Scoliosis Blog

Another flight. its been a few months since my last one.

This time it's to Chicago. SOSORT which is the international society of conservative treatment for spinal deformity has its conference there. Its constitution requires the conference to be held every 3rd year in the USA and the other years in Europe. This will be my first SOSORT conference in the USA. who knows... one day we might even have it in Australia.

I was really hoping to have something to present at this conference but life is just too crazy to sit and research and collate the huge amount of data that needs to researched and analysed using the requisite statistical methods. Its really hard to reverse engineer these projects but I am slowly getting my head around a formal project on our patients.

This weeks email question was from a concerned mother, whose 12 year old girl has recently been diagnosed with scoliosis and is on the wait and watch program. I need to add some detail to my webpage as I had to ask for a follow up email to provide me some more background.. she has a 30 degree double curve. I dont know what her growth status is (yet) but will find out as its paramount to the management decision making process. If she still has heaps to grow then bracing might be indicated but it appears that the surgeon involved has suggested bracing would not be appropriate in this case. We will wait and see. I did suggest that the mother chat to Jeb as he should be able to provide a better opinion regarding bracing.

I must admit that I am a bit disappointed in the public bracing that I have seen. I wrote earlier that I met up with a bracing specialist from the local childrens hospital. He was aware of SOSORT and the conference and was hoping to go. I hope he is there and I will write about it on my return. This bracing specialist works with the surgeons and at least we are slowly getting into their world. I really think that the parents and families need to demand more out of the surgeons when it comes to bracing and to pressure them to recognise that their bracing specialists need to trained up and experienced to do great work; and then to monitor and demand that the braces do their jobs effectively.

When I was in Barcelona I saw Dr Rigo remake a few braces that he felt could do a better job. I havent seen much of this attention to detail in Australia. Its time to demand it!!

The email question had 2 other points.. is there any proof that Schroth works and why is the treatment program so expensive.

I explained that there is not yet any level 1 evidence that Schroth works. This means a well designed randomised double blinded study published in a very good peer reviewed journal. I cannot wait for this to occur but am worried that it will be too hard. I explained that there are currently 3 studies underway (1 in England, 1 in Canada and one in Sweden). The problem is that no therapist is alike and I do not know how they apply and teach the method. This thing is an art and requires an artist who can work in or on all the physical and non-physical facets of our patients.

Back on the plane travelling to Sydney. My brother- in- law who travels a lot for work has a joke whenever we talk about our travels. He always asks if I turned right or left. The most common curve in scoliosis is a right thoracic curve- I turn right. He turns left.

Deciding to go to these events is always difficult from a financial, family and energy level. Is there such a thing as "travellers remorse" ? I suspect there is as this time I have none (yet..) There were some particularly good papers and good discussions. The experience of the leaders of the field is being spread around and the discussion and thoughts of the group is deepening. The first few years I would just sit and watch but now its good to able to follow and contribute but I am still not able to pre-emt and forsee.

I took the time to for a run this morning -it was freezing and windy!! Sometimes the solitude of the run allows me to think through some aspects that I wish I was able to voice when we have some of our discussions. It will come.

Unfortunately Dr Rigo was unable to attend Chicago and neithere was Dr Weiss from Germany (Katarina Schroth's grandson). Rebecca Harding was there from Melbourne and it was great to see her mind swimming in the ocean of the discussion. We had a good chat to the President of SOSORT, who is also the president of the American Scoliosis Foundation. 

Dr Kamal Ibrahim,the head of the SRS was there again to present the keynote address. The relationship between the global surgeons and SOSORT bodies is improving. The chair of the SRS conservative body was there as well and was a very impressive person. Finally, there will be a half day co-meeting of SOSORT and SRS at the SRS meeting in Lyon in September 2013. This time the SOSORT leaders will present to the SRS members. Hopefully this will lead to a positive outcome as the previous experience of attending a spinal surgeon present conservative management data was very distressing to experience.

I was able to spend some time with Dr Eric Parent who is leading the Canadian randomised pilot into Scroth therapy. He presented his preliminary data which is showing effectiveness of the method in preventing the natural progression of the curve. Eric advised that once the randomised control group finish the treatment program (they had no treatment for 6 months) and will enter treatment now then he will publish his data to expand the trial into a multi center large cohort (sample size) trial.

Luke Stikeleather is bracing specialist who uses Rigo principles in his Cheneau braces. Many years ago he made a brace for a girl who had contacted me from Melbourne. She had the brace made in the states and she did her Schroth treatment in Canada.

Scoliosis page. Braist study.. dont let your surgeon prevent you from bracing because he doesnt believe in its effectiveness.
We had our half day session on research methods for SOSORT members. Last year i was secretary of the educatinional comitee but but time have agreed to liase with the research committee to faciliate the the research course at the next SOSORT meeting in Wiesbaden Germany.

Speaking of Germany I met up with Helmut Diers. The engineer who invetented the Formetric. We finally got permision from TGA to import the machine and we had some very interesting discusion on collaborating research, especially in the saggital plane. I cannot wait.. but its a very expensive piece of equipment.