Adult Scoliosis: Clinical impact and comprehensive treatment

Abstract

This thesis explores the clinical implications and conservative treatment of adult spinal deformities (ASD), with a primary focus on scoliosis. ASD includes various conditions characterized by alterations in spinal alignment that progressively impair quality of life (QoL) and cause disability in adulthood. The two most common forms are de novo degenerative scoliosis and progressive adolescent idiopathic scoliosis. While both types cause pain and functional limitations, degenerative scoliosis is typically associated with more rapid progression and greater clinical burden. Part I of the thesis examines the clinical presentation of adult scoliosis, particularly focusing on pain and QoL. Chapter 2 identifies characteristic patterns of low back pain (LBP) in scoliosis patients, which is often asymmetric and may radiate differently than in patients with non-specific LBP. These distinctions can inform more targeted treatment approaches. The study also identifies functional limitations, such as difficulty with sitting, standing, walking, and lifting, particularly in patients with larger spinal curves. QoL is primarily assessed using disease-specific questionnaires like the SRS-22 and ISYQoL. Chapter 3 compares these tools, showing that ISYQoL, although originally developed for younger patients, is valid for adults and offers a unidimensional approach to assessing QoL. In contrast, the SRS-22 is multidimensional but lacks disease specificity. Chapter 4 explores whether existing disability questionnaires (e.g., ODI, COMI) can distinguish between scoliosis-related and non-specific LBP. Surprisingly, the tools failed to show significant differences, suggesting their limitations in differentiating between scoliosis and other LBP conditions. Demographic factors such as sex, age, and BMI showed small but relevant influences on QoL and disability, highlighting the multifactorial nature of ASD. Part II focuses on bracing as a conservative treatment option for ASD. Despite its common use, research on adult bracing is limited. A new brace, the Peak Brace, was developed and evaluated in Chapters 5 and 6. In short-term (1-month) and mid-term (6-month) follow-ups, significant pain reduction was observed, although improvements in disability and QoL were less pronounced. A novel approach in Chapter 7 tested a custom-made night-time brace designed for sagittal and coronal balance rather than structural correction. It was well tolerated and effective in reducing pain, particularly among younger adults, offering a promising alternative to more visible, full-time braces. Part III investigates scoliosis-specific exercise (SSE) using the SEAS (Scientific Exercises Approach to Scoliosis) method. An initial case in Chapter 8 showed that SSE could reverse a sudden curve worsening in a young adult. Chapter 9 expands these findings to a cohort of 34 adults, showing that 68% improved in spinal alignment with regular SSE. However, the benefits depend on consistent and long-term engagement. While SSE shows potential to reduce progression and support spinal stability, its long-term effectiveness still needs further research. Chapter 10 explores the challenges of research about ASD conservative treatment. In conclusion, this thesis provides valuable insights into adult scoliosis, especially regarding pain, QoL, and conservative treatments such as bracing and exercise. The findings support a tailored, multidisciplinary approach and emphasize the need for ongoing research to optimize non-surgical management of ASD.