Grivas TB 1, Kotwicki T 2, Maruyama T 3, O Brien J 4, Labelle H 5, Hresko T 6, Lonner B 7

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1 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece 11 th International Conference on Conservative Management of Spinal Deformities 9 th SOSORT Annual Meeting, 8-10 May 2014, Wiesbaden The BrAIST Study and the Implications for Scoliosis Screening: Our Duty for Raising Awareness and Advocacy Grivas TB 1, Kotwicki T 2, Maruyama T 3, O Brien J 4, Labelle H 5, Hresko T 6, Lonner B 7 1.Traumatology & Orthopaedic Department, "Tzaneio" General Hospital of Piraeus NHS, Tzanni & Afendouli str, 18536, Piraeus, Greece, tgri69@otenet.gr 2. Department of Paediatric Orthopaedics, University of Medical Sciences, Poznan, Poland 3. Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Tokyo, Japan 4. President National Scoliosis Foundation, USA 5. University of Montreal, Ste-Justine Mother & Child University Hospital, Montreal, Canada 6. Harvard Medical School, Boston Children Hospital, Boston, USA 7. Mount Sinai Medical Center Beth Israel Hospital Professor of Orthopaedic Surgery, NY, USA

2 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Background A recently published NIH-funded study named Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) affirmed the efficacy of bracing for moderate AIS & reduced surgical recommendations in braced patients. The implications of this study are numerous. affirms the value of bracing confirms the importance of wear time need to assess compliance w/ compulsory utilization of brace monitors key implication of the study relates to early detection, possibly heralding a new era for scoliosis screening policy adoption

3 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Aim To engage & enlist the feedback & potential advocacy, on behalf AIS patients, 1) of all persons involved in relevant state agencies 2) scientific organizations & health care professions

4 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Methods BrAIST results & its implications on a) brace treatment b) importance of compliance c) value of screening programs implications on screening concepts & recommendations

Methods 2013 Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Bracing in Adolescent Idiopathic Scoliosis Trial UIVERSITY OF

5 Methods 2013 Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Bracing in Adolescent Idiopathic Scoliosis Trial UIVERSITY OF IOWA STUART L. WEINSTEIN, MD PRINCIPAL INVESTIGATOR NIH/NIAMS 1RO1ARO52113 USA - National Institute of Arthritis & Musculoskeletal & Skin Diseases - NIAMS

6 Methods Weinstein SL et al. N Engl J Med DOI: /NEJMoa Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

7 Methods Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

8 Methods Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

9 importance of compliance Thermobrace - Thermobutton T S H

10 importance of compliance A Boston Cricket installed

11 Compliance

12 Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

13 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Results - implications on screening concepts & recommendations This established bracing effectiveness, reducing the number of patients who progress to surgery, resulting in cost savings & great benefit for scoliotics, also calls for raising awareness & advocacy of all the involved related professionals Awareness will be increased by familiarizing people w/ the a) history & geography of screening policies, b) current evidence about screening c) impact of screening on frequency of surgical treatment & its negative discontinuation effects on patients d) the analysis of evolving aim of screening e) the encouragement for policy statement publications from professional organizations and governmental agencies regarding scoliosis screening f) by legislating national program & g) by presentations in pertinent scientific meetings

14 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Results The advocacy will be benefited by a)providing guidelines on setting up these programs b)recommendations for improvement of a screening program c)popularizing its additional benefits on its contribution to clinical research on IS aetiology

15 SSS & IS aetiology Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

16 Traumatology & Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece Conclusions Due to the fact that the implementation of screening programs is inextricably bonded to non-operative IS treatment, it is believed that this reported BrAiST trial will have further impact on IS management swinging the pendulum back to full activation of these programs

17 Current concepts SOSORT SRS recommendations To screen or not to screen SOSORT SRS Yes we must screen! Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

18 Screening policies Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

19 Screening policies Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, Greece

20 Trauma and Orthopaedic Department Tzaneio General Hospital of Piraeus, 2014 Zea Coast Thank you very much for your attention T z a n i o H o s p i t a l

Dr. Theodoros B Grivas MD, PhD

Dr. Theodoros B Grivas MD, PhD 11 th International Conference on Conservative Management of Spinal Deformities 4 th SOSORT Educational Course, 6-7 May 2014, Wiesbaden (Germany) Idiopathic Scoliosis definitions, detection, clinical picture