcome: The percentage of patients with surgery, curves above 45° or 50°, and a Cobb angle change are all included in the study. Nine papers (563 patients, average worst curve of 44.8°) are included: four are retrospective case series, two are retrospective and two are prospective cohort studies, and one is a prospective controlled study. The overall quality was good, with respect to the type of design. A total of 32% of the patients improved, 26% were stable, and 42% worsened. The rate of improvement ranged from 11% to 78%; the rate of worsening ranged from 4% to 64%. There are some studies suggesting the use of bracing even in the case of severe curves when patients are motivated by trying to avoid surgery. More and better-quality research with coherent outcome criteria is needed.

This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement., (Copyright © 2022 International Society for Prosthetics Orthotics.)

We introduced pelvis semi-rigid material (ethylene vinyl acetate) (Free-Pelvis) to improve the comfort and adaptability of very rigid braces (VRBs) for adolescents with idiopathic scoliosis (AIS), but this can also negatively impact the corrective forces on the trunk. Study Design: This was a matched retrospective cohort study. The inclusion criteria were AIS, age 10-16, VRB 23 h/day, X-rays available, primary curve 36°-65°, and angle of trunk rotation 7-23°. The cases were Sforzesco VRB with Free-Pelvis (FPB). The controls included classical Sforzesco VRB matched for Risser (range 0/4), menarche age (10/15), weight (33.5/83 kg), height (140/180 cm), BMI (13.5/29 kg/sqm), aesthetics (TRACE 4/12), plumbline distances (S1: -60/35; C7 + L3: -10/115 mm), and referred brace use (22/24 h/day). Statistics: predictors of the results have been tested with linear and logistic regression according to the outcome variable type. We performed logistic regression for improved vs. worsened. The explanatory variable was brace type. We included 777 VRB and 25 FPB, age 13 ± 1, 47° ± 8° Cobb, and 11% men. The few baseline statistical differences were not clinically relevant. We achieved in-brace corrections of 15.2° ± 7.7° and 17.4° ± 6.5° for VRB and FPB, respectively ( p = 0.21); out-of-brace corrections at 5 ± 2 months were 7.8° ± 0.2° for VRB and 8.1° ± 1.3° for FPB ( p = 0.83). The type of brace did not influence the Cobb angle at either time interval or affect the odds of improvement. Free-Pelvis innovation, introduced to improve comfort and adaptability, does not change the in-brace or short-term results of classical VRB and consequently can be safely applied.

Purpose: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability., Methods: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments., Results: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes., Conclusions: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe., (© 2022. The Author(s).)

Purpose: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types., Methods: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM., Results: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups., Conclusion: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field., (© 2022. The Author(s).)

Objectives: To investigate the feasibility and acceptability of telemedicine as a substitute for outpatient services in emergency situations such as the sudden surge of the COVID-19 pandemic in Italy., Design: Observational cohort study with historical control., Setting: Tertiary referral outpatient institute., Participants: Consecutive services provided to patients with spinal disorders (N=1207)., Interventions: Telemedicine services included teleconsultations and telephysiotherapy, and lasted as long as usual interventions. They were delivered using free teleconference apps, caregivers were actively involved, and interviews and counseling were performed as usual. Teleconsultations included standard, but adapted, measurements and evaluations by video and from photographs and videos sent in advance according to specific tutorials. During telephysiotherapy, new sets of exercises were defined and recorded as usual., Main Outcome Measures: We compared the number of services provided in 3 phases, including corresponding periods in 2018 and 2019. During the control (30 working d) and COVID-19 surge (13d) only usual consultations and physiotherapy were provided; during the telemed phase (15d), only teleconsultations and telephysiotherapy were provided. If a reliable medical decision was not possible during teleconsultations, usual face-to-face interventions were prescribed. Continuous quality improvement questionnaires were also evaluated., Results: During telemed, 325 teleconsulations and 882 telephysiotherapy sessions were provided in 15 days. We found a rapid decrease (-39%) of outpatient services from the control to the COVID-19 phase (R 2 =0.85), which partially recovered in the telemed phase for telephysiotherapy (from -37% to -21%; P<.05) and stabilized for teleconsultation (from -55% to -60%) interventions. Usual face-to-face interventions were required for 0.5% of patients. Patients' satisfaction with telemedicine was very high (2.8 out of 3)., Conclusions: Telemedicine is feasible and allows medical professionals to continue providing outpatient services with a high level of patient satisfaction. During the current pandemic, this experience can provide a viable alternative for many outpatient services while reducing the need for travel and face-to-face contact to a minimum., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Low back pain (LBP) is the most common musculoskeletal condition affecting the quality of life of individuals, especially if persistent. Over the decades, a lot of work has been done in an attempt to reduce the negative impact of back pain, and help patients recover and maintain a better quality of life. New insights are coming from different fields of research, with a lot of work being done in searching for the etiology of LBP, describing the different phenotypes of symptomatic spines, and identifying factors involved in the persistence of the disease. Nevertheless, still a lot remains to be done to fully understand the problem of back pain and its causes. Even today, there appears to be a wide gap between basic science and applied rehabilitation research on LBP. The first is still searching in many different ways for the "holy grail" of the pain generator and providing very interesting results with particular relevance to surgical, drug-related and other biological approaches, while the second is pragmatically focusing on modifiable factors that may influence back pain outcomes. Yet, personalized, effective spine care has not been fully realized. While we recognize the potential of basic science advances, there is an immediate need for more translational rehabilitation research, as well as studies focused on the effectiveness of rehabilitation approaches.

Competing Interests: SD nothing to disclose. FZ nothing to disclose. SN owns ISICO stocks.

Background: Adult scoliosis is sometimes associated with back pain. Recently, the Peak ™ Scoliosis Brace was designed to alleviate pain in adult patients with scoliosis., Objectives: To test the efficacy of the Peak Scoliosis Brace in reducing pain in adult scoliosis patients., Study Design: Prospective experimental cohort study., Methods: A total of 20 adult females with back pain secondary to idiopathic scoliosis were included. Patients were evaluated at baseline immediately before starting bracing and after 1 month. The brace had to be worn for at least 2 h per day. The outcome measures used were Graphical Rating Scale, Roland-Morris Questionnaire, Core Outcome Measurement Index, and Oswestry Disability Index., Results: Worst pain, back pain, and leg pain significantly improved from 7.15 to 5.85, from 6.55 to 5.25, and from 5.65 to 3.55, respectively ( p < 0.05). A total of 75% of patients reported improved worst and leg pain, 65% improved back pain, 30% of patients achieved the minimal clinically significant difference of 2 points for worst pain, 60% for leg pain, and 25% for back pain. Roland-Morris Questionnaire and Core Outcome Measurement Index improved ( p < 0.05) and no differences were observed for Oswestry Disability Index., Conclusion: The Peak Scoliosis Brace led to some improvement of pain at 1 month in a group of adult women with scoliosis and chronic low back pain. The quality of life did not change significantly. Clinical relevance According to our data, the Peak Brace is helpful to quickly improve pain in patients with chronic low back pain secondary to scoliosis. To achieve this goal, it should be applied for at least 2 h per day.

Objective: The aim of this study was to examine the association between trunk sagittal posture and nonspecific chronic low back pain (CLBP) by evaluating plumb-line distances in subjects recruited in an everyday clinical setting., Methods: Of the 1364 subjects recruited, 63.1% were female (mean age ± SD: 56.2 ± 16.8 years). Subjects were categorized into CLBP and control groups and were prospectively assessed over a 3-month period. They provided information about their daily activities and their history of CLBP. Prognostic factors were analysed using univariate and multivariate logistic regression analyses. A physical examination was performed to record demographic (i.e. age, height and weight) and pain characteristics, and the intensity of pain was assessed using a numerical visual analogue scale. Disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). A simple measure generally used for sagittal plane screening purposes during growth was also utilized., Results: Multivariate logistic regression analysis revealed that gender (OR = 1.70), RMDQ score (OR = 0.51) and thoracic hyperkyphosis (C7 + L3 at the plumb-line distance) (OR = 1.57) were associated with CLBP. The final regression model explained 85.6% (R 2  = 0.56; P < 0.001) of the variability., Conclusions: General practitioners can clinically and easily assess trunk posture in subjects with low back pain to identify subjects at higher risk of CLBP., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The aim of the study was to provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth., Design: A comprehensive search of Medline, Embase, And Scopus databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile idiopathic scoliosis, juvenile idiopathic scoliosis, or adolescent idiopathic scoliosis, followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The following studies were grouped per diagnosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis., Results: Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included infantile idiopathic scoliosis patients (347 participants), five studies included a mixed population of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis (1330 participants), and five studies included adolescent idiopathic scoliosis patients only (624 participants). The random pooled estimated progression rate was 49% (95% confidence interval = 1%-97%) for infantile idiopathic scoliosis, 49% in a mixed group of patients affected by juvenile idiopathic scoliosis or adolescent idiopathic scoliosis (95% confidence interval = 19%-79%), and 42% in adolescent idiopathic scoliosis (95% confidence interval = 11%-73%)., Conclusions: During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous.

Purpose: A long debate exists about the connection between anorexia nervosa (AN) and scoliosis due to conflicting evidence. No study so far has evaluated the prevalence of scoliosis in patients with AN. The aim of the study is to evaluate the prevalence of idiopathic scoliosis in patients with AN., Methods: Design: cross-sectional study., Study Group: convenience sample of all patients matching the inclusion criteria., Control Group: female participants coming from an epidemiological screening for scoliosis., Inclusion Criteria: patients had a diagnosis of AN during adolescence according to the DSM-IV-TR criteria. We applied a two-level screening using a Bunnell scoliometer and a radiograph. We calculated the odds ratio compared with participants coming from a school screening., Results: Seventy-seven females with AN were compared to 816 females screened for scoliosis. The prevalence of scoliosis in the AN group was 16.9% (OR 5.77, 95% CI 3.12-10.67) with respect to the control group. If we consider as positive only those who received a scoliosis diagnosis during adolescence, the OR would be 3.15 (95% CI 1.55-6.42)., Discussion: This is the first study performed on patients with AN showing a sixfold greater odds of presenting with scoliosis. A cause-effect relationship cannot be determined due to the design.

Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS)., Methods: Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016., Results: The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing ( n  = 25), PSSE to prevent scoliosis progression during growth ( n  = 12), PSSE during brace treatment and surgical therapy ( n  = 6), other conservative treatments ( n  = 2), respiratory function and exercises ( n  = 3), general sport activities ( n  = 6); and assessment ( n  = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8., Conclusion: The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee., Competing Interests: Not applicable.Not applicable.All Commission Members are physicians, orthothists and physiotherapists who earn from their own work. The conflict of interests declared by the authors are as follows: ✓ Stefano Negrini has a stock of ISICO (Italian Scientific Spine Institute), Italy. ✓ Manuel Rigo is advisor of Ortholutions, Germany. ✓ Michele Romano has a stock of ISICO (Italian Scientific Spine Institute), Italy. ✓ James H. Wynne is an employee of Boston Brace Corp., USA: ✓ No other conflict of interests have been declared.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: The literature did not show clearly if a correlation between trunk and facial asymmetry exists. The aim of this study was to verify the association between trunk and facial asymmetries, and trunk and facial sagittal configuration in adolescents., Methods: This is a cross-sectional screening study. It was carried out in a small town in Northern Italy, from February to April 2014. Healthy children met the inclusion criteria. Exclusion criteria were subjects with physical and cognitive disability, genetic disease, and polymorphism. All subjects underwent a three phases for postural screening program., Results: 1029 healthy children were 491 females and 538 males with mean age: 12 (range 11-16) years. The association of facial and trunk asymmetry had a point prevalence rate around 1% for the various regions of the spine, the association on the sagittal plane of almost 1.3% for hyperkyphosis and hyperlordosis. Overall, results showed a very low sensitivity, specificity, and predictive values of facial anomalies for trunk asymmetry and sagittal spinal posture., Conclusion: While correlations between jaw position and body posture for cervical spine can exist, our study denied association with trunk and back in a general population: postural compensatory mechanism may have minimized the effects of one area on the other, if any existed.

Purpose: Overweight was found to be a negative predictor of brace effectiveness for adolescent idiopathic scoliosis (AIS), with a threefold higher risk of progression than in normal weight patients. The aim of this study is to investigate overweight, as a predictor of brace results in AIS patients., Methods: Design: retrospective cohort study., Population: 351 AIS patients (306 females), mean age 12.9 ± 1.4, mean Cobb 35.6 ± 11.4°, mean ATR 11 ± 4.3°, BMI 19.7 ± 3, median Risser: 2., Inclusion Criteria: no previous treatment, full-time prescription of brace at first visit (18-23 h per day), scoliosis physiotherapeutic exercise according to the SEAS protocol associated., Outcome: improved, progressed, and stable according to the 5° Cobb agreed threshold., Statistics: a stepwise linear regression was used to look for the effect of BMI as a predictor of result. A Chi-square test and logistic regression were used for the overweight category (BMI ≥ 85th percentile). Control for possible confounders was applied., Results: BMI is poorly correlated with final results. Confounders' adjustment did not change the correlation, and the predictive model explained about 10% of the result. Brace results were not statistically different in overweight and normal weight: 44 vs 52% improved, 52 vs 41% stable, and 3 vs 7% worsened, respectively., Discussion: Brace results were similar in overweight and normal weight subjects. These findings subvert the previous results and disprove the role of overweight as a negative predictor. Treatment management, brace type and effectiveness may play a major role in reducing the risks of scoliosis progression.

Purpose: The eosinophilic granuloma is a unifocal or multifocal Langerhans cell histiocytosis characterized by an expanding proliferation of Langerhans cells in bones. Skeletal LCH is a rare condition, and vertebral regeneration in cases of vertebral body collapse is even rarer. We report the case of a girl with spontaneous complete healing., Methods Ad Results: A 3-year-old girl was referred for nighttime back pain, with no fever and no neurologic signs. Within a few days, she developed sudden painful restriction of all spine movements. X-ray and computed tomography (CT) of the spine showed reduced T7 vertebral body height (vertebra plana).The patient underwent T7 curettage and the histopathological exam was suggestive of LCH. Two additional skull lesions were found and therefore she underwent chemotherapy. After 7 years of follow-up, total vertebral reconstruction was observed., Conclusions: Despite the rarity of the condition and despite the rarity of vertebral body lesion resolution, total vertebral body reconstruction was observed over a 7-year period. Long-term follow-up is necessary for a better understanding of the final outcome of patients with EG.

Background: A temperature monitor is used to objectively measure brace wear time in adolescent idiopathic scoliosis. The reliability of this device have been demonstrated, and some specialists introduced the use of a compliance monitor as a standard of care in everyday clinical practice, as we did since 2010 with the Thermobrace (TB). The attitude towards these objective monitors has never been investigated. The present study aims to investigate the attitude of parents and patients towards the use of temperature sensors for measuring brace wear compliance., Methods: Three hundred one consecutive girls and 63 boys and their parents have been interviewed. The inclusion criteria were as follows: brace wear full-time prescription at first visit and at least one visit with download and discussion of TB data. Usefulness, acceptability, reliability, and feeling related to data download were the investigated domains. Patients were invited by the administrative staff to complete anonymously the questionnaire. The European Commission was informed about the present survey and approved it (ICT-37-2015-1). Descriptive statistic was used to present the results., Results: Among the 364 invited patients and parents, 336 adhered by completing it (rate of responders was 93.2%). The mean age was 14.65 (SD 2.36), the mean Cobb angle was 34.18 (SD 13.57), and the average brace wear prescription was 21.76 h per day (SD 2.53). We did not ask parents about their age, profession, nor other personal data. Globally, the interviewed patients and parents showed a very positive attitude towards the TB monitor: the mean rate of parents stating a completely or at least partially positive attitude towards this electronic device was 94.0% while among patients, it was 85.6%., Conclusions: This is the first study investigating the attitude of parents and patients towards a brace wear compliance monitor. People who experienced this objective monitoring are aware of the advantages related to it and support its usefulness not only for clinicians but also for patients and parents to respect the hours prescribed without any affection on the children and parents or the patient-physician relationship. The present results should encourage the spread of these tools in daily clinical practice.

Background: Despite its importance in affecting adult pain, and disability, there is a lack of universal criteria for the diagnosis and evaluation of thoraco-lumbar Junctional Kyphosis (JK) and a gold standard measurement and diagnostic system does not exist. This study aims to verify the sensibility and specificity of clinical, and Formetric surface topography (FST) data in identifying Junctional Kyphosis in respect to the radiographical standard references., Methods: Design: This is a cross sectional study from a prospective database started in March 2003. Participants: 38 subjects. Inclusion criteria: Patients selected by age according to Risser score 1, at first visit with lateral x-rays and FST. Diagnostic test used to detect JK:FST criteria: level of thoraco-lumbar inflexion point in percentage compared to the total height of the spine.X-ray criteria: lower limit of thoracic kyphosis below T12. Statistics: sensitivity, specificity, positive (PPV) and negative predictive values (NPV), ROC curve., Results: FST showed a good reliability in detecting JK: with a threshold of 75 %, PPV was 100 %, NPV was 86 % and the Area Under the Curve was 83 %., Conclusion: The need for a useful criteria able to characterize JK to allow diagnosis and monitoring of the deformity is still lacking, and further studies will deepen this issue.

Background: Scoliosis is a three dimensional deformity, and brace correction should be 3D too. There is a lack of knowledge of the effect of braces, particularly in the sagittal and transverse plane. The aim of this study is to analyse the Sforzesco Brace correction, through all the parameters provided by Eos 3D imaging system., Method: Design: This is a cross sectional study from a prospective database started in March 2003. Participants: 16 AIS girls (mean age 14.01) in Sforzesco brace treatment, with EOS x-rays, at start, in brace after 1 month and out of brace after the first 4 months of treatment. Outcome measures: All the parameters and the Torsio-Index obtained from 3D Eos System, in and out of brace, in the three planes. Statistical analysis: the variability of the parameters and the mean differences were analyzed and compared using paired T test. ANOVA was used for multiple comparisons. Critical P value was set at 0.05., Results: In the comparison of in-brace vs start of treatment, the mean Cobb angle changed significantly from 36.44 +/- 4 to 28.99 + -3.9° ( p  = 0.01). Significant changes in all the sagittal parameters were found ( p  = 0.02). In the axial plane, the Torsio Index changed significantly in-brace for thoracolumbar and lumbar curves ( P  < 0.05). The analysis of the single vertebral tilt demonstrated that the effect of the brace is mostly concentrated at specific segments: T4-T5, T10-T12, L1 and L5 in the axial plane and T3-T6 and T10-L1 in the frontal plane., Conclusion: The Sforzesco brace mostly modifies the middle of the spine and preserves the sagittal balance. The single vertebral orientation in each plane should be considered together with the typically used values to assess brace effect.

Purpose: Tennis is widely practiced by adolescents in many countries. Many spinal deformity experts consider this activity, together with other asymmetrical sports, as risk factors for scoliosis development even though scientific data are missing. The aim of the present study was to verify the prevalence of spinal deformities and LBP in adolescent competitive tennis players compared to healthy controls., Methods: We designed a cross-sectional study. A convenience sample of 102 adolescent tennis players (52 girls) was compared to 203 scholars (102 girls) of the same age (12 years). We used a questionnaire to collect data on LBP and we measured the ATR to screen for spinal deformities and the plumb line distances for kyphosis (C7 and C7 + L3) and lordosis (L3)., Results: We found similar spinal deformities in both groups: ATR female: 3.2° ± 1° (tennis) versus 2.8° ± 1° (school), NS; ATR males: 2.8° ± 1° (tennis) versus 2.6° ± 1° (school), p < 0.05. No differences were found for kyphosis and lordosis. Low back pain prevalence was similar for both groups, but a significant difference was found for limitation of usual activity, which was higher for tennis players than controls., Conclusion: The correlation between tennis, an asymmetric sport, and spinal deformities that has been postulated by many experts was not confirmed by our data. There was no correlation between tennis and LBP, even if there were some differences among groups for limitations of the daily activities. Adolescent competitive tennis showed to be a safe sport without an increased risk of spinal deformities and LBP.

Introduction: This systematic literature review aims to check the current state of affairs of non-gait-related optoelectronic trunk movement analysis; results have been analyzed from a clinical and a methodological perspective., Evidence Acquisition: Extensive research was performed on all papers published until December 31st, 2015, dealing with trunk movement analysis assessed by optoelectronic systems, excluding those related to gait. The research was performed on the 14th of January 2016 on three databases: Scopus, Science Direct and Pubmed. A reference search and expert consultation were also performed., Evidence Synthesis: Out of a total number of 8431 papers, 45 were deemed relevant: they included 1334 participants, 57.9% healthy, with age range 8-85. Few studies considered the whole trunk, and none focused on each vertebra independently: the trunk was almost always divided into three segments. Thirteen studies included 20 or more markers. Most of the papers focused mainly on the biomechanics of various movements; the lumbar area and low back pain were the most studied region and pathology respectively., Conclusions: This study has shown the relative scarcity of current literature focusing on trunk motion analysis. In clinical terms, results were sparse. The only quite well represented group of papers focused on the lumbar spine and pathologies, but the scarcity of individuals evaluated make the results questionable. The use of optoelectronic systems in the evaluation of spine movement is a growing research area. Nevertheless, no standard protocols have been developed so far. Future research is needed to define a precise protocol in terms of number and position of markers along the spine and movements and tasks to be evaluated.

Study Design: A systematic review., Objectives: The aim of this study is to evaluate the effectiveness of different types of surgery compared with different types of nonsurgical interventions in adults with symptomatic lumbar spinal stenosis (LSS)., Summary of Background Data: LSS is a debilitating condition associated with degeneration of the spine with aging. People with LSS experience a range of symptoms, including back pain, leg pain, numbness and tingling in the legs, and reduced physical function. Main treatment options are surgery, physical therapy, exercise, braces, and injections into the spine., Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases, and two trials registries up to February 2015, reference lists, and conference proceedings related to treatment of the spine. Randomized controlled trials (RCTs) compared surgical versus nonoperative treatments in participants with LSS.Outcomes included quality of life, disability, function, pain, complication rates, and side effects., Results: From the 12,966 citations screened, we included five RCTs (643 participants).Three studies compared spine surgery versus various types of nonsurgical treatment. It is difficult to draw conclusions from these studies because nonsurgical treatments were inadequately described. One study that compared surgery versus bracing and exercise found no differences in pain. Another study compared surgery versus spinal injections and found better physical function with injections, and better pain relief with surgery at six weeks. Still another trial compared surgery with an implanted device versus nonsurgical care. This study reported favorable outcomes of surgery for symptoms and physical function., Conclusion: We cannot conclude on the basis of this review whether surgical or nonsurgical treatment is better for individuals with LSS. Nevertheless, we can report on the high rate of effects reported in three of five surgical groups, ranging from 10% to 24%. No side effects were reported for any of the conservative treatment options., Level of Evidence: 1.

Background: Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine with aging., Objectives: To evaluate the effectiveness of different types of surgery compared with different types of non-surgical interventions in adults with symptomatic LSS. Primary outcomes included quality of life, disability, function and pain. Also, to consider complication rates and side effects, and to evaluate short-, intermediate- and long-term outcomes (six months, six months to two years, five years or longer)., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases and two trials registries up to February 2015. We also screened reference lists and conference proceedings related to treatment of the spine., Selection Criteria: Randomised controlled trials (RCTs) comparing surgical versus non-operative treatments in participants with lumbar spinal stenosis confirmed by clinical and imaging findings., Data Collection and Analysis: For data collection and analysis, we followed methods guidelines of the Cochrane Back and Neck Review Group (Furlan 2009) and those provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011)., Main Results: From the 12,966 citations screened, we assessed 26 full-text articles and included five RCTs (643 participants).Low-quality evidence from the meta-analysis performed on two trials using the Oswestry Disability Index (pain-related disability) to compare direct decompression with or without fusion versus multi-modal non-operative care showed no significant differences at six months (mean difference (MD) -3.66, 95% confidence interval (CI) -10.12 to 2.80) and at one year (MD -6.18, 95% CI -15.03 to 2.66). At 24 months, significant differences favoured decompression (MD -4.43, 95% CI -7.91 to -0.96). Low-quality evidence from one small study revealed no difference in pain outcomes between decompression and usual conservative care (bracing and exercise) at three months (risk ratio (RR) 1.38, 95% CI 0.22 to 8.59), four years (RR 7.50, 95% CI 1.00 to 56.48) and 10 years (RR 4.09, 95% CI 0.95 to 17.58).Low-quality evidence from one small study suggested no differences at six weeks in the Oswestry Disability Index for patients treated with minimally invasive mild decompression versus those treated with epidural steroid injections (MD 5.70, 95% CI 0.57 to 10.83; 38 participants). Zurich Claudication Questionnaire (ZCQ) results were better for epidural injection at six weeks (MD -0.60, 95% CI -0.92 to -0.28), and visual analogue scale (VAS) improvements were better in the mild decompression group (MD 2.40, 95% CI 1.92 to 2.88). At 12 weeks, many cross-overs prevented further analysis.Low-quality evidence from a single study including 191 participants favoured the interspinous spacer versus usual conservative treatment at six weeks, six months and one year for symptom severity and physical function.All remaining studies reported complications associated with surgery and conservative side effects of treatment: Two studies reported no major complications in the surgical group, and the other study reported complications in 10% and 24% of participants, including spinous process fracture, coronary ischaemia, respiratory distress, haematoma, stroke, risk of reoperation and death due to pulmonary oedema., Authors' Conclusions: We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.

Background Context: The Scoliosis Research Society 22 Questionnaire (SRS-22) has shown to worsen with increasing deformity in adolescents with idiopathic scoliosis (AIS). However, all the studies have been performed on patients who have already been diagnosed and in relatively small samples., Purpose: The purposes of this study were to evaluate a large sample of consecutive patients before diagnosis to develop reference values and check the discriminative validity and correlation with deformity of the SRS-22., Study Design/setting: This is a cross-sectional study, with patients referred to a specialized outpatient scoliosis rehabilitation institute., Patient Sample: The recruited subjects were 1,205 consecutive adolescents, 75% females (13.7±1.9 years), before their first scoliosis evaluation. Five subgroups were 0°-10° Cobb (normal) and 11° to 20°, 21° to 30°, 31° to 40°, and greater than 40° (AIS)., Outcome Measures: The outcome measure is based on the SRS-22., Methods: The SRS-22 was used to examine the differences between the domains of the five subgroups and total scores, and it was correlated with Cobb degrees and curve location. We used one-way analysis of variance and Spearman rho test., Results: Apart from the self-image domain in both genders and all subgroups, all other scores were greater than 4 points with small standard deviations. Females showed significant differences among groups for all domains and total score (p<.05). In males, function, pain, and mental health did not show statistically significant differences among groups (p>.1). All differences found were less than the minimally clinically significant change (0.5 points). The correlations with the severity of deformity measures were very low (rs<0.289)., Conclusions: According to our results, deformity is apparently not a real issue for AIS before diagnosis made, treatment planned, and/or specialists interfere with their everyday life. Scoliosis Research Society 22 Questionnaire demonstrated some discriminative validity between small and large curves, but the differences found were small., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background.

Objective: To compare the prevalence of spinal deformities and low back pain (LBP) in adolescent competitive swimmers and normal controls., Study Design: This was a cross-sectional study with convenience sample of 112 adolescent competitive swimmers (62 females) compared with 217 students (106 females) of the same age (12.5 years). We designed a questionnaire to collect data on LBP and measured the angle of trunk rotation with a Bunnell scoliometer to screen for scoliosis, along with the plumbline distances for kyphosis and lordosis. Clinical cutoffs defined in the literature for detection of spinal deformities were applied. Analyses were performed using the t test and χ(2) test, and ORs and 95% CIs were calculated., Results: Swimming was found to increase the risk of trunk asymmetries (OR, 1.86; 95% CI, 1.08-3.20). Swimming also increased the risk of hyperkyphosis (OR, 2.26; 95% CI, 1.35-3.77) and hyperlordosis (OR, 2.24; 95% CI, 1.06-4.73), and increased LBP in females by 2.1-fold (95% CI, 1.08-4.06)., Conclusion: Swimming is associated with an increased risk of trunk asymmetries and hyperkyphosis. Although swimming has been considered a complete sport and a treatment option for scoliosis, our data contradict that approach, and also show a higher prevalence of LBP in females., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Scoliosis Research Society-22 (SRS-22) questionnaire was developed to evaluate health-related quality of life (HRQL) in adolescent idiopathic scoliosis (AIS) patients. Rasch analysis (RA) is a statistical procedure which turns questionnaire ordinal scores into interval measures. Measures from Rasch-compatible questionnaires can be used, similar to body temperature or blood pressure, to quantify disease severity progression and treatment efficacy. Purpose of the current work is to present Rasch analysis (RA) of the SRS-22 questionnaire and to develop an SRS-22 Rasch-approved short form. 300 SRS-22 were randomly collected from 2447 consecutive IS adolescents at their first evaluation (229 females; 13.9 ± 1.9 years; 26.9 ± 14.7 Cobb°) in a scoliosis outpatient clinic. RA showed both disordered thresholds and overall misfit of the SRS-22. Sixteen items were re-scored and two misfitting items (6 and 14) removed to obtain a Rasch-compatible questionnaire. Participants HRQL measured too high with the rearranged questionnaire, indicating a severe SRS-22 ceiling effect. RA also highlighted SRS-22 multidimensionality, with pain/function not merging with self-image/mental health items. Item 3 showed differential item functioning (DIF) for both curve and hump amplitude. A 7-item questionnaire (SRS-7) was prepared by selecting single items from the original SRS-22. SRS-7 showed fit to the model, unidimensionality and no DIF. Compared with the SRS-22, the short form scale shows better targeting of the participants' population. RA shows that SRS-22 has poor clinimetric properties; moreover, when used with AIS at first evaluation, SRS-22 is affected by a severe ceiling effect. SRS-7, an SRS-22 7-item short form questionnaire, provides an HRQL interval measure better tailored to these participants., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Unlabelled: A recent study suggests a correlation between idiopathic scoliosis in adolescence and eating disorders. However, this does not correspond with our clinical experience in the same population. The aim of this study was to verify the correlation between scoliosis and eating disorders in adolescence. A cross-sectional study was designed including 187 consecutive adolescent girls with a diagnosis of idiopathic scoliosis (mean Cobb angle 26°, range 11-73°, age 15.2±2.5; 24% juveniles, 76% adolescent type) and 93 schoolgirls as controls (age 14.9±1.0). All of the participants answered the Italian validated questionnaire EAT-26 about eating habits in order to identify any eating disorders. Body mass index (BMI) was calculated for all participants and compared to reference data., Statistical Analysis: chi-square test, Student's t-test, Pearson's correlation coefficient. Only 3 (1.6%; 95% CI -0.2-3.4%) participants in the scoliosis group showed EAT-26 scores suggestive for eating disorders versus 7 (7.5%; 95% CI 2.2-12.9%) in the school population (p<0.05). The BMI was slightly lower (p<0.05) for scoliosis patients (19±0.2) than for school girls (21±0.3). EAT-26 is recognized among the most valid questionnaires for eating disorders and has been widely applied in various countries. By applying this questionnaire, a lower incidence of eating disorders in female scoliosis patients was found than in the general population (using both our own controls and Italian reference values). This contrasts with some expert opinions and a recent study performed in Italy. The low BMI already reported in the literature as being typical of scoliosis participants is confirmed by our data., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain (cLBP). Osteopathy is a discipline emphasizing the conservative treatment of the disease in an olistic vision. We designed a randomized controlled study to investigate whether Osteopathic Manipulative Treatment (OMT) combined with specific exercises (SE) is more effective than SE alone in obese patients with cLBP., Methods: nineteen obese females with cLBP, randomized into 2 groups: SE + OMT and SE were studied during the forward flexion of the spine using an optoelectronic system. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest., Outcome Measures: kinematic of the thoracic and lumbar spine and pelvis during forward flexion, pain according to a visual analogue scale (VAS), Roland Morris Disability Questionnaire and Oswestry Low Back Pain Disability Questionnaire., Results: significant effects on kinematics were reported only for OMT + SE with an improvement in thoracic range of motion of nearly 20%. All scores of the clinical scales used improved significantly. The greatest improvements occurred in the OMT + SE group., Conclusions: combined rehabilitation treatment including Osteopathic Manipulative Treatment (OMT + SE) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP. Such results are to be attributed to OMT, since they were not evident in the SE group. We also observed a reduction of disability and pain. The clinical results should be considered preliminary due to the small sample size., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: This report is the SOSORT Consensus Paper on Terminology for use in the treatment of conservative spinal deformities. Figures are provided and relevant literature is cited where appropriate., Methods: The Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed., Results: A final agreement was found for all the terms, which now constitute the base of this glossary. New terms will be added after being discussed and accepted., Discussion: When only one set of terms is used for communication in a place or among a group of people, then everyone can clearly and efficiently communicate. This principle applies for any professional group. Until now, no common set of terms was available in the field of the conservative treatment of scoliosis and spinal deformities. This glossary gives a common base language to draw from to discuss data, findings and treatment.

Background: Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of orthopaedics, there is deficit of data which clinical and radiological parameters are considered in everyday practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life., Aim of the Study: To investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis., Methods: Structured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Session on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement., Results: 90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and researchers., Conclusion: The consensus was reached on evaluation of the morphology of the patient with idiopathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the variety of parameters indicated by the panellists, the Cobb angle, yet the gold standard, can be seen neither as the unique nor the only decisive parameter in the management of patients with idiopathic scoliosis.

Objective: To compare the effect of Scientific Exercises Approach to Scoliosis (SEAS) exercises with "usual care" rehabilitation programmes in terms of the avoidance of brace prescription and prevention of curve progression in adolescent idiopathic scoliosis., Design: Prospective controlled cohort observational study., Patients: Seventy-four consecutive outpatients with adolescent idiopathic scoliosis, mean 15 degrees (standard deviation 6) Cobb angle, 12.4 (standard deviation 2.2) years old, at risk of bracing who had not been treated previously., Methods: Thirty-five patients were included in the SEAS exercises group and 39 in the usual physiotherapy group. The primary outcome included the number of braced patients, Cobb angle and the angle of trunk rotation., Results: There were 6.1% braced patients in the SEAS exercises group vs 25.0% in the usual physiotherapy group. Failures of treatment in the worst-case analysis were 11.5% and 30.8%, respectively. In both cases the differences were statistically significant. Cobb angle improved in the SEAS exercises group, but worsened in the usual physiotherapy group. In the SEAS exercises group, 23.5% of patients improved and 11.8% worsened, while in the usual physiotherapy group 11.1% improved and 13.9% worsened., Conclusion: These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression. Compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.

The third-dimension of scoliosis represent a great challenge for clinicians used to think in two dimensions due to the classical radiographic representation of the deformity. This caused problems in everyday clinical approaches, and led to the development of new bidimensional classifications (King, Lenke) who tried in different ways to face these problems, mainly in a surgical perspective. Recently, some three-dimensional classifications have been proposed, all developed in laboratory by bioengineers. In this paper we present the existing classifications of scoliosis, both bi-dimensional and three-dimensional and we thoroughly discuss the 3-DEMO (3-D Easy Morphological) that has been first presented years ago, and recently thoroughly published; this classification has been developed by clinicians with the main aim of being understandable and easily applicable to everyday clinical life.

The biomechanical action of an orthesis for the conservative treatment of AIS has two goals: correction and stabilization. These goals have been pursued through very well established principles of correction, developed over the years, divided in terms of efficacy (the correct positioning of pushes, as well as through escape ways and proper drivers of the forces and stops) and acceptability (compliance, perfect body design, maximal freedom in the ADL). To achieve all these goals, the Sforzesco brace has been developed through progressive changes and verification. Finally, we discovered we had something new, and summarised it in the SPoRT acronym: Symmetric, Patient-oriented, Rigid, Three-dimensional, active. The SPoRT concept always requires a customised construction of the brace according to the patient's individual requirements. It's possible to apply CAD-CAM technologies, which usually allow us to obtain the best results in this case, but without using pre-built forms stored in databases, as is usually done. Once done, a final test must be made on the patient so as to change the first theoretical project and adapt it in the best possible way, depending on the real interaction between the body and the brace. The results that are today available on the SPoRT concept relate to the Sforzesco brace and necessarily are short-term, because the first treated patients are now reaching the third-year follow-up examination and haven't yet completed their treatments. According to first studies we can state that: tte Sforzesco brace is more effective than the Lyon brace after six months of treatment; the Sforzesco brace is equally effective as Risser Plast brace.

Unlabelled: The clinical evaluation, even today, remains a central point in the diagnosis, prognostic definition and treatment prescription regarding scoliosis. The clinical evaluation of a scoliotic patient has been established for a long time, but it has not been standardized. The aim of the present work is to report the most common clinical measures for the assessment of scoliosis, explain the usefulness of each clinical measurement, and report the repeatability and limits in order to help the physician in making appropriate clinical choices., Methods: The height of the hump, the angle of trunk rotation, the sagittal and frontal profiles, and the Trunk Aesthetic Clinical Evaluation (TRACE) have been fully described, and their reliability and repeatability have been assessed., Results: The measures analyzed showed good reliability and repeatability on the intra-operator basis. The inter-operator repeatability is usually not that good., Conclusion: The main measures of the clinical assessment of scoliotic patients have been tested, and their reliability has been evaluated. The knowledge of measurement error, as well as intra- and inter-operator reliability, are essential for the clinical evaluation and treatment of scoliosis. This is an unavoidable basis for decision making in the assessment and the treatment of scoliosis.

Background: In the literature the rate of surgery for AIS (Adolescent Idiopathic Scoliosis) of 30 degrees ranges from 22.4% to 31% when braces are used, versus the natural history rate of 28.1%. When a complete conservative approach is used (braces and exercises), this rate decreases to the range of 3.8% to 7.3%. All these studies are retrospective., Aim: The aim was to evaluate the final results of a prospective set of patients treated in a center fully dedicated to a complete conservative treatment (exercises and braces) of AIS., Materials and Methods: This is an everyday clinical, retrospective study on a prospective data base. The population included 112 AIS patients, 13.2+/-1.8 years old, with 23.4+/-11.5 degrees Cobb degrees at the start of treatment. All the patients had been treated with a full set of conservative treatments, including exercises, according to their individual needs. We used the SEAS (Scientific Exercises Approach to Scoliosis) protocol and the ISICO approach, while the orthosis used included: Risser cast, and the Lyon, Sforzesco-SPoRT, Sibilla-Chêneau and Lapadula braces. The patients had been followed up by the same physician, braces had been made and exercises had been applied by the same team. The outcomes were established for each single patient: The absolute aim was to avoid surgery, while the minimal and optimal outcomes were defined according to the starting curve. An efficacy analysis and worst-case analysis had been performed., Results: The rate of surgery was 0.9% (efficacy analysis), and 4.5% (worst case); the minimal outcomes had been obtained in 99% of patients and the optimal ones in 84%. Overall, the curves over 40 degrees , which numbered eleven at the start of observation, were reduced to three. In total, eight patients exited the presumable area of risk in adulthood (final curve over 30 degrees ). The treatment produced a statistically significant reduction in the worst curves, and the best results have been obtained in the curves over 40 degrees., Conclusion: Provided the use of a complete conservative approach, there is very little doubt that it is possible to reduce the rate of surgery in AIS treatment.

Objective: To develop a clinical and instrumental protocol to assess the postural and dynamic effects following treatment with botulinum neurotoxin A in children with cerebral palsy affected by spastic equinus., Design: Open study, in which every patient served as his or her own control., Patients: Ten sequential children with cerebral palsy and spastic dynamic equinus foot., Methods: Botulinum neurotoxin A was injected in the gastrocnemius, soleus and tibialis posterior muscles. The main measures were: pedobarometry, dynamic surface electromyography, video gait analysis scale, and the modified Ashworth Scale., Results: After treatment with botulinum neurotoxin A, pedobarometric evaluation revealed a significant change in all parameters, including a decrease in the modified Ashworth Scale and an increase in the range of motion. All children showed significant improvement in initial foot contact, as documented by the video gait analysis scale. The calf muscle electromyography pattern showed a decrease in co-contraction during gait in all children. These modifications were statistically significant for all parameters considered (p < 0.05)., Conclusion: This pilot study suggests that dynamic electromyography and pedobarometry are simple to use and provide useful data; this protocol could be preferable in young and uncooperative children in order to monitor rehabilitation treatments.