title: Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: ISICO (Italian Scientific Spine Institute), Milan, Italy. stefano.negrini@isico.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Negrini
authors.forename: Theodoros B
authors.initials: TB
authors.lastname: Grivas
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kotwicki
authors.forename: Toru
authors.initials: T
authors.lastname: Maruyama
authors.forename: Manuel
authors.initials: M
authors.lastname: Rigo
authors.forename: Hans Rudolf
authors.initials: HR
authors.lastname: Weiss