Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage.

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.

Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.

Sport improved medium-term results in a prospective cohort of 785 adolescents with idiopathic scoliosis braced full time. SOSORT 2018 award winner.

PURPOSE: The association between idiopathic scoliosis (IS) and sports activities remains vague. We aimed to analyse their effect on full-time braced adolescents with IS. METHODS: We retrospectively recruited all the consecutive patients of a tertiary referral Institute of age ≥ 10 (adolescents), with a juvenile (JIS) or adolescent (AIS) IS diagnosis, Risser 0-2, TLSO brace prescription and self-reported adherence ≥ 20 h per day, and follow-up out-of-brace X-rays 18 months after brace prescription. We divided participants into two groups: SPORT (sport twice or more per week) and CONTROL (sport once per week or less). We calculated odds ratio (OR) to compare the outcome of subjects performing to those not performing sport. We ran a logistic regression with covariate adjustment to assess if sports frequency affected the outcomes. RESULTS: Out of 33,311 participants assessed for eligibility, 785 satisfied the inclusion criteria (693 females, age 12.7 ± 1.3 and 40 ± 11° Cobb). The SPORT group consisted of 290 participants and the CONTROL group of 495. The SPORT group showed higher odds of improvement (OR = 1.59, 95%CI = 1.17-2.16, p = 0.0018). The odds of improving increased with the frequency of sports activity (OR = 1.20, 95%CI 1.08-1.34). CONCLUSION: This study shows that sports activities increase the odds of improvement at 18-month follow-up in adolescents with IS treated with a full-time brace. The odds of improvement increase with sports week frequency.

Feasibility and Acceptability of Telemedicine to Substitute Outpatient Rehabilitation Services in the COVID-19 Emergency in Italy: An Observational Everyday Clinical-Life Study.

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 (R2=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.

Spinal Coronal and Sagittal Balance in 584 Healthy Individuals During Growth: Normal Plumb Line Values and Their Correlation With Radiographic Measurements.

BACKGROUND: Plumb line distances (PDs) are widely used in conservative clinical practice to evaluate the sagittal shape of the spine. OBJECTIVE: The objective was to assess the normative values of PDs in a large, healthy population in an age range representative of the adolescent population with spinal deformities, and to correlate it with x-ray measurements. DESIGN: This was a cross-sectional study. METHODS: Participants were 584 healthy individuals (341 females) with x-rays showing no spine deformities. The whole sample (OVERALL) was divided into 5 groups: 6 to 9 years old (n = 106); >10 years, Risser 0 with triradiate cartilage open (n = 129) or closed (n = 104); Risser 1 to 2 (n = 126); and Risser 3 to 5 (n = 119).PDs were taken by maintaining a tangent to the thoracic kyphosis apex at C7, T12, L3, and S2. Sagittal index (C7 + L3), and sagittal and coronal balances (C7 related to S2) were calculated. RESULTS: In OVERALL, PDs at C7, T12, L3, and S2 were 39.9 ± 16.7, 21.4 ± 15.3, 39.9 ± 15, 20.6 ± 17.0 mm, respectively. Sagittal index was 79.8 ± 26.8, sagittal balance was 19.3 ± 17 mm anterior to S2 plumb line; 13.5% had a coronal imbalance of 11.4 ± 5.4 mm to the right and 24.7% of 13.2 ± 6.0 mm to the left. C7 and L3 PDs, sagittal index, and sagittal balance were significantly lower in ages 6 to 9 compared to older patients in Risser 1 to 2 group. C7 and S2 PDs and sagittal index were significantly larger in males. Sagittal index correlated with thoracic kyphosis Cobb degrees (r = 0.47). LIMITATIONS: The participants were not randomly chosen from the general population; and they had an x-ray because of spine pathology suspicion. CONCLUSIONS: This study shows normative data to be used in clinical practice. Sagittal spinopelvic alignment has gained more and more importance in the last decades because of its high correlation to Health-Related Quality of Life scores in adults. 1.

Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial.

BACKGROUND: In an ideal experimental setting, 2 randomized controlled trials recently showed the efficacy of physiotherapeutic scoliosis-specific exercises (PSSEs) for adolescents with idiopathic scoliosis (AIS). Now large observational studies are needed to check the generalizability of these results to everyday clinical life. OBJECTIVE: To explore the effectiveness of PSSEs for avoiding bracing or progression of AIS in everyday clinics. METHODS: This was a longitudinal comparative observational multicenter study, nested in a prospective database of outpatient tertiary referral clinics, including 327 consecutive patients. Inclusion criteria were AIS, age≥10 years old at first evaluation, Risser sign 0-2, and 11-20°Cobbangle. Exclusion criteria were consultations only and brace prescription at baseline. Groups performed PSSE according to the SEAS (Scientific Exercise Approach to Scoliosis) School, usual physiotherapy (UP) and no therapy (controls [CON]). End of treatment was medical discharge, Risser sign 3, or failure (defined by the need for bracing before the end of growth or Cobb angle>29°). The probability of failure was estimated by the risk ratio (RR) and 95% confidence interval (CI). The number needed to treat was estimated. Statistical analysis included intent-to-treat analysis, considering all participants (dropouts as failures), and efficacy analysis, considering only end-of-treatment participants. Propensity scores were used to reduce the potential effects of confounders related to the observational design. RESULTS: We included 293 eligible subjects after propensity score matching (SEAS, n=145; UP, n=95; controls, n=53). The risk of success was increased 1.7-fold (P=0.007) and 1.5-fold (P=0.006) with SEAS versus controls in the efficacy and intent-to-treat analyses, respectively, and the number needed to treat for testing SEAS versus controls was 3.5 (95% CI 3.2-3.7) and 1.8 (95% CI 1.5-2.0), respectively. The success rate was higher with SEAS than UP in the efficacy analysis. CONCLUSIONS: SEAS reduced the bracing rate in AIS and was more effective than UP. PSSEs are additional tools that can be included in the therapeutic toolbox for AIS treatment.

Junctional kyphosis: how can we detect and monitor it during growth?

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.

Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study.

BACKGROUND: Scoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression. METHODS: We designed a retrospective cohort study. We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises. INSTRUMENTATION: SEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min. OUTCOME MEASURES: Radiographic progression was the main outcome and it was analysed as a continuous variable. STATISTICS: One way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05. RESULTS: The mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment. CONCLUSIONS: Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises.

BACKGROUND: SEAS is the acronym for "Scientific Exercise Approach to Scoliosis", a name related to the continuous changes of the approach based on results published in the literature. REHABILITATION PROGRAM: SEAS is an individualized exercise program adapted to all situations of conservative treatment of scoliosis: stand-alone in low-medium degree curves during growth to reduce the risk of bracing; complimentary to bracing in medium-high degree curves during growth, with the aim to increase correction, prepare weaning, and avoid/reduce side-effects; for adults either progressing or fused, to help stabilising the curve and reduce disability. SEAS is based on a specific active self-correction technique performed without external aid, and incorporated in functional exercises. Evaluation tests guide the choice of the exercises most appropriate to the individual patient. Improvement of the stability of the spine in active self-correction is the primary objective of SEAS. SEAS exercises train neuromotor function so to stimulate by reflex a self-corrected posture during the activities of daily life. SEAS can be performed as an outpatient (two/three times a week 45 for minutes) or as a home program to be performed 20 minutes daily. In the last case, expert physiotherapy sessions of 1.5 hours every three months are proposed. RESULTS: Different papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace. CONCLUSIONS: SEAS is an approach to scoliosis exercise treatment with a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Therefore, SEAS allows treating a large number of patients coming from far away. Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises prescribed at a lower dose than some of the other scoliosis-specific exercise approaches, real expertise in scoliosis, exercises, and patient and family management is required. The program has no copyrights, and teachers are being trained all over the world.

SpineCor, exercise and SPoRT rigid brace: what is the best for Adolescent Idiopathic Scoliosis? Short term results from 2 retrospective studies.

INTRODUCTION: SpineCor is a dynamic brace that showed good results in scoliosis treatment. But data suggest that its efficacy is reduced as curves magnitude increase, and no comparisons exist versus exercise alone. The objective of this double study is to compare the short term results of the SpineCor versus SEAS exercises and versus rigid SpoRT brace for AIS. STUDY DESIGN: 2 retrospective controlled studies. Population 1: 56 consecutive AIS patients (39 female; age 13±1, Cobb 21±4°; ATR 11±4°): 28 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±4°; ATR 12±4°, Risser 0-3) treated by SpineCor 20/24 hours; 28 patients (20 females; age 13±1; TRACE 5; Cobb angle 20±4°; ATR 9±3°, Risser 0-3) treated by SEAS exercises. Population 2: 103 consecutive AIS patients from our prospective database (85 females; age 13±1, Cobb 24±5°; ATR 8±4°): 29 patients (19 females; age 13±1; TRACE 6; Cobb angle 22±5°; ATR 9±3°, Risser 0-3) treated by SpineCor 20/24 hours per day; 74 patients (66 females; age 13±1; TRACE 5; Cobb angle 25±4°; ATR 8±4°, Risser 0-3) treated by SPoRT Brace 18 to 23 hours per day. The short term results of treatment, both clinical and radiographic, were evaluated after 18 months. OUTCOME MEASURES: N° of rigid brace prescribed, TRACE, Cobb angle (changes > ±5), ATR (changes > ±2). RESULTS: Study 1: the N° of patients prescribed with a rigid brace was not significantly different in the 2 groups. TRACE was stable for SEAS while decreased for SpineCor (p<0.05). Considering the number of patients changed > ±5° Cobb in the SEAS Group we found 39.3% improved and 14.3% worsened vs 25% and 21.4% in SpineCor (NS); no differences for ATR. Study 2: Both the treatment showed to be effective in improving the TRACE. Considering the other parameters, the SPoRT brace seems to be slightly more effective than the SpineCor both for the Cobb angle and the ATR. CONCLUSION: Short term results showed the SpineCor's efficacy to be between rigid brace and exercise for treatment efficacy for AIS.

Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT's 2008 Award for Best Clinical Paper.

BACKGROUND: Exercises are frequently performed in order to improve the efficacy of bracing and avoid its collateral effects. Very frequently there is a loss of correction during brace weaning in AIS treatment. AIM: To verify the efficacy of exercises in reducing correction loss during brace weaning. STUDY DESIGN: Retrospective controlled study. POPULATION: Sixty-eight consecutive patients (eight males), age 15 +/- 1 and Cobb angle 22 +/- 8 degrees at start of brace weaning. METHODS: The start of brace weaning was defined as the first visit in which the wearing of brace for less than 18/24 hours was prescribed (according to our protocol, at Risser 3). Patients were divided into two groups according to whether or not exercises were performed: (1) EX (exercises), included 39 patients and was further divided into two sub-groups: SEAS (who performed exercises according to our institute's protocol, 14 patients) and OTH (other exercises, 25 patients) and (2) CON (controls, 29 patients) that was divided into two other sub-groups: DIS (discontinuous exercises, 19 patients) and NO (no exercises, 10 patients). Complete brace weaning was defined as the first visit in which the brace was no longer prescribed (ringapophysis closure or Risser 5, according to our protocol). ANOVA and Chi Square tests were performed. RESULTS: There was no difference between groups at baseline. However, at the end of treatment, 2.7 years after the start of the weaning process, Cobb angle increased significantly in both the DIS and NO groups (3.9 degrees and 3.1 degrees Cobb, respectively). The SEAS and OTH groups did not change. Comparing single groups, OTH (with respect to DIS) had a significant difference (P < 0.05). CONCLUSION: Exercises can help reduce the correction loss in brace weaning for AIS.

Adult scoliosis can be reduced through specific SEAS exercises: a case report.

BACKGROUND: It has been known since many years that scoliosis can continue to progress after skeletal maturity: the rate of progression has shown to be linear, and it can be used to establish an individual prognosis. Once there is progression there is an indication for treatment: usually it is proposed a surgical one. There are very few papers on an alternative rehabilitation approach; since many years we propose specific SEAS exercises and the aim of this study is to present one case report on this approach. CASE PRESENTATION: All radiographs have been measured blindly twice using the same protractor by one expert physician whose repeatability error proved to be < 3 degrees Cobb; the average measurement has been used. In this case a 25 years old female scoliosis patient, previously treated from 14 (Risser 1) to 19 years of age with a decrease of the curve from 46 degrees to 37 degrees , showed a progression of 10 degrees Cobb in 6 years. The patient has then been treated with SEAS exercises only, and in one year progression has been reverted from 47 degrees to 28.5 degrees . CONCLUSION: A scoliosis curve is made of different components: the structural bony and ligamentous components, and a postural one that counts up to 9 degrees in children, while it has not been quantified in adults. This case shows that when adult scoliosis aggravates it is possible to intervene with specific exercises (SEAS) not just to get stability, but to recover last years collapse. The reduction of scoliotic curve through rehabilitation presumably does not indicate a reduction of the bone deformity, but rely on a recovery of the upright postural collapse. This reduction can decrease the chronic asymmetric load on the spine and, in the long run, reduce the risks of progression.

Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: a prospective controlled cohort study with worst-case analysis.

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.

Scientific Exercises Approach to Scoliosis (SEAS): efficacy, efficiency and innovation.

SEAS is an acronym for "Scientific Exercises Approach to Scoliosis". Main characteristics of SEAS are team approach and cognitive-behavioural approach because in our view these are two indispensable elements in chronic disease rehabilitation. In this article we describe the main differences between SEAS approach and other exercise techniques as well as theoretical bases and therapeutic goals. We illustrate practical application of SEAS concept and scientific results in order to reduce the patient's progress of scoliosis so that a brace would be needed. When compared to usual care, improvement of scoliosis parameters and balance normalization in scoliosis patients.

End-growth results of bracing and exercises for adolescent idiopathic scoliosis. Prospective worst-case analysis.

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.

A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis.

UNLABELLED: The Lyon school has proposed a preparation to brace wearing through an intensive mobilization in order to obtain a better reduction of the braced scoliotic curve. Our aim was to verify this hypothesis. DESIGN: A prospective controlled study on consecutive patients having idiopathic scoliosis with brace management. OUTCOME: Results after 5 months of brace wearing were reviewed by radiographic examination without the brace. TREATMENT: SEAS Group exercises according to the protocol SEAS.02 (Scientific Exercises Approach to Scoliosis, version 2002); CONT Group various type of exercises. Population. 110 patients (34 females), 13.5+/-2.4 years, 31.1 degrees +/-11.1 degrees Cobb (degrees C), 14.4 degrees +/-6.0 degrees Bunnell (degrees B). All parameters improved at follow-up in both groups. SEAS had better results than CONT for degrees C. Clinical results (variations of at least 5 degrees C and 2 degrees B) were better in SEAS than CONT. This study proves the efficacy of SEAS.02 exercises preparatory for bracing. Bracing demonstrated its short term efficacy.