title: Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis.
abstract: BACKGROUND
  Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Interventions for the prevention of AIS progression include scoliosis-specific exercises, bracing, and surgery. The main aims of all types of interventions are to correct the deformity and prevent further deterioration of the curve and to restore trunk asymmetry and balance, while minimising morbidity and pain, allowing return to full function. Surgery is normally recommended for curvatures exceeding 40 to 50 degrees to stop curvature progression with a view to achieving better truncal balance and cosmesis. Short-term results of the surgical treatment of people with AIS demonstrate the ability of surgery to improve various outcome measures. However there is a clear paucity of information on long-term follow-up of surgical treatment of people with AIS.
  
  
  OBJECTIVE
  To examine the impact of surgical versus non-surgical interventions in people with AIS who have severe curves of over 45 degrees, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short term (a few months) and the long term (over 20 years).
  
  
  METHODS
  We searched the Cochrane Back Review Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, four other databases, and three trials registers up to August 2014 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive handsearch of the grey literature.
  
  
  METHODS
  We searched for randomised controlled trials (RCTs) and prospective controlled trials comparing spinal fusion surgery with non-surgical interventions in people with AIS with a Cobb angle greater than 45 degrees. We were interested in all types of instrumented surgical interventions with fusion that aimed to provide curve correction and spine stabilisation.
  
  
  METHODS
  We found no RCTs or prospective controlled trials that met our inclusion criteria.
  
  
  RESULTS
  We did not identify any evidence comparing surgical to non-surgical interventions for AIS with severe curves of over 45 degrees.
  
  
  CONCLUSIONS
  We cannot draw any conclusions.
authors.affiliation: School of Health and Social Care, University of Teesside, Victoria Road, Middlesbrough, Cleveland, UK, TS13BA.
authors.forename: Josette
authors.initials: J
authors.lastname: Bettany-Saltikov
authors.forename: Hans-Rudolf
authors.initials: HR
authors.lastname: Weiss
authors.forename: Nachiappan
authors.initials: N
authors.lastname: Chockalingam
authors.forename: Razvan
authors.initials: R
authors.lastname: Taranu
authors.forename: Shreya
authors.initials: S
authors.lastname: Srinivas
authors.forename: Julie
authors.initials: J
authors.lastname: Hogg
authors.forename: Victoria
authors.initials: V
authors.lastname: Whittaker
authors.forename: Raman V
authors.initials: RV
authors.lastname: Kalyan
authors.forename: Tracey
authors.initials: T
authors.lastname: Arnell
mesh_terms: D000293:Adolescent; D006801:Humans; D012600:Scoliosis / Q000628:therapy*