Dear friends and colleagues,
It was my pleasure and honour to chair the 2011 SOSORT Annual Meeting and 8th International Conference on Conservative Management of Spinal Deformities. Like in many others Mediterranean cities, May is the month, in the middle of the spring, when the city of Barcelona is in its brightest moment, with good weather and long days. It was really amazing to share with all of you those few days. Too short, after more than one year of enthusiastic preparation, involving a big group of collaborators. My first acknowledgement goes to all the people who contributed in the organization to this little-big meeting.
We offered you, exclusively, the first Introduction Educational SOSORT Course, which was chaired by Josette Bettany-Saltikov and hosted by Judith Sánchez-Raya from the Rehabilitation service in the Traumatology, Orthopaedic Surgery and Rehabilitation Hospital Vall d’Hebron. I want to express my highest gratitude to the representatives from the Hospital Vall d’Hebron for agreeing to host the course, Dr Martínez Ibañez, director of the Surgical Processes Ciutat Sanitaria Vall D’Hebron; Dr Caceres, Clinical Director of Traumatology and Spine Unit; Dr Nardi, Chief of the Traumatology Service and, finally, Dr. Cuxart, Chief of the Rehabilitation Service.
The course presented several schools or approaches for conservative management of spinal deformities that are well represented in SOSORT currently. From the physical therapy point of view, different schools coming from all around the world presented their specific exercises to the audience, being Michele Romano who exposed the specific exercises according to the Italian school ISICO, Dr Hans Rudolf Weiss represented the German School, who showed, in his already traditional informal way, his approach combining classical Schroth with physiologic, 3D easy and power Schroth; Jean Claude De Mauroy gave us a new vision of the classical French ‘Lyonnaise’ school; and finally the Polish school was represented by two different approaches: the DOBOMED, lectured by Jacek Durmala and the FITS by Andrejz Mango.
Bracing concepts were also deeply explored, from the classical Lyonaisse school, combining modified EDF and Lyon brace, to the non rigid-dynamic concept of SpineCor. The Boston brace, in slow but permanent evolution, was presented by J. Wynne, but not the Milwaukee brace, with limited current indications, in spite of its quite regular use in some parts of the world. The Italian SPoRT concept and the already classical Chêneau brace and derivates were also showed and discussed.
In its first edition, evaluation from the participants was quite good. The course is obviously improvable and the comments from the participants were very important and will allow us to reach excellence in further editions. Next year, in Milan, there will be a second edition, which will reach such an excellence for sure under the organization of the ISICO group. We are excited to participate in this new edition to share our knowledge and experience.
I want to share with you a personal reflection: since we met for the first time in 2004, and respecting the idiosyncrasy of each school, we can realize the existence of an inter-school contamination which is more and more clear through the years. From a radical scientific point of view, were things are black or white, as far as any approach is able to show its efficacy when is applied by a team, we should improve our approach adopting the best concepts and abandoning the worse ones. This is what some colleagues are claiming. Nowadays, no system has really shown to be better than other, from a pure scientific point of view, and even in that case, an effective method could not be so efficient when applied by a different team. Thus, in this scenario, and considering that methods have some things in common and things, which are different, contamination will make the schools more sibling and efficient at the same time.
The 8 lecture room in the hotel Condes de Barcelona was completely full. Every scientific session was followed with big interest by most of the attendants and this is the main sign confirming the growing strength of our Society. The International Scientific Committee, chaired by Dr. Tomasz Kotwicki, was the group responsible for such a success. The Committee had to evaluate 111 abstracts submitted. It is highly remarkable the number of submissions from at least four countries, starting with Poland (20) and following with Italy (15), the USA (13), Spain (13); 15 other countries also submitted papers, reaching a final number of 99 accepted abstracts and only 12 rejected. All the accepted abstracts were exposed in 74 oral presentations, distributed in 14 scientific sessions, and 25 poster presentations.
The focus of our Society is clear looking at the issues of the different scientific sessions: 4 sessions on bracing; 3 sessions on physiotherapy; 3 sessions on clinical, radiological and surface topography evaluation; 2 sessions on Health Related Quality of Life; one miscellanea and one on etiopathogenesis and related issues.
I would like to point out here, and this should not be interpreted as a conclusion, some of the topics discussed during the sessions, for its relevance. Three Key Note Lectures and one Special Invited Lecture gave the counterpoint to those important topics. E. D’Agata introduced in her Key Note Lecture the essential issue of HRQL. Although still predominant in the daily clinical setting, the old bio-medical model, where, most of times, the unique value defining the severity of this complex disorder is the Cobb angle, should be slowly but unquestionably surpassed by a much less simplistic bio-psycho-social model, where not only the treatment modality but also the interaction between all the members of the so called team, patient, family, medical doctor, physiotherapist, technical orthopaedic, psychologist and why not to say a well educated society. The importance of the team has been already stressed in several studies from the ISICO group but, I am full convinced, it will gain more and more relevance in the short future.
One of the most remarkable facts, probably, is that teams with similar approaches are nowadays reporting similar results. The approach is based on the application of different conservative indications including observation plus education, specific physiotherapy exercises and rigid braces under a supportive atmosphere, with no unethical manipulation when the operation becomes the treatment of first election. Another approach combines exercises with dynamic brace. Any tool used by an isolate inexperienced ‘professional’ is not successful by it self. It is essential to have a deep knowledge on the potential and limitation of every tool in order to prevent ‘bad practice’.
Dr Richard McCarthy, the former president of the SRS, serving as an introduction to the ‘controversial issue’, presented his lecture on early onset scoliosis. The ‘controversial issue session’ on infantile scoliosis, chaired by Dr Theo Grivas, was excellent. Dr JC de Mauroy and Dr F Sánchez Pérez-Grueso, were discussing the benefits and drawbacks, showing the importance of the indications and limitations as well as the importance of the technical quality of bracing. They also stressed the importance of the team.
The team is an essential part of this new model but still insufficient without a technical quality of excellence. Some presentations on in-brace correction using known principles, reported percentage similar to those obtained by pioneer’s teams during the nineties. Nowadays, after 20 years of continued evolution, those teams have almost duplicated their percentages of in-brace correction. That means something. The potential is obvious. Another sign of this potential is the observed catastrophic effect of bad use. As clinicians, we all have seen some treated cases showing evolutions not explainable from natural history. Bad practice, talking about technical quality, makes worse the prognosis, that is something generally accepted in our Society. Thus, it is of vital importance to improve the standard of our techniques promoting research on its mechanics of action. In other words, how do braces work?
The potential of a good program of specific physiotherapy exercises should not be denied more but investigated more seriously. Notwithstanding, we should be realistic/cautious about expectations in relation with the capability of physiotherapy in preventing progression to bracing or surgery. Many other benefits could be however expected and investigated, like positive changes in HRQL, independently of the magnitude of the spinal deformity. But research cost time and money so which are the possibilities that physiotherapists have to show the outcomes of their interventions? Another problem is the risk that some techniques, coming from other fields, take a place beside other higher contrasted specific techniques, getting advantage of this relatively wild situation. For many colleagues, and for the general population, specific physiotherapy exercises means nothing different to exercises, gymnastic, Pilates, manipulations, anti-gymnastic, yoga, etc and it is not the same. How do we clarify this? There is an impressive task in front of us. The situation, in any case, is much better than 10 years ago and the first steps to clarify this situation have been built into SOSORT.
What to say about etiopathogenesis?, just one session is not really so much but most probably this is not the role of the SOSORT. It is very difficult for clinicians, especially for those few devoted to conservative management, to put their eyes on this topic for research. Dr K Bagnall, in his brilliant Key Note Lecture, gave us a new perspective on how we should look at this problem. Dr Theo Grivas’ Key Note Lecture on ‘the contribution of the International Research Society on Spinal Deformities –IRSSD- in the field of scoliosis research’ was very descriptive on how much it has been done in the last 20 years. The IRSSD is specifically focussed on this topic. A future interaction between the members and the boards of both societies is desired. In fact, Dr Grivas, has been serving in the board of both societies with the office of President, and this is a good example.
An absolutely positive relationship was established with the SRS years ago. We had in Barcelona the chance to met the former President of the SRS, Dr Richard McCarthy, an excellent professional and even better person. This relationship started in Boston, under the auspices of Joe O’Brien, and continued later in Athens, Lyon and Montreal.
I opened the meeting in Barcelona with our sincere condolences and deepest sympathy to the people from Japan. Our past President, Dr Toru Maruyama, had to make a difficult decision coming to Barcelona after what happened in his beautiful country. We all understand what this means. Emotions were very strong at the beginning of the meeting and also at the end. I missed totally some words to say thank you – all the attendants - after the funny show you offered the last day.
Tomasz, I do not know how you were able to organize everything but you did it and it all sounded very well. I felt it like a homage to all the people who take part in the organization of the meeting, all the members of the local committees: Joan Bagó, Jose María Climent, Ferrán Escalada, Ester Marco, María Martínez, Elena Pou, Gloria Quera (my wife), Judith Sánchez-Raya, Mónica Villagrasa, Carlos Villanueva, Esther Pages and Mar Meléndez, as well as the sponsors: Diers, DM Orthotics, Ortholutions, Grau Soler and OrtOiberica. I think it was also like a homage to Grupo Pacífico for their excellent job in the technical secretary and support to the International Scientific Committee.
Now it is time to continue with our clinical practice looking at the patients and their families. I believe our Society is like a source of energy to move on and for this reason, and others, obviously, we are already looking forward to meet up again. Dr Stefano Negrini, our President, and all his team will organize the SOSORT meeting 2012 in Milano. We wish all the best to Dr Negrini and we offer him our total support to have next year the best SOSORT meeting.
Dr Manuel Rigo,
Chair of the 2011 SOSORT Annual Meeting and 8th Conservative Management of Spinal Deformities.