FOUR-YEAR FOLLOW-UP OF A PATIENT UNDERGOING CHIROPRACTIC REHABILITATION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS
 
   

Four-Year Follow-Up of a Patient Undergoing
Chiropractic Rehabilitation for
Adolescent Idiopathic Scoliosis

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org
 
   

FROM:   J Pediatric, Maternal & Family Health 2011 (May);   2:   54-58 ~ FULL TEXT

Mark Morningstar DC, FACSP, FRCCM, FAAIM

Private Practice of Chiropractic,
Grand Blanc, MI, USA


Objectives:   The purpose of this study was to retrospectively report the results of patients who completed an exercise-based chiropractic program and its potential to alter the natural progression of adult scoliosis at 24 months after the clinic portion of treatment was concluded.

Methods:   A retrospective chart review was conducted at 2 spine clinics in Michigan, USA. Each clinic uses the same chiropractic rehabilitation program to treat patients with adult scoliosis. Multidimensional patient outcomes included radiographic, respiratory, disability, and pain parameters. Outcomes were measured at baseline, at end of active treatment, and at long-term follow-up.

Results:   A total of 28 patients fit the inclusion criteria for the study. The average beginning primary Cobb angle was 44° ± 6°. Patients received the same chiropractic rehabilitation program for approximately 6 months. At the end of active treatment, improvements were recorded in Cobb angle, pain scores, spirometry, and disability rating. All radiographic findings were maintained at 24-month follow-up.

Conclusion:   This report is among the first to demonstrate sustained radiographic, self-rated, and physiologic benefits after treatment ceased. After completion of a multimodal chiropractic rehabilitation treatment, a retrospective cohort of 28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment and 24 months later.


From the FULL TEXT Article:

Introduction

Adolescent idiopathic scoliosis affects approximately 2-9% of the population, [1-3] with geographic variations based on potential genetic and environmental factors. [4] Historically, observation has been the preferred management for scoliosis measuring between 10° and 30°. [5] However, even when the scoliosis falls within this range, it can cause a variety of potential health problems. Chronic back pain [6, 7] is significantly more frequent, self-image is consistently poorer, [6, 8] and respiratory function is inversely impacted starting with curvatures at 10°. [9-11]

Relatively little information on chiropractic management of adolescent idiopathic scoliosis is available. In searching the PubMed database using keywords “scoliosis” AND “chiropractic”, a total of 8 studies were found specifically discussing chiropractic management. None of these studies contained long-term follow-up after the treatment had been completed. Using the search term “scoliosis” in the Index to Chiropractic Literature, a total of 167 entries were found. However, none of these studies reported information obtained at long-term follow-up, meaning at least 6 months following conclusion of clinic treatment.

The purpose of this paper is to discuss the treatment and results of a patient with a diagnosis of adolescent idiopathic scoliosis. This report details the total treatment time, as well as long-term follow-up schedule. Multiple outcome assessments are reported, including chest expansion, peak expiratory flow, disability, axial trunk rotation


Discussion

This report outlines the long-term follow-up of a single patient. This is the first report in the chiropractic literature to report on four-year outcomes following management for adolescent idiopathic scoliosis. Because of the combination of modalities used in her treatment plan, it is impossible to know which of the procedures had the biggest impact on the outcomes reported and observed.

Adolescent patients with scoliosis often exhibit a significant amount of instability. This may be perhaps due to lack of full muscular development, neuromotor dyscoordination secondary to the primary scoliosis disorder, or a combination of these. Therefore, when the treatment goals were developed it was very important that any corrections in her spinal curvature be done without further compromising her current level of stability (or instability).

Over the duration of the patient’s treatment she only grew one inch, thus confirming the initial Risser staging. Hence, the spinal curvature is not likely to have resolved without treatment. The patient was also six months post menarche at the initiation of care, which correlates with the initial Risser staging as well. Skeletal maturity, and hence minimal risk of progression, are typically reached when the patient approaches one year post menarche. [14, 15]

Anecdotally, cases of adolescent idiopathic scoliosis progress when short term correction of the Cobb angle increases apical deviation beyond what is likely the ability of the spinal musculature to support an increased translated posture in forsake of the Cobb angle. This is consistent with the vicious cycle model proposed by Hawes and O’Brien. They write:

“Once asymmetric loading is established and maintained beyond a critical threshold for weight and time, there will be an inevitable tendency for progression to occur unless compensatory action offsets the biomechanical effects of the imbalance. Most important, when the load asymmetry is removed while significant growth potential remains, progression stops; when the asymmetry of the vertebral column is reversed and the unbalanced loading is thereby corrected, complete resolution of deformity occurs.” [16]

This suggests that increasing the apical deviation at the expense of a Cobb angle correction may be detrimental longterm. Therefore, it was important to make sure that any observed corrections could be stabilized intrinsically by the spine and its supporting musculature.

The breathing function tests used in this report signify the importance of respiratory function in patients with scoliosis. Chest wall excursion and vital capacity are inversely correlated with scoliosis, even for curvatures beginning at a Cobb angle of 10°. [17]

Interestingly, despite the patient reporting decreased exercise capacity, she did not report any disability during normal daily activities as measured by the initial Functional Rating Index. It has been suggested that a reason for this is that scoliosis curvatures often progress at a subclinical rate, and therefore any detriment to normal physiological function also remains subclinical until a threshold is reached. [18]

Being a case report, no solid conclusions can be drawn from this study. However, it does provide insight that chiropractic rehabilitation, when correctly applied to patients with adolescent idiopathic scoliosis, can have a significant, longstanding effect on the structure of the spine and related symptoms.


Conclusion

Following a trial of chiropractic care, a patient with adolescent idiopathic scoliosis had improvements in axial trunk rotation, peak expiratory flow, and chest expansion. Radiographic improvements in Cobb angle and apical deviation were also noted. These outcomes continued to improve at a 4-year follow-up. Further research on similar cases may provide more understanding on how the specific modalities utilized in conjunction with chiropractic could have an impact on adolescent idiopathic scoliosis.


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