In April this year, I was fortunate enough to travel to San Francisco for the 15th annual SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment) conference through support from the OETT. I have worked as an orthotist for the past 5 years and throughout my career, as well as during training, I have been lucky to garner significant and varied experience in an area I am passionate about: idiopathic scoliosis bracing.
Idiopathic scoliosis has been treated with external bracing for centuries, using principles that are familiar to this day, such as 3-point-pressure, derotation and distraction. Thankfully, methods of treatment and brace design have become more sophisticated during this time. This has happened because of dedicated practitioners and researchers gathering clinical data over months, years and sometimes decades in order to augment global knowledge of the aetiology of idiopathic scoliosis (IS) and therefore develop protocols for bracing (as well as other conservative treatment and surgery) in order to achieve the best possible outcomes for patients. There is plenty of diversity in clinical evidence and practice however. This can make things a little confusing when trying to decide which is the best treatment for our patients.
This is what led me to the conference in San Francisco. SOSORT have developed globally recognised bracing guidelines which are reviewed every year. The conference has been held annually all over the world since 2004 and is an opportunity for delegates to present papers on the research they have undertaken, as well as educational lectures. The committee boasts names familiar to anyone who has researched IS and/or IS bracing – Weinstein, Negrini, Zaina. Et al.
The conference this year took place at the Parc 55 Hilton hotel, in the middle of Embarcadero, the bustling financial district of the city. Day 1 was a pre-conference education day to kick off proceedings; the next 3 days the conference itself. The main event room was accessed through a concourse area populated with posters of various studies submitted by SOSORT members. Once inside the conference room one could easily find a seat amongst the rows of desks and chairs adorned with information packs, paper and pens. The room was fronted with 2 projector screens, a podium for the speakers and seating for the moderators and presenters.
The first day was no gentle introduction, as from 8am to 5.30pm were rigorously timetabled lectures on the natural history of adolescent idiopathic scoliosis (AIS), a background on normal 3D vertebral growth and the patho-biomechanics of growth and development in IS to name but a few. Meticulously scheduled coffee and lunch breaks allowed the participants to review the posters and mingle, networking with professionals from all over the globe. The main aim of the pre-conference day was to focus on growth and development in scoliosis and the biomechanical, physiological and psychological intricacies thereof. The lectures on this first day were delivered mainly by members of the committee. Following each lecture was a question and answer session and audience members were able to express ideas and discuss the lectures with each presenter.
The first day of the conference started with a welcome from the local host (an orthotist practising in the area, a Salford alumnus in fact) and then further presentations, only this time of clinical and technical research papers. Over 30 papers were presented by a mix of doctors, orthotists and physiotherapists on the first day alone. Subjects included psychological complexities associated with bracing, development of an AIS patient decision aid, quality of life questionnaires, physiotherapeutic scoliosis-specific exercises (PSSE), brace design analysis for upper thoracic curves, biomechanical spinal simulation/models for curve and correction prediction and many more. Again there was opportunity to question and discuss the topics presented. In the midst of the papers being presented was a lecture on PSSE by Dr Manuel Rigo (of Rigo-Cheneau fame!) a lecture by Dr Stuart Weinstein (renowned researcher and practitioner in the field of IS) and further opportunity to review the posters. Alongside these posters were 5-6 stalls set up and manned by various commercial sponsors of the event. These included brace suppliers such as Boston and Aspen, and more technical companies such as EOS Imaging and ScolioScan. This allowed introduction to new or alternative methods of curve detection and analysis, as well as a range of brace types.
The second conference day continued with the presentation of papers interspersed with discussion, the theme of the papers covering lung function, long term bracing results, de novo scoliosis and surface topography. In addition there was an address by the SOSORT president, a choice of two symposia over lunch and a guest lecture by Dr Scott Haldeman on the Global Spine Care Initiative, a charity providing management of spinal disorders in developing countries.
The last day (which was just a morning session) started with a guest lecture from Rachel Mulvaney, VP of Curvy Girls Scoliosis Foundation, a US support group. Papers presented on this day were relating to bracing and treatment adherence and further analyses of PSSE effectiveness.
The conference was closed with the announcement of award winners for papers and posters.
Overall the three and a half days were jam-packed and very intensely timetabled. The information presented in the papers was from evidence gathered in the last few years, or if over a long time, then the evidence was analysed and conclusions drawn in the last year ensuring the data was up to date. I have been able to take comfort in the papers reinforcing the evidence behind rigid bracing, ensuring I am committing fully to evidence-based practice. Auxiliary areas such as long-term effects of scoliosis after bracing, bone development, aerobic capacity and pulmonary function will augment the breadth and depth of my knowledge in the subject and help me hone my skills in assessment and individual case management.
On the whole, attending SOSORT was a very worthwhile endeavour from which I learned a great deal. This will be implemented in my own practice and the information has been presented to and disseminated amongst my colleagues. It is experiences like this which not only expose one to new clinical data and innovation, but to different cultures, processes and practitioners who all have a common goal: to improve clinical outcomes and the patient experience.