No effect of osteopathic treatment on trunk morphology and spine
flexibility in young women with adolescent idiopathic scoliosis
Abstract
Introduction
Brace treatment is
the gold standard for patients with mild adolescent idiopathic scoliosis (Cobb
angle 20°–40°). However, negative psychosocial impacts, physical constraints
and incompliance cause many patients and parents to seek for so-called holistic
and apparently less harmful approaches within the field of complementary and
alternative medicine (CAM). Osteopathy—manual interventions on the viscera and
locomotor system—is widely used for scoliosis. There is, however, a complete
lack of evidence regarding its efficacy. We, therefore, tested the hypothesis
that osteopathy alters trunk morphology, a prerequisite to unload the concave
side of the scoliosis, and that it halts curve progression.
Methods
This was a
prospective, controlled trial of 20 post-pubertal young women (20°–40°
idiopathic scoliosis) randomly allocated to an observation (group 0) or
osteopathic treatment (group 1). The latter comprised three sessions
(5 weeks). Trunk morphology (clinical examination, video
rasterstereography) and spine flexibility (MediMouse®) were assessed at a pre- and post-intervention with a 3-month interval
(blinded examiner). We chose scoliometer measurement (rib hump, lumbar
prominence) as the main outcome parameter.
Results
Two patients in the
treatment group refused further treatment and the final examination, as they
felt no benefit after two osteopathic treatments. Regression analysis for
repeat measurements (independent statistician) revealed no therapeutic effect
on rib hump, lumbar prominence, plumb line, sagittal profile and global spinal
flexibility.
Conclusions
We found no
evidence to support osteopathy in the treatment of mild adolescent idiopathic
scoliosis. Therefore, we caution against abandoning the conventional standard
of care for mild idiopathic scoliosis. As for other CAM therapies, the use of
osteopathy as a treatment option for scoliosis still needs to be clearly
defined.
Keywords: Osteopathy,
Adolescent idiopathic scoliosis, Trunk morphology, Randomised trial
Introduction
The treatment of
mild idiopathic scoliotic curves (Cobb angle 20°–40°) during growth to halt
progression is a classic conservative orthopaedic domain [1]. However, bracing as the cornerstone of
this strategy remains controversial, as its effect is limited by non-compliance
and potential negative psychosocial effects [2–9]. Intensive scoliosis-specific
rehabilitation regimens might alter the curve’s natural history, but these
programmes are time-consuming and lack evidence regarding their effectiveness [10–12]. Therefore, patients will often abandon
these traditional approaches in favour of so-called “holistic” approaches,
which are allegedly less harmful and more efficient alternatives. As in other
fields of medicine, complementary and alternative medicine (CAM) methods are
increasingly promoted and utilised. Amongst these, osteopathy has gained
widespread popularity, in particular for spinal disorders [13]. The term “osteopathy” was coined by
Andrew Taylor Still, MD in the second half of the nineteenth century.
Education, licensing and practice rights vary from country to country. The
philosophy of osteopathy emphasises the musculoskeletal system as the origin of
health or disease and promotes the “integration” of body, mind and spirit.
However, there are no strict definitions of this apparently comprehensive and
drug-free approach. It is based on the belief that a range of manual treatment
interventions on the viscera and the locomotor system will stimulate
self-regulatory mechanisms, ultimately restoring form and function, for
example, in scoliotic spines. To date, there is no scientific evidence
supporting these assumptions [14]. Legal, medical, ethical and economic
implications and the increasing use of this approach in children and
adolescents which we have observed in our spinal practice have prompted us to
perform a prospective randomised trial.
The hypothesis of
this study was “osteopathic treatment improves trunk morphology and spine
flexibility in post-pubertal young women with mild idiopathic scoliosis.”
Methods
Patient selection
After approval of the local Ethical
Committee (Ethikkommission beider Basel, Switzerland),1 informed parental
written consent and patient’s written assent was obtained from all
participants. Twenty consecutive young women with adolescent idiopathic
scoliosis were recruited from the spine clinic by the principal investigator
(CH) according to the following inclusion criteria:
- Idiopathic adolescent scoliosis
- Cobb angle 20°–40°
- No restrictions regarding curve
type
- Standing PA spine radiograph
within 3 months before the start of the study
- At least 2 years
post-menarchal status to exclude growth and ongoing brace treatment as
confounding factors
- Upper age limit: 20 years
- No concomitant scoliosis therapy
(e.g. physiotherapy, brace treatment etc.) and no vigorous sporting
activities within 3 months before the start and during the study
Randomisation
Blocked
randomisation (allocation ratio 1:1) of eligible patients was performed with a
concealed envelope. It either contained a request to avoid any kind of therapy
during the observation period (0, control group) or to contact the osteopath
(CS or AE) within 3 days (1, intervention group).
Pre- and post-intervention assessment
All patients
underwent two standardised assessments of their trunk morphology and spine
flexibility at a 3-month interval (measurement I, prior to randomization and
II, 3 to 4 weeks after the last osteopathic intervention) between 5 and
7 pm by a blinded, experienced scoliosis physiotherapist (CN).
Clinical examination included body weight, standing height, body mass index, plumb line from C7
and pelvic obliquity. Trunk rotation—rib hump and lumbar prominence—was
assessed with a Bunnell scoliometer™ (Orthopedic Systems, Inc., Hayward, CA,
USA) in a standing, bent-over position (arms dangling, palms pressed together)
with the pelvis horizontalised (wooden blocks) and the subject standing on a
foot template [15]. The scoliometer measurement is a reliable
non-invasive method when used by a single trained observer, with the best
reproducibility in a standing, forward-bending position [16, 17]. The intrarater agreement is excellent
(intraclass correlation coefficient Rho = 0.995 and
Rho = 0.998 for the thoracic and lumbar regions, respectively) and
the accuracy was 2° [15, 17–19]. There is a statistically significant
correlation between scoliometer values and the radiographic Cobb angles for
each of the segments measured (Pearson’s correlation coefficient r = 0.685, 0.572
and 0.677 for thoracic, thoracolumbar and lumbar curves, respectively) [20]. Therefore, the scoliometer provides a
fairly reliable estimation of the Cobb angle at the initial clinical
examination of a scoliosis patient. However, if the initial Cobb angle is known
and its relationship to the gibbosity calculated, longitudinal measures of the
gibbosity over time provide the clinician with a highly reliable estimation of
the Cobb angle and this is, therefore, a reliable tool to detect curve
progression or improvement, especially if further radiographs within a short
time interval are not feasible [21].
Trunk morphology was also
assessed without radiation using a static video rasterstereographic surface
analysis (Formetric®,
DIERS International, Schlangenbad, Germany) tool. When using this apparatus,
the patient is standing upright, the feet are placed in a foot template and the
shoulders are in 10° of abduction. Stereography is a reproducible and reliable
method for the three-dimensional surface measurement of idiopathic scoliosis
with Cobb angles of up to 50° [22–24]. Rotational standing surface values are
smaller than actual vertebral rotation angles but correlate well (r = 0.79). Adam’s
forward-bending test combined with scoliometer measurements correlate badly
with the standing stereographic examinations. As there is an individual correlation
between stereographic and clinical measurements of rib hump/lumbar prominence
with frontal plane Cobb angle, a given assessment of one patient may be related
to a wide range of possible Cobb angles. These methods are, therefore, often
restricted to use as screening tools, but are suitable for longitudinal
observations and evaluation of patients without direct reference to
radiographs, as in this study [23, 25–29]. Significant Cobb angle changes would
alter at least one associated topographic measurement [30].
Active global
sagittal and coronal spine flexibility
was objectively assessed with computerized non-invasive scanning (SpinalMouse®, Idiag, Fehraltorf, Switzerland) of the trunk in maximal
flexion, extension and bilateral side-bending. The device was found to be
applicable for in vivo studies of the sagittal profile and range of motion, as
consistently reliable results were found for the flexibility measurements of
global regions, e.g. the thoracic spine, but not for individual segmental
flexibility [31–33].
Osteopathic intervention
The protocol
comprised three standardised osteopathic sessions (90-, 30- and 60-min
duration), with the 90-min session at the start and the others at 1 and 4 weeks
interval, respectively. They included patient education on osteopathic
principles, history taking, diagnostic osteopathic testing and osteopathic
visceral and parietal manipulations by two experienced, certified osteopaths
(CS, AE). Parietal interventions act directly on the locomotor system (muscles,
joints, ligaments, tendons) and, thereby, influence the function of the inner
organs, whereas, vice versa, visceral osteopathic treatment works on the inner
organs, which, by their connective tissues, interact with the locomotor system.
The osteopaths
defined the protocol according to their daily common osteopathic practice for
scoliosis patients. None of the patients had undergone osteopathic treatments
previously.
Statistical analysis
The analyses were performed
by an independent statistician (TE) who was blinded to the group assignments.
Sample size calculation was based on the variable of primary interest (rib hump
measurements) using the nQuery Advisor 4.0 software package (Statistical
Solutions Ltd., Boston, MA, USA). Based on pilot data, a sample size of 10
patients per group had an 80% power to detect a difference in means of 2°
between the rib hump measurements, assuming a common standard deviation of 1.5°
using a two-group t-test
with a 0.05 two-sided significance level.
Demographic and
procedural data were analysed for normal distribution by the Shapiro–Wilk test,
and the data are reported as mean (standard deviation [SD]) or median
(interquartile range). Repeated measures were analysed with regression
techniques using the PROC MIXED procedures in SAS software version 9.1 (SAS
institute, Cary, NC, USA). The regression model used the patient’s group
assignment (G), the repeated measures factor (I, indicated the two
measurements) and the interaction between the two (G*I) as independent
variables
(Y = b0 + b1(G) + b2(I) + b3(G*I)).
Here, the interaction parameter b3 is of interest, because a statistically
significant non-zero value for b3 indicates that the two patient groups reacted
differently to the interventions.
Results
The demographic
characteristics of the patients did not show significant differences (Table 1). Two patients missed an osteopathic
session. They wanted to be excluded from the study since they felt that they
did not benefit from the intervention. No intervention-related side-effects or
complications were recorded.
Patients and curve
characteristics
The statistically
non-significant interaction term of the regression analysis for all parameters
indicated that the change between the measurements levels was not different
between the two groups (Table 2).
Results of clinical
examination, video stereography and flexibility assessment
The hypothesis that
osteopathy alters trunk morphology in scoliotic post-pubertal girls was,
therefore, rejected.
Because of the
non-compliance of two patients in the osteopathy group, the planned sample size
was missed in the treatment group. Based on the actual sample size and
measurements, the study has a power of 80% to detect a difference of 3.1° of
the rib hump between the study groups.
Discussion
The primary goal of
treating mild idiopathic scoliotic curves (20°–40°) is curve stabilisation by
breaking the vicious cycle of concave overload: growth inhibition–vertebral
deformation–scoliosis progression and, subsequently, more asymmetric load on
the vertebral growth plates. The logical concept is, therefore, diminution of
these forces and breaking of the vicious circle. The current literature shows
that only continuous wear of a well-fitted brace will be biomechanically
effective [5, 9, 34, 35]. At least 50% in-brace Cobb angle
correction and adherence to a 20–23 h per day wear regimen are mandatory
for success [36–39]. However, the use of bracing is
controversial: compliance (hours in brace/prescribed brace regimen) has been
found to be as low as 62–67.5% in rigid braces [6, 40, 41] and pooled data in meta-analysis on
observation, exercises and bracing did not provide evidence to recommend one
approach over the other [42, 43]. This may reflect the physical and
psychosocial impacts of a rigid, visible and warm orthosis. There may also be a
conflict between an otherwise healthy patient and a disease, which, to the
patient, represents only a radiographic phantom but otherwise does not cause
pain or cardiopulmonary symptoms or major cosmetic upset in the early stages.
Therefore, patients with
adolescent idiopathic scoliosis are particularly liable to consulting non-MD
practitioners who offer gentle, brace-free therapeutic pathways within the wide
and popular field of CAM. It is prudent not only to inquire as to a patient’s
use of CAM therapy, but also to consider the medico-legal and economic
implications, as the patient usually remains the responsibility of the MD, most
commonly an orthopaedic surgeon. The risk of possible adverse reactions is
small, since most CAM is safe, but the main issue is clinical efficacy and the
raising of false expectations. Our own current systematic research using
scientific databases (Medline, Embase, Cinahl, Cochrane Library, Index to
Chiropractic Literature, PEDro) and a former extensive literature survey
conducted by the Scoliosis Research Society [44]
including over 30 complementary and alternative approaches for the treatment of
scoliosis such as acupuncture, biofeedback, chiropractic, craniosacral therapy,
Feldenkrais, Rolfing and Reiki—to name the most prominent—could not reveal any
scientific rationale to support their use. In particular, there is a complete
lack of serious, high evidence level studies on manual therapies such as
osteopathic, chiropractic and massage technique [14]. Nevertheless, their popularity continues
to increase. The Internet offers access to more than 1.5 million sites on
scoliosis, 130,000 on scoliosis and alternative medicine, and 60,000 on the
osteopathic treatment of scoliosis, most of them of limited quality and poorly
informative [45]. However, it is
only human nature that some parents and patients judge this information by how
well it agrees with “the way they want the world to be” [46].
It is our duty to learn about existing and emerging CAM options in our field of
speciality and to educate and counsel our patients accordingly.
The major concerns are
exposing the patient to the natural history of the disease by delaying or—even
worse—abandoning the conventional standard of care and to burden the health
care system with additional costs in favour of unproven strategies. Moreover,
with alternative health care professionals entering the mainstream of health
care and an increasing number involved in scoliosis care, parents and patients
seek their physician’s opinion about the risks and benefits of CAM or may ask for
referral to or a prescription for CAM .
We aimed at exemplarily
validating the effectiveness of one of the most popular CAM representatives,
osteopathy. It is premised on the understanding of humans as units of body,
mind and spirit, balanced by self-regulatory mechanisms and the interdependency
of structure and function. Different craniosacral, myofascial and visceral
manual techniques diagnose and relieve imbalances and restrictions in the
interconnections between the motion of all organs and structures of the body.
In contrast to bracing, this is effectuated smoothly and away from scrutiny by
peers, neighbours or relatives. As scoliosis is defined by an inherent
asymmetry which disturbs functionality and structures on all levels, it is a
logical target disease for osteopathic treatment. The commonly accepted
orthopaedic rationale relies on the ability to improve the three-dimensional
morphology of the scoliotic trunk as a prerequisite to halt or slow down curve
progression. Consequently, all parameters describing trunk morphology are
feasible endpoints to assess the effects of any scoliosis treatments, including
instrumented fusions. Though the gold standard to determine curve progression
is Cobb angle measurement, ethical concerns would be raised in regard to repeat
exposure to ionising radiation within a relatively short study observation
period [47]. Non-invasive
three-dimensional analysis of trunk topography with a surface scanner is a
reliable alternative [48]. The best documented and most reliable
clinical examination is scoliometer measurement of trunk rotation, which was
used for our pre-study power analysis and determination of group sizes.
Randomisation, blinding of
observers and statisticians, as well as isolating osteopathy as the only
parameter with potential influence on trunk morphology during the observation
period are strengths
of this study. Ongoing growth and concomitant treatment as potential
confounding factors were removed by selecting post-pubertal young women, which
is an advantage over former studies on manual treatments [49]. Randomised controlled studies during the
pubertal growth spurt including control groups, brace groups and osteopathy
groups would reach the highest evidence level, but would not match ethical
standards, as the patients in two groups would be deprived from the common
standard of care.
Two relatively small
groups of 10 patients each and two drop-outs in the intervention group are
identifiable weaknesses
of this study. However, the only existing studies on the manipulative treatment
of young patients with scoliosis are case reports with one, two and three
patients [50–52] and a pilot study on chiropractic
treatment which described six patients [49]. They all combine manipulative cycles with
concomitant, simultaneous other treatments, such as electric stimulation,
bracing or exercise programmes. Also, these studies lack control groups and
evaluate outcomes only by visual assessments or palpation. These weak points
render the objective evaluation of the therapeutic effects of spinal
manipulation on scoliosis impossible.
The lack of any
osteopathic treatment effect in our study might be ascribed to a dose–effect
problem, but the frequency and details of the three sessions over a 5-week
period were proposed by experienced and certified osteopaths and coincides with
that of a former case series [50]. In contrast, a pilot study on
chiropractic manipulation based on a survey among American chiropractors relied
on a six-month protocol [49].
Our study does not exclude
that osteopathy could improve scoliotic trunks if applied earlier in the
disease process. However, this is unlikely, as accelerated spinal growth during
the pubertal growth spurt represents the main driving force for curve
progression and adds many more therapeutic challenges compared to the
post-pubertal setting, as is described here.
In conclusion, CAM
sees a widespread global application in the treatment of adolescent idiopathic
scoliosis in clinical practice and increasingly gains legitimacy and loyal
followers, despite the lack of efficacy data from rigorous clinical trials. No
evidence of effectiveness was shown in this trial, which emphasises the need to
further investigate osteopathy and similar methods. Given the well-established
biomechanical understanding of increased concave loading and subsequent growth
inhibition in progressively scoliotic growing spines, it is scientifically
implausible that a range of smooth manual treatments may break this vicious
cycle. The proposed effectiveness of other underlying mechanisms as suggested
by CAM—yet enigmatic—remain to be proven. Meanwhile, this approach continues to
constitute a belief system rather than science, a complement but not an
alternative to the current standard of scoliosis care and should, consequently,
not replace current established orthopaedic strategies [5, 9, 34, 35]. The reimbursement of CAM for scoliosis
treatment at a time when public health system budgets are overstretched should
be a matter for urgent debate.
Acknowledgments
Study approval was
obtained from the local ethical committee (no. 114/05).
Conflict of
interest statement We have not received any
funds for this study.
Footnotes
Contributor Information
References
1. Danielsson AJ, Hasserius R,
Ohlin A, Nachemson AL. A prospective study of brace treatment versus
observation alone in adolescent idiopathic scoliosis: a follow-up mean of
16 years after maturity. Spine (Phila Pa
1976) 2007;32(20):2198–2207. [PubMed]
2. Climent JM, Sánchez J.
Impact of the type of brace on the quality of life of adolescents with spine
deformities. Spine (Phila Pa 1976) 1999;24(18):1903–1908. [PubMed]
3. Goldberg CJ, Dowling FE,
Hall JE, Emans JB. A statistical comparison between natural history of
idiopathic scoliosis and brace treatment in skeletally immature adolescent
girls. Spine (Phila Pa 1976) 1993;18(7):902–908. [PubMed]
4. MacLean WE, Jr, Green NE,
Pierre CB, Ray DC. Stress and coping with scoliosis: psychological effects on
adolescents and their families. J Pediatr Orthop.
1989;9(3):257–261. [PubMed]
5. Nachemson AL, Peterson LE.
Effectiveness of treatment with a brace in girls who have adolescent idiopathic
scoliosis. A prospective, controlled study based on data from the Brace Study
of the Scoliosis Research Society. J Bone Joint
Surg Am. 1995;77(6):815–822. [PubMed]
6. Nicholson GP, Ferguson-Pell
MW, Smith K, Edgar M, Morley T. The objective measurement of spinal orthosis
use for the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2003;28(19):2243–2250. [PubMed]
7. Noonan KJ, Dolan LA,
Jacobson WC, Weinstein SL. Long-term psychosocial characteristics of patients
treated for idiopathic scoliosis. J Pediatr
Orthop. 1997;17(6):712–717. doi: 10.1097/00004694-199711000-00004. [PubMed] [Cross Ref]
8. O’Neill PJ, Karol LA,
Shindle MK, Elerson EE, BrintzenhofeSzoc KM, Katz DE, Farmer KW, Sponseller PD.
Decreased orthotic effectiveness in overweight patients with adolescent
idiopathic scoliosis. J Bone Joint Surg Am. 2005;87(5):1069–1074. doi: 10.2106/JBJS.C.01707. [PubMed] [Cross Ref]
9. Rowe DE, Bernstein SM,
Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the
efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(5):664–674. [PubMed]
10. Weiss HR, Klein R.
Improving excellence in scoliosis rehabilitation: a controlled study of matched
pairs. Pediatr Rehabil. 2006;9(3):190–200. [PubMed]
11. Weiss HR, Weiss G.
Curvature progression in patients treated with scoliosis in-patient
rehabilitation—a sex and age matched controlled study. Stud Health Technol Inform. 2002;91:352–356. [PubMed]
12. Stone B, Beekman C, Hall
V, Guess V, Brooks HL. The effect of an exercise program on change in curve in
adolescents with minimal idiopathic scoliosis. A preliminary study. Phys Ther. 1979;59(6):759–763. [PubMed]
13. Birbaumer N, Flor H, Cevey
B, Dworkin B, Miller NE. Behavioral treatment of scoliosis and kyphosis. J Psychosom Res. 1994;38(6):623–628. doi:
10.1016/0022-3999(94)90060-4. [PubMed] [Cross Ref]
14. Romano M, Negrini S.
Manual therapy as a conservative treatment for adolescent idiopathic scoliosis:
a systematic review. Scoliosis. 2008;3:2. doi: 10.1186/1748-7161-3-2. [PMC free article] [PubMed] [Cross Ref]
15. Bunnell WP. An objective
criterion for scoliosis screening. J Bone Joint
Surg Am. 1984;66(9):1381–1387. [PubMed]
16. Murrell GA, Coonrad RW,
Moorman CT,, 3rd, Fitch RD. An assessment of the reliability of the
Scoliometer. Spine (Phila Pa 1976) 1993;18(6):709–712. [PubMed]
17. Amendt LE, Ause-Ellias KL,
Eybers JL, Wadsworth CT, Nielsen DH, Weinstein SL. Validity and reliability
testing of the Scoliometer. Phys Ther. 1990;70(2):108–117. [PubMed]
18. Côté P, Cassidy JD. Re: A
study of the diagnostic accuracy and reliability of the scoliometer and Adam’s
forward bend test (Spine 1999;23;796–802) Spine
(Phila Pa 1976) 1999;24(22):2411–2412. [PubMed]
19. Côté P, Kreitz BG, Cassidy
JD, Dzus AK, Martel J. A study of the diagnostic accuracy and reliability of
the Scoliometer and Adam’s forward bend test. Spine
(Phila Pa 1976) 1998;23(7):796–802. [PubMed]
20. Sapkas G, Papagelopoulos
PJ, Kateros K, Koundis GL, Boscainos PJ, Koukou UI, Katonis P. Prediction of
Cobb angle in idiopathic adolescent scoliosis. Clin
Orthop Relat Res. 2003;411:32–39. doi:
10.1097/01.blo.0000068360.47147.30. [PubMed] [Cross Ref]
21. Griffet J, Leroux MA,
Badeaux J, Coillard C, Zabjek KF, Rivard CH. Relationship between gibbosity and
Cobb angle during treatment of idiopathic scoliosis with the SpineCor brace. Eur Spine J. 2000;9(6):516–522. doi:
10.1007/s005860000175. [PubMed] [Cross Ref]
22. Hackenberg L, Hierholzer
E. 3-D back surface analysis of severe idiopathic scoliosis by rasterstereography:
comparison of rasterstereographic and digitized radiometric data. Stud Health Technol Inform. 2002;88:86–89. [PubMed]
23. Hackenberg L, Hierholzer
E, Bullmann V, Liljenqvist U, Götze C. Rasterstereographic analysis of axial
back surface rotation in standing versus forward bending posture in idiopathic
scoliosis. Eur Spine J. 2006;15(7):1144–1149. doi: 10.1007/s00586-005-0057-9. [PMC free article] [PubMed] [Cross Ref]
24. Lyon R, Liu XC, Thometz
JG, Nelson ER, Logan B. Reproducibility of spinal back-contour measurements
taken with raster stereography in adolescent idiopathic scoliosis. Am J Orthop. 2004;33(2):67–70. [PubMed]
25. Stokes IA. Axial rotation
component of thoracic scoliosis. J Orthop Res. 1989;7(5):702–708. doi: 10.1002/jor.1100070511. [PubMed] [Cross Ref]
26. Stokes IA, Armstrong JG,
Moreland MS. Spinal deformity and back surface asymmetry in idiopathic
scoliosis. J Orthop Res. 1988;6(1):129–137. doi: 10.1002/jor.1100060117. [PubMed] [Cross Ref]
27. Stokes IA, Shuma-Hartswick
D, Moreland MS. Spine and back-shape changes in scoliosis. Acta Orthop Scand. 1988;59(2):128–133. [PubMed]
28. Thulbourne T, Gillespie R.
The rib hump in idiopathic scoliosis. Measurement, analysis and response to
treatment. J Bone Joint Surg Br. 1976;58(1):64–71. [PubMed]
29. Liu XC, Thometz JG, Lyon
RM, Klein J. Functional classification of patients with idiopathic scoliosis
assessed by the Quantec system: a discriminant functional analysis to determine
patient curve magnitude. Spine (Phila Pa 1976) 2001;26(11):1274–1278. [PubMed]
30. Goldberg CJ, Kaliszer M,
Moore DP, Fogarty EE, Dowling FE. Surface topography, Cobb angles, and cosmetic
change in scoliosis. Spine (Phila Pa 1976) 2001;26(4):E55–E63. [PubMed]
31. Mannion AF, Knecht K,
Balaban G, Dvorak J, Grob D. A new skin-surface device for measuring the
curvature and global and segmental ranges of motion of the spine: reliability
of measurements and comparison with data reviewed from the literature. Eur Spine J. 2004;13(2):122–136. doi:
10.1007/s00586-003-0618-8. [PMC free article] [PubMed] [Cross Ref]
32. Schulz S (1999)
Measurement of shape and mobility of the spinal column: validation of the
SpinalMouse by comparison with functional radiographs. Dissertation,
Ludwig-Maximilians University, Munich, Germany
33. Post RB, Leferink VJ.
Spinal mobility: sagittal range of motion measured with the SpinalMouse, a new
non-invasive device. Arch Orthop Trauma Surg. 2004;124(3):187–192. doi: 10.1007/s00402-004-0641-1. [PubMed] [Cross Ref]
34. Emans JB, Kaelin A, Bancel
P, Hall JE, Miller ME. The Boston bracing system for idiopathic scoliosis.
Follow-up results in 295 patients. Spine Phila
Pa. 1986;11(8):792–801. [PubMed]
35. Fernandez-Feliberti R,
Flynn J, Ramirez N, Trautmann M, Alegria M. Effectiveness of TLSO bracing in
the conservative treatment of idiopathic scoliosis. J Pediatr Orthop. 1995;15(2):176–181. [PubMed]
36. Richards BS, Bernstein RM,
D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic
scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976) 2005;30(18):2068–2075. [PubMed]
37. Rahman T, Bowen JR,
Takemitsu M, Scott C. The association between brace compliance and outcome for
patients with idiopathic scoliosis. J Pediatr
Orthop. 2005;25(4):420–422. doi: 10.1097/01.bpo.0000161097.61586.bb. [PubMed] [Cross Ref]
38. Lindeman M, Behm K.
Cognitive strategies and self-esteem as predictors of brace-wear noncompliance
in patients with idiopathic scoliosis and kyphosis. J Pediatr Orthop. 1999;19(4):493–499. doi:
10.1097/00004694-199907000-00013. [PubMed] [Cross Ref]
39. Korovessis P, Zacharatos
S, Koureas G, Megas P. Comparative multifactorial analysis of the effects of
idiopathic adolescent scoliosis and Scheuermann kyphosis on the self-perceived
health status of adolescents treated with brace. Eur Spine J. 2007;16(4):537–546. doi:
10.1007/s00586-006-0214-9. [PMC free article] [PubMed] [Cross Ref]
40. Helfenstein A, Lankes M,
Ohlert K, Varoga D, Hahne HJ, Ulrich HW, Hassenpflug J. The objective
determination of compliance in treatment of adolescent idiopathic scoliosis
with spinal orthoses. Spine (Phila Pa 1976) 2006;31(3):339–344. [PubMed]
41. Lou E, Raso J, Hill D,
Durdle N, Mahood J, Moreau M. Brace monitoring system for the treatment of
scoliosis. Stud Health Technol Inform. 2002;88:218–221. [PubMed]
42. Dolan LA, Weinstein SL.
Surgical rates after observation and bracing for adolescent idiopathic
scoliosis: an evidence-based review. Spine
(Phila Pa 1976) 2007;32(19 Suppl):S91–S100. [PubMed]
43. Lenssinck ML, Frijlink AC,
Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and
other conservative interventions in the treatment of idiopathic scoliosis in
adolescents: a systematic review of clinical trials. Phys Ther. 2005;85(12):1329–1339. [PubMed]
44. Price CT, Abel MF,
Richards BS, D’Amato C (2000) Report from the bracing and non-operative
committee of the Scoliosis Research Society. 2000
45. Mathur S, Shanti N,
Brkaric M, Sood V, Kubeck J, Paulino C, Merola AA. Surfing for scoliosis: the
quality of information available on the Internet. Spine (Phila Pa 1976) 2005;30(23):2695–2700. [PubMed]
46. Park RL. Voodoo science. The road from foolishness to fraud. Oxford: Oxford University Press; 2001.
47. Hoffman DA, Lonstein JE,
Morin MM, Visscher W, Harris BS, 3rd, Boice JD., Jr Breast cancer in women with
scoliosis exposed to multiple diagnostic X rays. J Natl Cancer Inst. 1989;81(17):1307–1312. doi:
10.1093/jnci/81.17.1307. [PubMed] [Cross Ref]
48. Ovadia D, Bar-On E,
Fragnière B, Rigo M, Dickman D, Leitner J, Wientroub S, Dubousset J.
Radiation-free quantitative assessment of scoliosis: a multi center prospective
study. Eur Spine J. 2007;16(1):97–105. doi: 10.1007/s00586-006-0118-8. [PMC free article] [PubMed] [Cross Ref]
49. Rowe DE, Feise RJ,
Crowther ER, Grod JP, Menke JM, Goldsmith CH, Stoline MR, Souza TA, Kambach B.
Chiropractic manipulation in adolescent idiopathic scoliosis: a pilot study. Chiropr Osteopat. 2006;14:15. doi:
10.1186/1746-1340-14-15. [PMC free article] [PubMed] [Cross Ref]
50. Morningstar MW, Joy T.
Scoliosis treatment using spinal manipulation and the Pettibon Weighting
System: a summary of 3 atypical presentations. Chiropr
Osteopat. 2006;14:1. doi: 10.1186/1746-1340-14-1. [PMC free article] [PubMed] [Cross Ref]
51. Niesluchowski W,
Dabrowska A, Kedzior K, Zagrajek T. The potential role of brain asymmetry in
the development of adolescent idiopathic scoliosis: a hypothesis. J
Nenhum comentário:
Postar um comentário