THE BACK PAGE RESEARCH REVIEW Chiropractic care for scoliosis REVIEWED BY SHAWN THISTLE I STUDY TITLE: Chiropractic Treatments for Idiopathic Scoliosis: A Narrative Review Based on the SOSORT Outcome Criteria AUTHORS: Morningstar MW, Stitzel CJ, Siddiqui A et al. PUBLICATION INFORMATION: Journal of Chiropractic Medicine 2017; 16(1): 64-71. diopathic scoliosis (IS) is widely treated by chiropractors. The com-mon goals of treatment include correction or stabilization of the Cobb angle (i.e. curve severity) and/or to provide pain relief. It is un-certain whether the body of chiroprac-tic literature fits the criteria for report-ing of results as outlined by the 2015 Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) and the Scoliosis Research Society (SRS) consensus paper and Weiss et al. The authors sought to determine whether the peer-reviewed literature examining the effect of chiropractic treatments on idiopathic scoliosis report results according to the recommended standard of the SOSORT/SRS consen-sus paper. The goal of the study is to strengthen future outcome reporting in chiropractic research and improve in-ter-professional communication. A total of only 27 studies that dis-cussed chiropractic scoliosis treatments were identified – 15 case reports, 10 case series, one prospective cohort, and one randomized clinical trial. Only two studies described their outcomes as recommended in the 2015 SOSORT and SRS Non-Operative Management Committee consensus paper. The pa-pers will be discussed below based on the intervention utilized. case study reviewed a Manipulation only One seven-year-old patient with juvenile IS who underwent four visits of Pierce technique manipulation over one month. Post-treatment radiographs showed an eight-degree curve reduc-tion. Additional Cobb measurements were not reported. A second case study reviewed a 15-year-old patient whose curve decreased by 12 degrees after five months of NUCCA upper cervical manipulation. The patient was managed for an additional four years; no addi-tional Cobb angles were reported. An-other case study reviewed a 10-year-old patient whose thoracolumbar scoliosis decreased by 10 degrees after 25 weeks of NUCCA manipulations. Unfortu-nately, no baseline Risser-stage or long-term Cobb angle measurements were reported. A separate case study reported a 16-degree curve correction after 18 months of full spine manipulation. In-terestingly, this patient’s curve report-edly progressed significantly prior to initiation of SMT, in spite of four years of physical therapy and spinal bracing. A prospective cohort study including 42 patients receiving full spinal manip-ulation, postural training and heel lifts showed no change in curve measure-ments after 14-months. Many of the studies falling into this category failed to follow patients into skeletal maturity. Also, many of the studies did not report outcomes con-sistent with the SOSORT criteria, apart from Cobb angle changes. One case report described full resolu-tion of IS in a 10-year-old after eight months of SpineCor bracing. Results were maintained at one-year follow-up. A separate case series reviewed Cobb angle changes after one year of scoliosis activity suit bracing in 62 adults with IS. The subjects were divided into two groups: one group who were < stage 5 on the Risser scale (skeletally imma-ture), and a second group who were > 5 (skeletally mature). The results were highly variable. There was a > 6 degree curve correction in 16 out of 26 pa-tients in the skeletally immature group. Meanwhile, six out of 26 remained within five degrees of baseline, while four patients’ curves advanced by > 6 degrees. Curves of 14 out of 36 skele-tally mature patients corrected to some degree. Meanwhile, 20 skeletally ma-ture patients’ curves remained un-changed during the study, while two progressed. Another study of 53 adult patients demonstrated that 79 per cent of sub-jects achieved curve correction after 18 months of scoliosis activity suit brac-ing. Seventeen per cent of subjects re-mained unchanged. Unfortunately, the three studies in-cluded in this category did not follow skeletally immature patients to matu-rity. They also did not follow adult patients for five years, as previously recommended. Bracing only (as performed by chiropractors) Manipulation plus bracing DR. SHAWN THISTLE is the founder and CEO of RRS Education, providing weekly research reviews, online courses and seminars to help busy clinicians integrate current research evidence rationally into practice. For more information, visit: www.rrseducation.com. Shawn can be reached by email at [email protected] 28 Canadian Chiropractor February 2018 One RCT included six patients receiv-ing combinations of different therapies. One of the six patients (Risser stage 1), improved her Cobb angle after six months of SMT and rigid bracing. IS progressed in four out of six patients in spite of management. The study re-ported the baseline Risser staging for www.canadianchiropractor.ca
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