ChiroACCESS Clinical Review



Adolescent Idiopathic Scoliosis: Therapy

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.

  

How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)



Published on

January 14, 2008

Text Size:     
A great disparity exists between allopathic medicine and chiropractic relating to the treatment of adolescent idiopathic scoliosis (AIS). Medical interventions often follow a "wait and see" philosophy where the goal of treatment is to prevent progression of the curve beyond a certain limit. When curves do progress significant time in the growth of the individual remains, the allopath can choose between two or three treatments, none which have been tested in randomized controlled trials. Chiropractic care is generally aggressively performed with the intention of reversing most curves, even minor curves. Similar to the allopath, very weak evidence demonstrates the efficacy of chiropractic care or the need to treat curves that have little statistical chance of progression to a significant level. Case studies represent the bulk of chiropractic research and are of limited value since up to 27.4% of curves show spontaneous improvement of at least 5° without treatment (1).


The following table has been modified from Reamy et al (2) and represents a common medical approach to treatment:

Cobb's angle

Risser grade

X-ray/Refer

Treatment

10 to 19 degrees

0 to 4

Every six months/ No

Observe

20 to 29 degrees

0 to 1

Every six months/Yes

Brace after 25°

20 to 29 degrees

2 to 4

Every six months/Yes

Observe/brace*

> 29 degrees

0 to 4

Refer

Brace or surgery**


* If patient is Risser grade 4 observation is warranted unless progression noted
** Surgery considered at 40°. If patient is Risser grade 4 surgery can be delayed unless progression is noted.

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References

1. 

Soucacos PN, Zacharis K, Soultanis K, Gelalis J, Xenakis T, Beris AE. Risk factors for idiopathic scoliosis: review of a 6-year prospective study. Orthopedics 2000; 23(8):833-838.



2. 

Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician 2001; 64(1):111-116.



3. 

Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995; 77(6):815-822.



4. 

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5. 

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6. 

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9. 

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10. 

Lantz CA, Chen J, Bachman T. Chiropractic Management of Adolescent Idiopathic Scoliosis. 1995. Chiropratic Centennial Foundation. Ref Type: Report



11. 

Morningstar MW, Woggon D, Lawrence G. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskelet Disord 2004; 5:32.

 [ Full-Text Link ]

12. 

Rowe DE, Feise RJ, Crowther ER, Grod JP, Menke JM, Goldsmith CH et al. Chiropractic manipulation in adolescent idiopathic scoliosis: a pilot study. Chiropr Osteopat 2006; 14:15.

 [ Full-Text Link ]

13. 

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14. 

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15. 

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 [ Full-Text Link ]