Following the Evidence for Scoliosis Management

In order to provide the best care for patients, it is important for clinicians to understand and incorporate current scientific evidence into their clinical decision making1. New risk factors and prognostic factors are regularly revealed, along with unique methods of diagnosis, and advances in scoliosis treatments. For this reason, it is of vital importance that scoliosis clinicians keep up-to-date with the research, and ensure they are well-equipped to deal with the many faces of scoliosis.

While the concept of keeping up with the latest research sounds simple, the volume of medical knowledge is expanding exponentially2. Unfortunately, this often means that unless a clinician is making a concerted effort to stay current, they may find themselves missing key learnings or practicing outdated approaches.

For example, prior to the publication of the BRAIST study3 in 2013 , there was no high-quality evidence demonstrating the efficacy of bracing for adolescent idiopathic scoliosis. This study provided firm proof that:

  • Bracing in high-risk patients with adolescent idiopathic scoliosis (AIS) reduced the likelihood of their curve progressing to the surgical threshold
  • Patients who wore their scoliosis brace more than 13 hours a day had upwards of a 90% chance of avoiding surgery.
  • The longer patients wore scoliosis braces, the better the outcome.

“While bracing has been a mainstay of nonoperative treatment for AIS for decades, evidence regarding its impact has been inconclusive,” said NIAMS Director Stephen I. Katz, MD, PhD, in a statement. “This study is certain to enhance clinical decision-making regarding the nonoperative management of AIS.”

Yet in 2019, many health professionals treating scoliosis are still of the opinion that brace treatment is ineffective. This outdated position means that many patients are missing out on referral for a treatment that has shown to be effective in minimizing the progression of scoliosis and reducing their likelihood for surgery.

Another example can be found in scoliosis diagnosis. X-ray imaging is commonly used to diagnose and monitor scoliosis patients throughout their treatment program. Recent innovations in diagnostic imaging, such as low dose x-ray (EOS)4 and spinal ultrasound5, have allowed clinicians to incorporate these technologies (with x-ray when required) in their scoliosis management and therefore reduce their patients’ overall exposure to ionising radiation. So these are just two examples of the evolving scientific landscape and how staying current with the evidence can lead to better patient outcomes and wellbeing.

Discoveries such as these are typically published in research journals or presented at scientific conferences. Dedicated clinicians attend these scientific conferences, are exposed to new information and also to the clinicians and researchers who conducted the research. With reference to scoliosis and related spinal disorders, the premiere research events around the world are the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) and the Scoliosis Research Society (SRS) meetings. There are also national spine societies (e.g. Spine Society of Australia) dedicated to the promotion of new ideas and research into scoliosis and related spinal disorders. These organisations are made up of clinicians and researchers with high-level expertise who present quality, peer-reviewed research.

Staying up-to-date with the research into scoliosis and related spinal disorders is crucial for a clinician to be able to deliver the best care to their patients. Some clinicians often have valuable contributions of their own, and submit abstracts to some of the scientific conferences mentioned above. By communicating ideas and clinical findings at these conferences, the standard of care provided to scoliosis patients around the world can be constantly improved.

The ScoliCare research team, led by Dr Benjamin Brown (PhD) and Dr Jeb McAviney (Chiropractor and CEO of ScoliCare), are committed to furthering the understanding of scoliosis and the advancement of diagnostic and treatment approaches. 

They recently presented new research at SOSORT in San Francisco, USA and the Spine Society of Australia meeting in the Gold Coast, Australia on:

  • The prevalence of adult de novo scoliosis: A systematic review and meta-analysis
  • Reduction of a severe scoliosis using an over-corrective rigid orthosis in an adolescent female
  • A systematic literature review of bracing treatment for adults with scoliosis
  • Treatment of degenerative adult scoliosis using a unique 3D over-corrective brace – A case report
  • Successful multi-modal treatment of severe adolescent idiopathic scoliosis after failing standard TLSO bracing

ScoliCare clinicians make it a priority to staying up to date and involved with scoliosis research, and also share their knowledge by attending and presenting at prominent local and international events. For upcoming ScoliCare seminars for health professionals, visit www.scolicare.com/seminars.

If you would like more information about the research papers or ScoliCare’s results, please email research@scolicare.com.

References

1)      Davidson KW, Goldstein M, Kaplan RM, Kaufmann PG, Knatterud GL, Orleans CT, et al. Evidence-based behavioural medicine: what is it and how do we achieve it? Ann Behav Med, 2003. 26(3): p. 161-71.

2)      Densen, Peter. “Challenges and opportunities facing medical education.” Transactions of the American Clinical and Climatological Association vol. 122 (2011): 48-58.

3)      Weinstein SL, Dolan LA, Wright JG, Dobbs MB, et al. Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine, 2013. 369(16):1512-1521.

4)      Illés T, Somoskeöy,S. The EOS™ imaging system and its uses in daily orthopaedic practice. International orthopaedics, 2012. 36(7):1325-1331.

5)      Brink RC, Wijdicks SPJ, Tromp IN, Schlösser TPC, Kruyt MC, Beek FJA, et al. A reliability and validity study for different coronal angles using ultrasound imaging in adolescent idiopathic scoliosis. The Spine Journal, 2018. 18(6):979-985.