Treatment of Scoliosis-Evidence and Management (Review of the Literature)

Abstract

Context: Scoliosis is a three-dimensional deformity of the spine and trunk which includes lateral deviation, rotation, and a disturbance of the sagittal profile. Treatment is indicated for scoliosis because it may lead to negative consequences with regard to the quality of life and other health issues for some patients. The purpose of this review was to gather current, up-to-date information, and to search the recent articles on scoliosis for evidence of the different modes of treatment. Evidence Acquisition: A PubMed search for review articles, prospective controlled trials (PCT), and randomized controlled trials (RCT) was performed. The search terms were: 1) scoliosis, treatment (12,045 items found); 2) scoliosis, physiotherapy (776 items found); 3) scoliosis, brace treatment (1,447 items found); and 4) scoliosis, surgery (10,485 items found). Results: When looking at the current literature, high quality evidence (level I) was found to support physical rehabilitation and brace treatments, while no evidence was found to support spinal fusion surgery. The numerous long-term complications that patients may face post-operation, and the lack of evidence for spinal fusion surgery indicate that there is no clear medical indication for this kind of treatment. Conclusions: There is a high level of evidence for the conservative treatment of scoliosis, but there are varying levels of success in the different approaches. The better the correction of the curve, the better the end result and outcome for the patient. This is supported by the current evidence reviewed in this paper. Physiotherapy and bracing should be used and, specifically, those approaches using high corrective methods. Spinal fusion surgery is not supported by the current evidence. According to the literature, the long-term complications of surgery for scoliosis far outweigh the consequences of untreated scoliosis.