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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):Â
Dwain M. Daniel, D.C.
How this evidence was rated:
Strength of Recommendation Taxonomy (SORT)
Strength of Recommendation Taxonomy (SORT)
Legend:A = consistent, good quality patient oriented evidence;
B = inconsistent or limited quality patient oriented evidence;
C = consensus, disease oriented evidence, usual practice, expert opinion or case series;
D = all or the preponderance of existing evidence is negative.
For more information on the Strength of Recommendation Taxonomy (SORT), please click here.
Published on
January 14, 2008
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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.Â
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.Â
Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician 2001; 64(1):111-116.
3.Â
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4.Â
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5.Â
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6.Â
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10.Â
Lantz CA, Chen J, Bachman T. Chiropractic Management of Adolescent Idiopathic Scoliosis. 1995. Chiropratic Centennial Foundation. Ref Type: Report
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[ Full-Text Link ]
12.Â
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 ]
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[ Full-Text Link ]