Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study

Analysis of Scoliosis-related Medical Services in South Korea Between 2010 and 2018: A Cross-sectional Study Using Health Insurance Review and Assessment Service Data

STUDY DESIGN

Retrospective, cross-sectional study.

OBJECTIVES

The aim of this study was to analyze types and cost of care for scoliosis and present health care utilization by patients to provide data on the standard treatment and cost for scoliosis in South Korea.

SUMMARY OF BACKGROUND DATA

Scoliosis is defined as an abnormally laterally curved spine with a Cobb angle of ≥10°.Data are lacking on which treatments are popular for general scoliosis and which service categories incur the most cost in South Korea.

METHODS

Data from the Health Insurance Review and Assessment Service-National Patient Sample were used. In total, 108,643 final cases and 32,362 patients in South Korea who received Western medicine care or Korean medicine care at least once with scoliosis (ICD-10 code M41) as the principal diagnosis during January 2010 to December 2018 comprised the study sample. We analyzed health care utilization according to certain factors (e.g., age, sex, payer type, type of visit, and medical institution), health care utilization by service category and service code, and medication prescriptions filled by private or hospital pharmacies.

RESULTS

Patients aged 24 years or younger most frequently utilized health care services, with more female (64.84%) than male patients (35.16%). Most patients received only Western medicine care (92.18%), whereas 6.56% only received Korean medicine care. Most cases (99.37%) corresponded to outpatient. Regarding service category, treatment and surgery, examination, special equipment and radiologic diagnosis accounted for a substantial percentage. Regarding service code, cost of examination, imaging, and physiotherapy comprised a high percentage of Western medicine, whereas cost of examination, acupuncture, and cupping therapy accounted for a high percentage of Korean medicine. The most commonly prescribed medications for scoliosis in pharmacies were anti-inflammatory analgesics (nonsteroidal anti-inflammatory drugs), antacids, and skeletal muscle relaxers.

CONCLUSION

The findings can be used as foundational data for experts such as health care policymakers, clinicians, and researchers.Level of Evidence: 4.

Impact of Physical Therapy on Pain and Function in a Patient With Scoliosis

Human spine is a complex and robust structure. Almost all spine deformities contribute to limitations in activities of daily living. Scoliosis is the most common deformity accompanied by rotation and progresses during the growth of an individual. It is classified into three categories: congenital, idiopathic, and neuromuscular. The common secondary causes of scoliosis include cerebral palsy, poliomyelitis, and other neuromuscular conditions. A case of a 23-year-old female with right shoulder pain with a history of adolescent idiopathic scoliosis, which leads to a decrease in self-image and disturbance in activities of daily living, is presented in this report. The assessment, medical history, and rehabilitation protocol are mentioned in this case report. Physical therapy to treat shoulder joints includes thermotherapy and manual therapy targeting pain over the joint and stiffness. The use of thermotherapy, bracing, and strengthening and stretching exercises to prevent further deformity and aggravation of the symptoms is described in this report. We report that there was a significant improvement in muscle strength, relief from pain, spinal mobility, postural control, and decreases in further complications.

Physiotherapeutic scoliosis-specific exercises performed immediately after spinal manipulative therapy for the treatment of mild adolescent idiopathic scoliosis: study protocol for a randomized controlled pilot trial

BACKGROUND

Spinal manipulative therapy is commonly used in the treatment of adolescent idiopathic scoliosis. Some therapists also rely on physiotherapeutic scoliosis-specific exercise (PSSE). Combining these two modalities seems reasonable, but the effectiveness of this combination has never been rigorously tested. Here, a protocol for a pilot study is proposed to determine the feasibility of conducting a larger randomized trial. The pilot study was designed to test the hypothesis that spinal manipulative therapy followed by PSSE is more effective than PSSE alone in improving the Cobb angle, sensorimotor integration, the angle of trunk rotation (ATR), body symmetry, and quality of life.

METHODS

The protocol describes a randomized controlled pilot trial with 40 subjects divided into study and control groups. Both groups will receive 8 weeks of PSSE, but the study group will also receive spinal manipulative therapy during the first 2 weeks before PSSE. The primary outcome will be an estimate of the feasibility of conducting a full-scale experiment. The influencing factors will be the time to complete enrollment, the recruitment rate, subject retention, and adherence to the treatment allocations. The secondary outcomes that will be used to assess the efficacy of treatment will include the Cobb angle, somatosensory evoked potentials, ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire. The Cobb angle will be measured at baseline and at the end of 8 weeks of training. The somatosensory evoked potentials will be measured at baseline and at the end of 2 weeks of training. The ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire will be measured at baseline and at 2 weeks, 4 weeks, and 8 weeks of treatment.

DISCUSSION

This study will inform the design of a future full-scale trial. The outcomes will provide preliminary data about the efficacy of the combination of spinal manipulative therapy and exercise in treating scoliosis.

TRIAL REGISTRATION

Prospectively registered at Chinese clinical trial registry, ChiCTR1900027037 . Registered on 29 October 2019. http://www.chictr.org.cn/edit.aspx?pid=44954&htm=4.

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

BACKGROUND

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS).

METHODS

Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016.

RESULTS

The contents of the new 2016 guidelines include the following: background on idiopathic scoliosis, description of CTIS approaches for various populations with flow-charts for clinical practice, as well as literature reviews and recommendations on assessment, bracing, PSSE and other CTIS. The present guidelines include a total of 68 recommendations divided into following topics: bracing (n = 25), PSSE to prevent scoliosis progression during growth (n = 12), PSSE during brace treatment and surgical therapy (n = 6), other conservative treatments (n = 2), respiratory function and exercises (n = 3), general sport activities (n = 6); and assessment (n = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8.

CONCLUSION

The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.

Chiropractic Treatments for Idiopathic Scoliosis: A Narrative Review Based on SOSORT Outcome Criteria

OBJECTIVE

The purpose of this review was to evaluate the current body of literature on chiropractic treatment of idiopathic scoliosis against the 2014 consensus paper of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) and the Scoliosis Research Society (SRS) Non-Operative Management Committee for outcome reporting in nonoperative treatments.

METHODS

A search of the PubMed and Index to Chiropractic Literature databases for studies published from January 2000 through February 2016 detailing specific treatments and outcomes for idiopathic scoliosis was conducted.

RESULTS

A total of 27 studies that discussed chiropractic scoliosis treatments were identified. Of these, there were 15 case reports, 10 case series, 1 prospective cohort, and 1 randomized clinical trial. Of the 27 studies, only 2 described their outcomes as recommended in the 2014 SOSORT and SRS Non-Operative Management Committee consensus paper.

CONCLUSION

The 2014 SOSORT and SRS Non-Operative Committee consensus paper details the format and types of outcomes they collectively believe are the most important and relevant to the patient. Among the chiropractic studies located in this review, 2 described outcomes consistent with how SOSORT recommends they be reported. Given that these consensus papers form the basis for nonoperative treatment recommendations and outcome reporting, future chiropractic studies should seek to report their outcomes as recommended by these papers. This will allow for better interprofessional collaboration and methodologic comparison.

Results of chiropractic scoliosis rehabilitation treatment at two years post-skeletal maturity in identical female twins

BACKGROUND

Scoliosis treatment guidelines for non-operative management suggest that patients should be followed for two years beyond skeletal maturity to appropriately evaluate treatment effect. This report outlines the results of identical twin girls' treatment with chiropractic rehabilitation treatment at two years post skeletal maturity.

FINDINGS

The twins participated in a treatment lasting two weeks, followed by home care maintenance and periodic follow-ups for they reached skeletal maturity. Two year follow up showed reduced Cobb angles of 19° and 15°, respectively.

CONCLUSION

Identical twin girls who were evaluated two years after skeletal maturity showed clinically significant improvements in Cobb angle measurements. Controlled, prospective study design for future patients treated in this manner will provide greater insight into how the treatment may have impacted the observed changes.

Manipulative and rehabilitative therapy as a treatment of idiopathic scoliosis without psychological sequelae: a case report

OBJECTIVE

The purpose of this case report is to describe management and outcomes of a patient with scoliosis.

CLINICAL FEATURES

A 9-year-old female patient with a double curve pattern with Cobb angles of 18° and 24° (thoracic/thoracolumbar) compatible with scoliosis presented for physical therapy treatment.

INTERVENTION AND OUTCOME

Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy.

CONCLUSION

The patient responded favorably to manipulative and rehabilitation techniques. At the end of care, the patient did not show psychological sequelae with selected outcome measures.

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

BACKGROUND

The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).

METHODS

All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.

RESULTS

The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.

CONCLUSION

These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

Inclusion of chiropractic care in multidisciplinary management of a child with Prader-Willi syndrome: a case report

OBJECTIVE

The purpose of this paper is to present a case of a child with Prader-Willi syndrome and the observed improvement in the degree of scoliosis, immune function, and behavior documented during the course of her treatment.

CLINICAL FEATURES

A 7-year-old girl presented to Kentuckiana Children's Center with a 15 degrees lumbar levoscoliosis and diagnosis of Prader-Willi syndrome.

INTERVENTION AND OUTCOME

The treatment plan consisted of chiropractic adjustments, craniosacral therapy, movement therapy, and nutritional therapy. Over the course of treatment, her muscle strength, tone, and motor activity increased. She improved in coordination of gait and balance. Over the course of 3 years, her scoliosis decreased to 4 degrees to 5 degrees . Improvements in immune function and a reduction in anxiety type behaviors were documented by the parents and doctor of chiropractic over the course of 5 years.

CONCLUSIONS

This case report describes the improvements and progression of one female child with Prader-Willi syndrome under chiropractic and multidisciplinary care.

The application of osteopathic treatments to pediatric sports injuries

The application of manual techniques to pediatric athletic injuries has been considered alternative medicine. There are many injuries that are associated with loss of normal motion. Altered biomechanics can be readily identified and treated using manual methods. These include articular or thrust techniques, muscle energy, strain-counterstrain, and myofascial treatments, among others. Although there are few high-quality studies available, most available literature reports effectiveness of manual techniques in combination with therapeutic exercise for common pediatric motion restrictions.

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

BACKGROUND

Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously.

CASE PRESENTATION

A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature.

CONCLUSION

This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis.