{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:54:04Z","timestamp":1787730844711,"version":"build-2784847793"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T00:00:00Z","timestamp":1571184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of nonsurgical treatments in symptomatic adult degenerative scoliosis (ADS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A systematic literature review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed, Web of Science, and The Cochrane Library were searched to identify research published since 1988. Randomized controlled trials (RCTs) and observational cohort studies were eligible if they featured symptomatic ADS patients aged \u226550 who received nonsurgical treatment. Minimum follow-up was six weeks, and outcomes of interest were pain, disability, quality of life, and Cobb angle. Evidence quality per intervention was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies were included. Of these, four focused specifically on injections, bracing, or yoga; two involved multiple treatments. One RCT provided evidence for greater effectiveness of transforaminal epidural steroid injection over anesthetic alone in reducing radiating pain and disability. Two single-group retrospective cohort studies lent support for bracing to slow curve progression. One retrospective single-group cohort study suggested an association between yoga and reduced curve progression. Evidence for injections to reduce ADS symptoms was rated as low quality; evidence for bracing and yoga was rated as very low quality. No specific evidence was identified regarding other treatments, including physical therapy and analgesics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Literature describing the effectiveness of nonoperative treatments in symptomatic ADS is scarce. The quantity and quality of the evidence regarding injections, bracing, and yoga are insufficient to advise for or against the use of these methods to improve outcomes in symptomatic ADS. For these and other nonoperative treatment forms, further research is needed.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnz253","type":"journal-article","created":{"date-parts":[[2019,9,12]],"date-time":"2019-09-12T11:40:59Z","timestamp":1568288459000},"page":"1263-1275","source":"Crossref","is-referenced-by-count":19,"title":["Outcomes of Nonsurgical Treatments for Symptomatic Adult Degenerative Scoliosis: A Systematic Review"],"prefix":"10.1093","volume":"21","author":[{"given":"Carlijn","family":"Schoutens","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M","family":"Cushman","sequence":"first","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary L","family":"McCormick","sequence":"first","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Conger","sequence":"first","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barend J","family":"van Royen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Spiker","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"issue":"3","key":"2020061021345462500_pnz253-B1","doi-asserted-by":"crossref","DOI":"10.3171\/2010.1.FOCUS09271","article-title":"Adult degenerative scoliosis: Evaluation and management","volume":"28","author":"Silva","year":"2010","journal-title":"Neurosurg Focus"},{"issue":"2","key":"2020061021345462500_pnz253-B2","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/01.brs.0000194777.87055.1b","article-title":"A prospective study of de novo scoliosis in a community based cohort","volume":"31","author":"Kobayashi","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"issue":"20","key":"2020061021345462500_pnz253-B3","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1097\/BRS.0b013e31820110b4","article-title":"Characterization of osteopenia\/osteoporosis in adult scoliosis: Does bone density affect surgical outcome?","volume":"36","author":"Yagi","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"2020061021345462500_pnz253-B4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1227\/01.NEU.0000325485.49323.B2","article-title":"Adult degenerative scoliosis: A review","volume":"63(3 Suppl)","author":"Birknes","year":"2008","journal-title":"Neurosurgery"},{"issue":"9","key":"2020061021345462500_pnz253-B5","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1097\/01.brs.0000160842.43482.cd","article-title":"Adult scoliosis: Prevalence, SF-36, and nutritional parameters in an elderly volunteer population","volume":"30","author":"Schwab","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2020061021345462500_pnz253-B6","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/00007632-198207000-00005","article-title":"Scoliosis in the elderly: A follow-up study","volume":"7","author":"Robin","year":"1982","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"2020061021345462500_pnz253-B7","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1097\/00007632-199305000-00004","article-title":"Degenerative symptomatic lumbar scoliosis","volume":"18","author":"Pritchett","year":"1993","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"2020061021345462500_pnz253-B8","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00007632-198803000-00004","article-title":"Degenerative adult onset scoliosis","volume":"13","author":"Grubb","year":"1988","journal-title":"Spine (Phila Pa 1976)"},{"key":"2020061021345462500_pnz253-B9","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1097\/00007632-199407001-00011","article-title":"Results of surgical treatment of painful adult scoliosis","volume":"19(Suppl)","author":"Grubb","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2020061021345462500_pnz253-B10","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s12178-017-9445-0","article-title":"Degenerative scoliosis","volume":"10","author":"York","year":"2017","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"9","key":"2020061021345462500_pnz253-B11","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1007\/s00586-010-1368-z","article-title":"Spinal decompensation in degenerative lumbar scoliosis","volume":"19","author":"de Vries","year":"2010","journal-title":"Eur Spine J"},{"issue":"2","key":"2020061021345462500_pnz253-B12","first-page":"77","article-title":"Adult degenerative lumbar scoliosis","volume":"32","author":"Daffner","year":"2003","journal-title":"Am J Orthop"},{"issue":"3","key":"2020061021345462500_pnz253-B13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4184\/asj.2014.8.3.371","article-title":"Surgical treatment of adult degenerative scoliosis","volume":"8","author":"Cho","year":"2014","journal-title":"Asian Spine J"},{"issue":"6","key":"2020061021345462500_pnz253-B14","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/01.BRS.0000049924.94414.BB","article-title":"Adult scoliosis: A health assessment analysis by SF-36","volume":"28","author":"Schwab","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"2020061021345462500_pnz253-B15","doi-asserted-by":"crossref","DOI":"10.1186\/1748-7161-3-9","article-title":"Rate of complications in scoliosis surgery: A systematic review of the Pub Med literature","volume":"3","author":"Weiss","year":"2008","journal-title":"Scoliosis"},{"key":"2020061021345462500_pnz253-B16","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jocn.2016.06.005","article-title":"Scoliosis surgery in the elderly: Complications, readmissions, reoperations and mortality","volume":"34","author":"Drazin","year":"2016","journal-title":"J Clin Neurosci"},{"issue":"5","key":"2020061021345462500_pnz253-B17","doi-asserted-by":"crossref","DOI":"10.3171\/2019.2.FOCUS1911","article-title":"The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: A human cadaveric study","volume":"46","author":"Rustenburg","year":"2019","journal-title":"Neurosurg Focus"},{"key":"2020061021345462500_pnz253-B18","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1097\/BRS.0b013e318134ea88","article-title":"A systematic literature review of nonsurgical treatment in adult scoliosis","volume":"32(Suppl)","author":"Everett","year":"2007","journal-title":"Spine"},{"issue":"2","key":"2020061021345462500_pnz253-B19","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0030-5898(20)30314-X","article-title":"Nonoperative treatment of adult scoliosis","volume":"19","author":"van Dam","year":"1988","journal-title":"Orthop Clin North Am"},{"issue":"7","key":"2020061021345462500_pnz253-B20","doi-asserted-by":"crossref","first-page":"e1000097.","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"2020061021345462500_pnz253-B21"},{"key":"2020061021345462500_pnz253-B22","article-title":"Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document)","author":"Howick","journal-title":"Oxford: Oxford Centre for Evidence-Based Medicine"},{"key":"2020061021345462500_pnz253-B23","author":"Higgins","year":"2011"},{"issue":"7650","key":"2020061021345462500_pnz253-B24","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"issue":"7","key":"2020061021345462500_pnz253-B25","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.jclinepi.2012.03.013","article-title":"GRADE guidelines: 14. Going from evidence to recommendations: The significance and presentation of recommendations","volume":"66","author":"Andrews","year":"2013","journal-title":"J Clin Epidemiol"},{"issue":"10","key":"2020061021345462500_pnz253-B26","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1097\/CORR.0000000000000419","article-title":"What are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions?","volume":"476","author":"Hung","year":"2018","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"2020061021345462500_pnz253-B27","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.spinee.2007.11.006","article-title":"Minimum clinically important difference in lumbar spine surgery patients: A choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008","journal-title":"Spine J"},{"issue":"4","key":"2020061021345462500_pnz253-B28","doi-asserted-by":"crossref","first-page":"514","DOI":"10.5535\/arm.2011.35.4.514","article-title":"Effects of transforaminal injection for degenerative lumbar scoliosis combined with spinal stenosis","volume":"35","author":"Nam","year":"2011","journal-title":"Ann Rehabil Med"},{"issue":"S2","key":"2020061021345462500_pnz253-B29","doi-asserted-by":"crossref","DOI":"10.1186\/s13013-016-0091-x","article-title":"Prospective study of 158 adult scoliosis treated by a bivalve polyethylene overlapping brace and reviewed at least 5 years after brace fitting","volume":"11","author":"de Mauroy","year":"2016","journal-title":"Scoliosis Spinal Disord"},{"issue":"1","key":"2020061021345462500_pnz253-B30","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.apmr.2016.05.019","article-title":"Effects of bracing in adult with scoliosis: A retrospective study","volume":"98","author":"Palazzo","year":"2017","journal-title":"Arch Phys Med Rehabil"},{"issue":"4","key":"2020061021345462500_pnz253-B31","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/TGR.0000000000000159","article-title":"Two isometric yoga poses reduce the curves in degenerative and adolescent idiopathic scoliosis","volume":"33","author":"Fishman","year":"2017","journal-title":"Top Geriatr Rehabil"},{"issue":"20","key":"2020061021345462500_pnz253-B32","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1097\/BRS.0b013e3181a8fdc8","article-title":"Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis a prospective multicenter evidence-based medicine study","volume":"34","author":"Bridwell","year":"2009","journal-title":"Spine"},{"issue":"5","key":"2020061021345462500_pnz253-B33","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1097\/BRS.0b013e3181b0f2f8","article-title":"The costs and benefits of nonoperative management for adult scoliosis","volume":"35","author":"Glassman","year":"2010","journal-title":"Spine"},{"key":"2020061021345462500_pnz253-B34","first-page":"361","article-title":"Side shift exercise for idiopathic scoliosis after skeletal maturity","volume":"91","author":"Mamyama","year":"2002","journal-title":"Stud Health Technol Inform"},{"key":"2020061021345462500_pnz253-B35","first-page":"290","article-title":"Treatment of chronic pain in adult scoliosis","volume":"88","author":"Barrios","year":"2002","journal-title":"Stud Health Technol Inform"},{"issue":"3","key":"2020061021345462500_pnz253-B36","doi-asserted-by":"crossref","first-page":"33.","DOI":"10.1519\/00139143-200225030-00027","article-title":"Myofascial release as complementary in physical therapy for two elderly patients with osteoporosis and kyphoscoliosis two case studies","volume":"25","author":"Davis","year":"2002","journal-title":"J Geriatr Phys Ther"},{"issue":"4","key":"2020061021345462500_pnz253-B37","doi-asserted-by":"crossref","DOI":"10.1067\/mmt.2002.123336","article-title":"Chiropractic and pilates therapy for the treatment of adult scoliosis","volume":"25","author":"Blum","year":"2002","journal-title":"J Manipulative Physiol Ther"},{"issue":"4","key":"2020061021345462500_pnz253-B38","first-page":"253","article-title":"Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: Two cases","volume":"17","author":"Tarola","year":"1994","journal-title":"J Manipulative Physiol Ther"},{"issue":"3","key":"2020061021345462500_pnz253-B39","first-page":"311","article-title":"Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy","volume":"7","author":"Cooper","year":"2004","journal-title":"Pain Physician"},{"issue":"1","key":"2020061021345462500_pnz253-B40","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1526-4637.2010.01000.x","article-title":"Radiculopathy in degenerative lumbar scoliosis: Correlation of stenosis with relief from selective nerve root steroid injections","volume":"12","author":"Ploumis","year":"2011","journal-title":"Pain Med"},{"issue":"7","key":"2020061021345462500_pnz253-B41","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1016\/j.apmr.2005.01.006","article-title":"A critical appraisal of the evidence for selective nerve root injection in the treatment of lumbosacral radiculopathy","volume":"86","author":"DePalma","year":"2005","journal-title":"Arch Phys Med Rehabil"},{"issue":"12","key":"2020061021345462500_pnz253-B42","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1007\/s00586-011-1829-z","article-title":"The impact of lumbar scoliosis on pain, function and health-related quality of life in postmenopausal women","volume":"20","author":"Urrutia","year":"2011","journal-title":"Eur Spine J"},{"issue":"3","key":"2020061021345462500_pnz253-B43","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jcm.2011.01.006","article-title":"Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: A 24-month retrospective analysis","volume":"10","author":"Morningstar","year":"2011","journal-title":"J Chiropr Med"},{"issue":"3","key":"2020061021345462500_pnz253-B44","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/BSD.0000000000000367","article-title":"Adult degenerative scoliosis","volume":"29","author":"Graham","year":"2016","journal-title":"Clin Spine Surg"},{"key":"2020061021345462500_pnz253-B45","article-title":"Adult scoliosis treatment combining brace and exercises","volume":"8(Suppl 2)","author":"Papadopoulos","year":"2013","journal-title":"Scoliosis"},{"key":"2020061021345462500_pnz253-B46","article-title":"SEAS (Scientific Exercises Approach to Scoliosis): A modern and effective evidence based approach to physiotherapic specific scoliosis exercises","volume":"10","author":"Romano","year":"2015","journal-title":"Scoliosis Spinal Disord"},{"issue":"1","key":"2020061021345462500_pnz253-B47","doi-asserted-by":"crossref","DOI":"10.1186\/s13013-017-0143-x","article-title":"Functional outcome of non-surgical and surgical management for de novo degenerative lumbar scoliosis: A mean follow-up of 10 years","volume":"12","author":"Faraj","year":"2017","journal-title":"Scoliosis Spinal Disord"},{"issue":"8","key":"2020061021345462500_pnz253-B48","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s00586-016-4619-9","article-title":"De novo degenerative lumbar scoliosis: A systematic review of prognostic factors for curve progression","volume":"25","author":"Faraj","year":"2016","journal-title":"Eur Spine J"},{"issue":"2","key":"2020061021345462500_pnz253-B49","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.spinee.2017.06.044","article-title":"Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: Initial steps to reduce ineffective ASD management","volume":"18","author":"Passias","year":"2018","journal-title":"Spine J"},{"issue":"5","key":"2020061021345462500_pnz253-B50","doi-asserted-by":"crossref","first-page":"E2 (1\u20137).","DOI":"10.3171\/2014.3.FOCUS1426","article-title":"Clinical improvement through nonoperative treatment of adult spinal deformity: Who is likely to benefit?","volume":"36","author":"Slobodyanyuk","year":"2014","journal-title":"Neurosurg Focus"},{"issue":"2","key":"2020061021345462500_pnz253-B51","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.spinee.2015.10.043","article-title":"The benefit of nonoperative treatment for adult spinal deformity: Identifying predictors for reaching a minimal clinically important difference","volume":"16","author":"Liu","year":"2016","journal-title":"Spine J"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/6\/1263\/33376816\/pnz253.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/6\/1263\/33376816\/pnz253.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T12:22:15Z","timestamp":1664367735000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/21\/6\/1263\/5588602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,16]]},"references-count":51,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,10,16]]},"published-print":{"date-parts":[[2020,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnz253","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,6]]},"published":{"date-parts":[[2019,10,16]]}}}