The President's letter

Dear Colleagues and patients,

A new society has been born called 'International Society on Scoliosis Orthopaedic and Rehabilitation Treatment', SOSORT. We met for the first time in Barcelona on January 2004 during the first International Conference on Conservative Management of Spinal Deformities'. The interest towards the different approaches from multidisciplinary teams working in this field prompted us to make a joint effort to form a 'study group' for a consensus meeting, which was successfully organized by Stefano Negrini in Milan, January 2005. Three important consensus papers were developed which are going to be published in the new 'scoliosisjournal.com', about physiotherapy, bracing and objectives of the treatment, in other words, why we treat?. Also a paper on guidelines is already published in 'scoliosisjournal'. This is the official journal of the society and its editor-in-chief is our colleague and friend Hans Rudolf Weiss, from Bad Sobernheim, Germany.

The first meeting of this newly established scientific society was held in Poznan, Poland April 2006. Tomasz Kotwicki and Jaced Durmala did exceedingly well. I liked very much the way Tomasz and Jacek invited us to participate in the meeting: 'The problem of progressive spinal curvatures in children and adolescents remains unsolved. The immense progress of basic and clinical science has failed to protect our patients from this chronic and disabling condition. With the foundation of SOSORT the professionals dealing with conservative management of idiopathic scoliosis: physiotherapists, physicians, orthotists and scientists have a common forum to exchange ideas and improve the quality of patient care. We cannot prevent a scoliotic curve appearing but we have to be able to stop its progression'. This is so true.

Although there is increasing evidence that conservative management works to prevent progression of the curvature and health deterioration in patients with spinal deformities, the surgical approach has been gaining more and more power during the last two decades becoming the 'gold standard', while conservative treatment has been loosing its popularity and credibility, due in most cases to false claims for unproven methods. Thus, in many countries, many colleagues, mainly orthopaedic surgeons, are convinced that according to evidence based medicine surgery alone should be ethically proposed as an effective alternative for scoliotic patients. The development of new techniques and instrumentation produced perhaps too optimistic an expectation, forcing too many people to undergo unnecessary spinal fusion, with all its short term and unpredictable long term risks. However, an indepth revision of the international literature cannot clearly demonstrate that spinal fusion is able to improve health, in terms of quality of life for those patients undergoing surgery during the adolescent growth period. Whilst we cannot predict future trends, it seems that, as happened after the two decades of crazy development and overuse of bracing in the past , surgery could progressively lose its popularity. Obviously scoliosis surgery has its place, which is not discussed here, as also has conservative management, which includes specific exercises. The key points are realistic expectations and sound medical principles in order to avoid over-treatment. It is also necessary to offer lifelong care and support, as we can not cure ? in order to restore personal health following an 'illness'-. However, scoliosis is not an illness by itself, thus treatment success cannot be defined solely by a straightened spine. After years of clinical we can all recognize ( I apologise for this simplification) two main groups of scoliosis sufferers, those who cope well and those who do not. In both groups we can find surgically and non-surgically treated patients, people with mild (sometime really minor curvatures) and those with moderate to severe scoliosis. Thus it seems that there is not a unique alternative to guarantee a health life. The multidisciplinary approach is not just a necessity but also a patient rights. There is an impressive task in front of us. We should be able to select those patients who are able to live without an operation or, in other words, those patients who will not benefit from a risky operation, compared to conservative care. We should be able to select those non-surgically treated patients doing badly, but who could be even worse after a risky operation, and do our best to help them. Finally we should be able to select those patients doing badly, but for whom an operation would change significantly their situation, thus allowing them to improve. Let us work together to improve our competence.

I wish to be realistic. Many societies start full of good intentions. We must work tireless, with humility, with humanity, and seek a balance between the scientific and the empirical approach, in order to give the best care to the patients. Conservative care, is of course, far from perfect. Some people offer alternatives which are at best totally inefficient and at worse even dangerous. Sometimes this happens apparently supported by 'scientific studies'. Again here, I would like to remind you that science is neutral by itself, but it is people who can misuse it, for their personal interest. It is impossible to totally avoid these people joining our society, but we will try to prevent this as much as possible. I invite everyone, patients and their families included, who deal with conservative management and share this type of approach, to join us. Please give your support to help us do our best.

Sincerely yours,

Manuel Rigo M.D.
President of SOSORT