each patient, but did not report on patient outcomes at, or after, skeletal maturity. Manipulation plus traction A case study reviewed an 11-year-old patient with a 22 degree left TL scoli-osis, who underwent 31 visits of chiro-practic manipulation and positional traction. Post-treatment radiographs demonstrated a three-degree curve reduction. Another retrospective case series evaluated 15 patients utilizing a propri-etary traction chair for IS treatment over six months. The study demon-strated insignificant Cobb angle de-creases in patients whose apical rota-tion improved while sitting in the chair. Higher quality research designs and reporting of outcomes are required to develop future guidelines for chiropractic management of scoliosis. and cranial manipulation. Cobb angle in this patient stabilized post-treat-ment. The patient was not followed to skeletal maturity. A 2004 case series investigating the effect of multimodal therapy in 22 patients between the ages of 15 and 65 demonstrated an average 17-degree Cobb angle correction for the entire cohort. The lowest correction was eight degrees. One hundred per cent of the cohort achieved scoliosis correction. Patients were followed-up after six weeks of treatment, which is vastly shorter than the recommended five-year follow-up for skeletally mature patients. The same multimodal treatment was provided for three patients with unique scoliosis presentations: a patient who was post-Harrington instrumentation; another who had concomitant Scheuer-mann’s kyphosis; and a third with a left thoracic scoliosis. All had a minimum scoliosis correction of eight degrees, alongside improvements in pain and functional status. Unfortunately, this too is well below the recommended five-year follow-up. Another case study showed a signif-icant reduction in pain and disability in a 59-year-old patient with adult de-generative scoliosis. The patient under-went manipulation under anaesthesia and subsequently performed eight weeks of rehabilitation. Results were maintained at sixth-month follow-up. The same authors later reported a four-week case study of a 20-year-old patient whose 35-degree thoracic sco-liosis corrected by 15 degrees. At three-year follow-up, radiographic examina-tion revealed a continued 18-degree improvement. A separate case report demonstrated a large decrease in thoracolumbar sco-liosis after a two week trial of chiro-practic treatment and rehabilitation of identical twins that were scheduled for spinal fusion. One final case report demonstrated a significant reduction in severe dou-ble-curve scoliosis after six months of SMT and exercise administered by a physiotherapist. They also reported additional improvements in the SRS-22, the Bad Sobernheim Stress Ques-tionnaire and Brace Questionnaire. The authors examined the peer-re-viewed literature regarding chiropractic treatment of IS. They compared the included studies’ reporting of results to the recommended reporting criteria set by the SOSORT/SRS consensus paper (2015) and Weiss et al. Only two studies reported outcomes consistent with consensus criteria. Interestingly, many of the studies documented improve-ments in pain, regardless of the treat-ments employed. This finding is impor-tant, as many scoliotic patients seek treatment for spinal pain. Unfortu-nately, the majority of these treatments failed to demonstrate Cobb angle changes. Additionally, the body of chiroprac-tic research related to scoliosis treat-ment is generally low quality. Higher quality research designs and reporting of outcomes as per the SOSORT/SRS criteria are required to develop future guidelines for the chiropractic manage-ment of scoliosis. More research review articles can be found online at www.canadianchiropractor.ca. www.canadianchiropractor.ca Manipulation plus exercises The authors included multiple case reports in this category. Two case series followed seven patients between ages six and 17 undergoing 38 chiropractic biophysics (CBP) treatments. Four of the patients had an average Cobb angle of 16.2 degrees (not sure why the other three were not included there). The average Cobb angle after three months of care was 11.6 degrees. This is con-sidered to be a valid stabilization ac-cording to the SOSORT criteria. Un-fortunately, Risser or Sanders staging were not reported. Another case study reviewed a 14-year-old patient (Risser 1) with a baseline Cobb angle of 17.2 degrees; Cobb angle changed by < 4 degrees over 15 visits. Additional improvements in posture were also visualized, how-ever. Another case report described the use of Network Spinal Analysis treat-ment for a 75-year-old patient with a 10-degree lumbar scoliosis. The au-thors reported on surface electromy-ography, paraspinal thermography and Cobb angle. The Cobb angle com-pletely resolved after two years of treatment. However, it is unknown whether the patient had adolescent IS, or an adult degenerative scoliosis. Another case report outlined the multimodal, six-year treatment of a four-year-old patient with 25 degree juvenile IS, craniosynostosis and type-1 Arnold-Chiari malformation. The pa-tient underwent upper cervical SMT, craniosacral therapy, raindrop therapy 30 Canadian Chiropractor February 2018 Conclusions
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