Negrini Stefano, Grivas Theodoros B, Kotwicki Tomasz, Maruyama Toru, Rigo Manuel, Weiss Hans Rudolf
ISICO (Italian Scientific Spine Institute), Milan, Italy.
Scoliosis. 2006 Apr 10;1:4. doi: 10.1186/1748-7161-1-4.
Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments.
To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis.
We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members).
The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood.
In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance.
We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family.
医学是一门科学艺术：一旦科学依据不明确，就会根据个人和集体信仰做出选择，而这些信仰应该得到更好的理解。在青少年特发性脊柱侧凸这样的领域尤其如此，目前对于保守治疗或手术治疗的疗效都不存在确凿的科学证据。
验证一组相信并采用特发性脊柱侧凸保守治疗方法的人群对于最终治疗结果的理念选择。
我们开展了一项多方面的研究，包括文献计量分析、问卷调查，以及在脊柱侧凸保守治疗专家（SOSORT成员）之间进行的细致的共识达成程序。
共识达成程序已证明是有用的：答案在统计学上有显著变化，并且纳入了9项新的结果标准。最重要的最终结果被认为是美观（100%）、生活质量和残疾状况（超过90%），而超过80%的偏好集中在背痛、心理健康、成年期进展、呼吸功能、脊柱侧凸Cobb角（X线侧屈位）、成年期进一步治疗需求。
在文献中，由特定治疗需求或拥有测量系统的可能性所驱动的结果标准占主导地位（即便似乎常规临床和X线检查方法比更复杂的残疾或生活质量评估工具受到更多重视）。SOSORT成员重视广泛的结果标准，其中临床和X线问题的重要性最低。
我们为患者治疗，既要考虑他们未来的需求（呼吸功能、成年期进一步治疗需求、成年期进展），也要考虑他们当下的需求（美观、残疾状况、生活质量）。诸如肋骨隆凸或X线侧方对线及旋转等技术问题，但不包括侧屈，是次要结果，仅对先前报告的主要结果有辅助作用。我们提倡对脊柱侧凸患者进行多维度、全面的评估，以收集完整治疗方法所需的所有必要数据，这种评估超越了X线检查，深入到患者本人及其家庭。
