The conservative management of adolescent idiopathic scoliosis

Abstract

Adolescent idiopathic scoliosis is a disorder which can exhibit considerable variation in both clinical presentation and rate of progression. Most severe scoliotic curves require surgical stabilization, however there is a group of patients with less severe presentations for whom conservative treatments are often considered as a first line of management. The most commonly utilized conservative therapies are bracing, electrical muscle stimulation and various forms of exercise. These treatments are time consuming and carry with them the potential for physical and psychological side effects. It is imperative therefore that such treatments, if they are to be utilized, should show a clear beneficial effect in limiting the progression and adverse effects of scoliosis. This paper reviews the available data from clinical trials investigating various forms of conservative therapy and discusses the outcomes of these trials in relation to the natural history of scoliosis. The author concludes that the benefits of conservative treatment are at best marginal and that there is little clear data to support the use of one treatment above any others. Published research in this area is fraught with methodological inadequacies which make it difficult to support or indeed, to categorically refute the value of any particular treatment for specific patient groups. Proposals relevant to improving the quality of future studies have therefore been included in the paper. While the present paper does not provide support for the use of conservative treatment modalities in the management of adolescent idiopathic scoliosis it is hoped that researchers will continue to address this topic and that new treatment approaches may be developed.