Non-Invasive Treatment of Adolescent Idiopathic Scoliosis: Systematic Literature Review by Using Citation Network Analysis

Abstract

There are many nonsurgical treatment options from adolescent idiopathic scoliosis (AIS) to control the progression of the spinal curvature. However, the existing studies are so diverse and diffuse that it is challenging to find potential trends for further studies without a more comprehensive review in place for reference purposes. Thus, the objective of this review article is to conduct a systematic literature review on the noninvasive treatment of AIS with a citation network analysis. The Web of Science (WoS) was searched using 9 reference keywords to collect published articles in English on nonsurgical treatment options for AIS from 1979 to 2019. Each eligible article focused on the nonsurgical options for treating AIS. In addition, the HistCite and the UCINet softwares were referred to for article distribution and citation network analysis. Only non-invasive treatment options of AIS were included. Studies that estimated the amount of spinal curvature, causes of or risk factors for AIS and any invasive treatments, such as surgery, were not focused on. The articles were independently extracted by 3 authors based on the predefined eligibility criteria. The title, authors, year of publication, country or region of publication, reference list, keywords and other bibliographic information from each article was extracted and analyzed purely based on the data with the HistCite and UCINet programs. At last, a total of 146 articles out of 1594 articles were selected for the literature review after the exclusion of 1357 irrelevant articles and 91 inappropriate studies, such as letters and proceedings papers. Of these 146 articles, the majority were empirical studies (74.0%). There was also a lack of meta-analyses in this research field. Based on the results of the citation network analysis, most of the top 10 articles with the highest local citation scores (LCSs) focused on bracing as a treatment. The popularity of bracing as a research topic was also supported by the citation network structure, as brace treatment was in the largest of the five research clusters; this cluster also included posture training through exercise, managing the corrective forces of braces, 3D analysis of braces and quality of life during brace treatment. However, most of these studies focused on rigid braces. A few studies on non-rigid braces and other types of nonsurgical treatment were available in the current literature, which might indicate potential research areas for future studies. To conclude, noninvasive treatment for AIS has been on the academic radar recently; but there are still research gaps, such as the lack of research on semi-rigid and flexible braces or posture training exercises with biofeedback systems. Further studies could explore these research directions.