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'. This first meeting was organized in a very short time. Our first idea was to organize an informal meeting with some old friends from the SIRER (Société Internationale de Recherche et d'Etude sur le Rachis) who also use to present papers on this topic in the IRSSD meetings. The aim of this meeting was to discuss our different approaches and to improve the standards of treatment. We were expecting a small meeting with only 20 or 30 colleagues however we were pleasantly surprised when we reached a quota of almost100 members, coming from many different countries and also using different strategies.
We decided to meet again a year later in Milan at Stefano Negrini’s place. Here, we decided to start a society on conservative management. 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 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?. Furthermore, 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 Theodoros B GRIVAS, from Athens, Greece.
This is probably the first time that an international body of specialists in conservative management of spinal deformities meets regularly with a clear purpose: to increase the evidence that rehabilitation and orthopaedic treatment are effective, and to provide efficient intervention. Our hope is that in a few years the patients will be able to find more alternatives for treatment with more high quality alternatives for treatments.
The third 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. The professionals dealing with conservative management of idiopathic scoliosis at the foundation of SOSORT: physiotherapists, physicians, orthotists and scientists who 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'. 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 losing its popularity and credibility, due in most cases to false claims from unproven methods. Thus, in many countries, many colleagues, mainly orthopaedic surgeons are convinced that evidence based medicine surgery alone should be ethically proposed as an effective alternative for scoliotic patients. The development of new techniques and instrumentation that were produced were 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 in depth revision of the international literature cannot clearly demonstrate that spinal fusion can 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, as has conservative management, which includes specific exercises although it is not discussed or even mentioned. 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 cannot 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 research we can all recognize (we apologize 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 healthy life. The multidisciplinary approach is not just a necessity but also a patient right. 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, in comparison 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.
We wish to be realistic. Many societies start full of good intentions. We must work tirelessly, 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, we 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.
We invite everyone, patients and their families included, who deal with conservative management and share this type of approach, to join us.
Now that the easiest part has been done, we have to look forward and continue the effort. From my experience, this will be the most difficult part. Hanging on my office wall there is a quote sent by some good American friends which says: “Never doubt that a small group of thoughtful, committed individuals can change the world; indeed, it’s the only thing that ever has (Mead)”.
Please give your support to help us do our best.
Manuel Rigo, MD Past President, SOSORT