A systematic literature review of nonsurgical treatment in adult scoliosis

STUDY DESIGN: A formal systematic review of the literature for conservative treatment of adult deformity was performed.

OBJECTIVE: To evaluate evidence for the efficacy and effectiveness of proposed conservative treatment options in adult deformity.

SUMMARY OF BACKGROUND DATA: Adult deformity is a major demographic health issue in the geriatric population in both the United States and the world communities. Surgeons are often very conservative in the treatment of adult scoliosis because of the complication rates associated with the surgeries and the marginal bone quality endemic to this population. A prerequisite to surgical intervention is usually failure of all appropriate conservative care. There is currently a lack of consensus on the most efficacious conservative treatments for adult deformity.

METHODS: A systematic review of clinical studies; using the key terms of adult or degenerative and scoliosis combined with any of the following: bracing, casting, physical therapy, chiropractic, and injections for treatment. The database inclusions were PubMed, OVID, and CINAHL. Articles were excluded if the primary patient populations were adolescents or the treatment options performed were primarily surgical. The methodology of the studies was graded and the evidence was classified into 1 of 5 levels based on study types. Based on this, a treatment recommendation was determined.

RESULTS: There is indeterminate, Level III/IV evidence on the effectiveness of any conservative care option. Specifically, there is Level IV evidence on the role of physical therapy, chiropractic care, and bracing. There is Level III evidence for injections in the conservative treatment of adult deformity. There is insufficient research for a treatment recommendation beyond Level 2c very weak evidence, but the available literature is supportive of further clinical research in conservative care as a treatment in adult deformity.

CONCLUSION: Conservative care in general may be a helpful option in the care of adult deformity, but evidence for this is lacking. Unfortunately, no treatment option within conservative care has support within the literature as a preferred solution. Basic clinical research at any level would be helpful to further clarify the options.