Approach to scoliosis changed due to causes other than evidence: Patients call for conservative (rehabilitation) experts to join in team orthopedic surgeons

Abstract

Purpose. To look critically at the present reality of AIS (Adolescent Idiopathic Scoliosis) treatment and verify the hypothesis that the current prevalence of a single medical specialty could be creating distortions in patient care and/or cure.

Method. This is a multifaceted study comprising a review of the evidence on AIS, a bibliometric study of the general and orthopedic literature since Medline start, and two case reports.

Results. Evidence exists to support the efficacy of exercises, bracing and fusion (grade B, B and C recommendations, respectively), but in clinics exercises are generally ignored; braces are used with some criticism, while fusion is generally considered the only reliable treatment. The literature on AIS treatment prevails in journals of orthopedic surgery, and therapy papers focused on surgery have increased from 34 to 55% over the past two decades. The two clinical cases show how an incorrect psychological approach to the patient and family, as well as inappropriate conservative treatments can have disastrous consequences for patients.

Conclusions. Our results seem to confirm the initial hypothesis: The interest of the AIS treatment community (composed almost exclusively by orthopedic surgeons) has shifted toward fusion whereas research has increased, while conservative treatment is suffering a decrease in professional interest (and diminished research). AIS requires expert, committed evidence-based care, but other specialists totally devoted to conservative treatment, particularly (but not exclusively) Physical and Rehabilitation Medicine specialists, should enter the field to create better treating teams.

Keywords:

• Adolescent idiopathic scoliosis
• rehabilitation
• bracing
• surgery
• surgery
• exercises