Scoliosis
What is scoliosis?
An abnormal lateral (sideways) curvature of the spine. It affects 2-3% of adolescents and over 50% of adults over 60 years of age.1
What are the symptoms?
In adolescent years, scoliosis may be asymptomatic (i.e. no symptoms) or be a cause for persistent back pain.
Whilst scoliosis may also be asymptomatic in older adults, it more frequently causes back pain, disability and is associated with a deterioration in health status. In fact, ‘comorbidities’ such as major arthritis, rotator cuff disease, cardiac disease, gastrointestinal and urogenital issues are reported frequently (up to 1 in 4 of adult cases).1 Additionally, in older females with degenerative scoliosis research has shown that lower back and trunk muscle wasting (sarcopaenia) occurs in nearly 50% of cases.2
What is the evidence for treating ADOLESCENT scoliosis (AIS)?
Surgery: Only 0.1 % require surgery and this is generally for cosmetic reasons (and associated psychological distress) rather than for pain relief. In the case of severe curves, the heart and lungs can be distressed.3
Exercises: There is good evidence for applying physiotherapeutic scoliosis specific exercises (PSSE) (Wow, that’s a mouthful!!).4,5,6 These exercises target weakened and wasted muscles and have been shown to reduce scoliosis curve progression.
Bracing: There is good evidence that bracing reduces curve progression. In one study of 106 patients with scoliosis, bracing was compared to no bracing (observation). 16 years later the patients were followed-up; 6 patients in the observation group went onto have surgery whilst no patients in the bracing group required surgery.7
Spinal Manipulation: Spinal manipulative therapies are yet to be proven regarding their impact on the progression of spinal curvature8, however spinal manipulation has been shown to be useful for pain relief in adolescents with scoliosis.9
A note from Cameron:
A comprehensive research review found an association between scoliosis and leg length discrepancy.10 The contribution of leg length discrepancy to scoliosis development is considered very important by our practitioners. It is routinely assessed and managed where appropriate.
The Schroth (PSSE) exercise method is complimented by spinal mobilisation therapies applied to the scoliotic curvature. Our practitioners employ Cox spinal mobilisations for treating scoliosis which allows directed mechanical stretching of the scoliosis.
Monitoring: It is strogly recommended that even small curves in growing children should be monitored periodically.10
What is the evidence for treating ADULT degenerative scoliosis?
Surgery: One study compared surgery to conservative management for patients with degenerative scoliosis. The surgical group were found to have less pain and disability at 2 years follow-up.12
Other studies have shown 30% of scoliosis patients have major complications, and 60% have minor complications following surgery.1 Major complications such as instrument failure (rods fracturing) and junction failures require reoperation. Minor complications include spinal dura tears and haematoma (bleeding) at the time of the surgery.
Conservative options such as bracing, spinal manipulation and exercises may be helpful, however there is currently insufficient evidence regarding the benefits of one specific therapy over another for managing adult degenerative scoliosis.13 More research is needed!
Does an x-ray determine whether I need surgery?
X-rays are not predictive: For adult scoliosis, the severity of degeneration seen on a spinal x-ray has not been found to predict which patients will need surgery.
A note from Cameron:
Given the substantial rate of complications following surgery for degenerative scoliosis, an extensive conservative treatment trial is recommended before surgery be considered. Scoliosis can be debilitating, and it is therefore important for patients to seek the opinion and management from experienced spine practitioners.
1. Pugely et al: Serious Adverse Events Significantly Reduce Patient-Reported Outcomes at 2-Year Follow-up: Nonoperative, Multicenter, Prospective NIH Study of 105 Patients. Spine: June 1, 2018 -Volume 43 -Issue 11 -p 747–753
2. Eguchi et al: Sarcopenia and degenerative lumbar scoliosis in older women. Scoliosis Spinal Disord. 2017 Mar 1
3. Tambe et al:. Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Joint J.2018 Apr 1;100B(4):415-424
4. Park et al: Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis. Eur J Phys Rehabil Med. 2017 Oct 2
5. Schreiber et al: Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? -results from a randomized controlled trial -"SOSORT 2017 Award Winner" Scoliosis Spinal Disord.2017 Nov 14;12:26.
6. Den Boer et al: Treatment of idiopathic scoliosis with side shift therapy: an initial comparison with a brace treatment historical cohort. Eur Spine J 1999:8;406-10
7. Danielsson et al: A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine 2007 Sep 15;32(20):2198-207
8. Romano et al: Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis 2008 Jan 22;3:2
9. Nykoliation et al: An algorithm for the management of scoliosis. J Manipulative PhysiolTher.1986 Mar;9(1):1-14.
10. Canavese et al: Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment. Indian J Orth 2011 Jan;45(1):7-14
11. Campbell et al: Shoe Lifts for Leg Length Discrepancy in Adults With Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature. Arch Phys Med Rehabil. 2018 May;99(5):981
12. Smith et al: Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery. 2009 Jul;65(1):86-93; discussion 93-4
13. Everett at al: A systematic literature review of nonsurgical treatment in adult scoliosis. Spine 2007 Sep 1;32
