The International Research Society for Spinal Deformities (IRSSD) was founded in 1994. The first concepts of forming the Society were raised by a group of researchers who had first gathered in Vermont in 1980 to hold what subsequently became a series of biennial meetings devoted to surface topography and deformity. At a meeting held in 1992 in Montreal, focussed on 3 dimensional interpretations of spinal deformities, discussions were held into whether a formal Society should be formed, and while debate rejected this concept at the time, it was two years later at a meeting in Pescara, Italy 1994 that the IRSSD finally came into being.
The Society has its roots in mathematical modelling, biomechanics and medical research and has always encouraged researchers to report their on-going projects in all aspects of the spinal deformities associated with scoliosis and other spinal deformity conditions. The biomechanical approach led to a better understanding of how the vertebral column behaves under stresses and how the surface shape related to the underlying columnar deformity. Developments in imaging and electronics allowed researchers to develop systems such as ISIS as a non-invasive method of recording back shape in out patient clinics as well as a tool for researchers.
Biologically based studies were also reported. It was appreciated early on by the membership that children with scoliosis have a range of growth disturbances associated with a marked skeletal asymmetry. While the biological approach has enabled a considerable amount of data to be amassed which relates to etiology and pathogenesis, no actual breakthrough into fully understanding why the spinal column rotates and curves to cause scoliosis has yet occurred.
The biennial meetings of the Society chart this research progress in each of the volumes of proceedings, with some reports being final papers while others are progress reports. This is a unique resource for the researcher, holding the key to many different aspects of the problems of the spine. However, some authors choose not to submit to the volumes as they are publishing elsewhere in peer-reviewed Journals, a trend which is inevitably going to challenge the way conference proceedings are reported in the future. There is therefore a challenge to the IRSSD to find an answer to this issue.
2008 could be viewed as a time of potentially exciting breakthroughs in our understanding of the deformity of scoliosis. The rapid advances in imaging technology will allow better and more detailed images of the spine, both on its surface and deeper internally, using techniques such as Laser scanning, Magnetic Resonance Imaging and ultrasound. There is little doubt these technologies are going to advance massively, new ones will come into the hands of clinicians and researchers and a better understanding of the complex functional anatomy of the spine will be developed. This will undoubtedly aid biomechanicians to model the spine and its function, under gravity and movement, allowing new insight into progressions of curves and ways to surgically control deformities.
However, it is probably the potential of biology and medical research which offer the greatest opportunities to further our understanding. The incredible advances at the molecular level, the expanding knowledge of genetics and the recent discoveries in the field of neurophysiology offer for the first time real potential for unravelling the puzzles of etiology. The discovery of molecular biochemical pathways, signalling agents, hormones such as leptin, genetic markers and a greater appreciation of the role of the nervous systems, both central, peripheral and autonomic, all indicate that the research field could expand dramatically with new ideas and inputs from research workers in fields outside the traditional ones devoted to the spine.
It is thus clear that to find a solution, we must build on these new developments and look beyond the spine to the whole body to discover if its biological functions are disturbed. A growing child is a dynamic environment internally, with rapid growth changes reflected in adolescence and these are known to result in tall, thin and asymmetrical children. These changes point to a whole body biological involvement. Researchers must reflect on this totality since it must ultimately allow us to explain the etiology and pathology of what are probably going to prove to be secondary events manifest as spinal curvatures.
These are exciting times and I hope the participants in the Liverpool meeting in 2008 will look back on it as a watershed in our understanding of the spinal deformities. Let's hope this is true, since a therapeutic intervention must surely be better than surgery or external bracing from the purely psychological, if not cosmetic, view of a growing child.
I would like to thanks all participants and authors for submitting their work to the meeting and to my colleagues Professor Nachi Chockalingam, Mr. Ashley Cole and Mr. El-Nasri Ahmed, for their help and support and to our sponsors who supported the meeting in Liverpool, European Capital of Culture 2008.
Peter Dangerfield, Liverpool, UK, April 2008