According to researchers from the University of Rochester School of Medicine in New York, conservative care for this abnormal sideways curving of the spine is poorly supported by scientific evidence.”

First, the details.

• A literature search identified studies in adult or degenerative and scoliosis.
• Secondary search terms included bracing, casting, physical therapy, chiropractic, and injections for treatment.
• The procedures (methodology) of the studies were graded, and the evidence was classified into one of 5 levels based on study types.

Assigning levels provides a shorthand way of ranking the nature (not the quality) of the evidence being used. Level I is best, while Level V is the lowest level of evidence.

And, the results.

Injections as part of the conservative treatment of adult deformity are supported by Level III evidence.

• Level III evidence includes studies where there is no attempt to randomly assign treatment.
• Examples include reports about the history of individual patients or groups of patients.

Chiropractic care, physical therapy, and bracing are supported by Level IV evidence.

• Level IV evidence is based on the opinion of respected authorities or that of expert committees as indicated in published consensus conferences or guidelines.
• That’s nice but in the absence of the results from well-designed studies, this level of evidence in anecdotal.

The bottom line?
The authors conclude, “Conservative care in general may be a helpful option in the care of adult deformity, but evidence for this is lacking. Unfortunately, no treatment option within conservative care has support within the literature as a preferred solution.”

Further discussion about levels of evidence is here. And background information on adult scoliosis is here at SpineUniverse.

10/5/07 14:42 JR