A Comparison of Patient-Reported Outcome Measures Following Different Treatment Approaches for Adolescents with Severe Idiopathic Scoliosis: A Systematic Review

Abstract

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine which is usually not symptomatic and which can progress during growth and cause a surface deformity. In adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Although surgery is usually recommended for curvatures exceeding 40° to 50° to stop curvature progression, recent reviews have shed some light on the long-term complications of such surgery and to the lack of evidence for such complicated procedures within the scientific literature. Furthermore, a number of patients are very fearful of having surgery and refuse this option or live in countries where specialist scoliosis surgery is not available. Other patients may be unable to afford the cost of specialist scoliosis surgery. For these patients the only choice is an alternative non-surgical treatment option. To examine the impact of different management options in patients with severe AIS, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short-term (a few months) and the long-term (over 20 years). We searched CENTRAL, MEDLINE, EMBASE, CINHAL and two other databases up to January 2016 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive hand search of the grey literature. We searched for randomised controlled trials as well as prospective and retrospective controlled trials comparing spinal fusion surgery with no treatment or conservative treatment in AIS patients with a Cobb angle greater than 40°. We did not identify any evidence of superiority of effectiveness of operative compared to nonoperative interventions for patients with severe AIS. Within the present literature there is no clear evidence to suggest that a specific type of treatment is superior to other types of treatment.

Brace Treatment for Children and Adolescents with Scoliosis

“…In addition, significant clinical and radiological improvements have been documented [47,75,79,82]. Considering that in patients with AIS, there is no long-term evidence supporting spinal fusion surgery [10][11][12][13][14], and in view of its significant long-term complications [15][16][17][18], brace treatment for curves exceeding 40° should be of importance. According to literature, asymmetrical high-quality braces offer success rates of about Brace Treatment for Children and Adolescents with Scoliosis DOI: http://dx.doi.org /10.5772/intechopen.91234 90% in this group of patients and can be regarded as the safest bracing approach for curves exceeding 40° when worn full-time at the start of treatment (Figure 11).…”

“…When considering surgery versus conservative treatment, high-quality evidence exists for the application of pattern specific exercises (PSE for example, Schroth) [5,6] and spinal bracing [7][8][9]. No long-term evidence exists to support spinal fusion surgery [10][11][12][13][14]. Further comparisons are not possible when there is a lack of publicised surgical outcomes.…”

Influence of physical activity on prevention and occurrence of spinal deformities in children during development

“…Structural deformities of the spine include deformities resulting from pathological changes in the structure and morphology of spinal vertebrae that are of etiologically different causes [1,2,3]. The results of systematic examinations of children in primary and secondary schools show that the deformities of the spinal column are increasing from year to year.…”

“…The development of spinal deformity in children in the developmental period is associated with the gender, body weight, body height and age of the child, family burden of the spinal column deformities, hereditary diseases and other conditions, as well as with insufficient physical activity [3,4]. The diversity of psychophysical abilities of children by age groups indicates that aerobic muscle endurance starts from early childhood, and anaerobic endurance and their strength from puberty and later [5].…”

Effect of a Long-Term Corrective Exercises With Using Brace on Cobb Angle and Postural Control of a Girl With Adolescence Idiopathic Scoliosis

“…coliosis is a three-Dimensional (3D) spinal deformity that includes a lateral curvature in frontal plate, vertebral rotation in transverse plate, and possible increase or decrease of thoracic and lumbar curves in sagittal plane. As a result of this deformity, the chest geometry and the symmetry of the trunk changes [1,2]. Changes in appearance and, in particular, elevation of the ribs and the scapula are the most important causes of dissatisfaction among people with Scoliosis, especially adolescents [3].…”