{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:28:32Z","timestamp":1791829712350,"version":"4.3.4"},"reference-count":20,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Adult spinal deformity (ASD) is increasingly prevalent due to an ageing population and is associated with significant pain, disability, and reduced quality of life. While surgery is often considered for severe deformities, many patients are either unsuitable for major corrective procedures or prefer conservative care. This narrative review synthesizes the current evidence on nonoperative management strategies for ASD. Methods: A literature search on the PubMed and Cochrane databases identified relevant studies published up to 25 October 2025. Medical Subject Headings and keywords related to nonsurgical ASD management were used. Eligible studies included nonsurgical series with a minimum of 12 months\u2019 follow-up, while case reports were excluded. Results: Seven studies met our inclusion criteria: three on bracing, three on physiotherapy and combined physical and cognitive rehabilitation programmes, and one on transforaminal epidural steroid injections (ESIs). Bracing was effective in slowing the curve progression rate. One study showed that the progression rate decreased from 1.47\u00b0\/year to 0.24\u00b0 for degenerative scoliosis (p &lt; 0.0001) and from 0.70\u00b0\/year to 0.24\u00b0 for idiopathic scoliosis (p = 0.03). Another study showed that there was no statistically significant difference in the Cobb angle or anticipated worsening when comparing the initial measurement with the final control after treatment (p = 0.973). Finally, a third study reported reduced back pain, with Roland\u2013Morris scores improving from 3.3 to 2.0 (p &lt; 0.001) at 18 months. Physiotherapy and multidisciplinary rehabilitation programmes appeared to be effective in significantly reducing pain and disability levels. One study found that Oswestry Disability Index (ODI) scores improved from 39.5 to 31.8 (p &lt; 0.001), while back pain, measured using the Numeric Pain Rating Scale (NPRS), improved from 58.4 to 42.1 (p &lt; 0.001), with 51% achieving minimal clinically important change (MCIC). Another study reported ODI reductions from 38 to 17.6 and pain scores from 6.5 to 2.2 (p &lt; 0.001), while in a third study, the \u201cKoshimagari Exercise\u201d programme yielded MCIDs in the ODI for 42% of patients. Finally, ESIs provided significant pain relief for at least a month in over half of the patients with degenerative scoliosis and radiculopathy, with diminishing effects throughout the first 2 years. More specifically, 37.2% of patients had a successful outcome at one year post-injection and 27.3% at 2 years (p &lt; 0.01). Conclusions: Our study suggests that bracing, physiotherapy, and multidisciplinary rehabilitation programmes, as well as ESIs, can serve as effective short term alternatives for patients with ASD who are either unsuitable for surgery or do not wish to pursue it. As such, this review provides valuable evidence-based insights that can guide clinicians in developing a treatment plan and lay the foundations for establishing a novel pathway for this specific subgroup of patients with ASD.<\/jats:p>","DOI":"10.3390\/jcm14248864","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Nonoperative Treatment of Adult Spinal Deformity: A Comprehensive Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1437-8851","authenticated-orcid":false,"given":"Christos G.","family":"Zlatanos","sequence":"first","affiliation":[{"name":"Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Hassanin","sequence":"additional","affiliation":[{"name":"Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK"},{"name":"Department of Orthopaedics and Trauma Surgery, Assiut University Hospitals, Assiut 71515, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Aly","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Faculty of Medicine, Aswan University, Aswan 81528, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid M.","family":"Salem","sequence":"additional","affiliation":[{"name":"Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasir A.","family":"Quraishi","sequence":"additional","affiliation":[{"name":"Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/BRS.0b013e3181e9f120","article-title":"Scoliosis in adults aged forty years and older: Prevalence and relationship to age, race, and gender","volume":"36","author":"Kebaish","year":"2011","journal-title":"Spine"},{"key":"ref_2","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"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00586-014-3542-1","article-title":"Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions","volume":"24","author":"Ferrer","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e870","DOI":"10.1016\/j.wneu.2018.08.179","article-title":"Outcomes of Operative and Nonoperative Treatment in Patients with Adult Spinal Deformity with a Minimum 2-Year Follow-Up: A Meta-Analysis","volume":"120","author":"Choi","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.wneu.2021.12.017","article-title":"Surgical versus Nonsurgical Treatment for Adult Spinal Deformity: A Systematic Review and Meta-Analysis","volume":"159","author":"Jia","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/BRS.0000000000001239","article-title":"Association Between Age and Complications in Adult Scoliosis Surgery: An Analysis of the Scoliosis Research Society Morbidity and Mortality Database","volume":"41","author":"Shaw","year":"2016","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1016\/j.spinee.2014.01.032","article-title":"Total hospital costs of surgical treatment for adult spinal deformity: An extended follow-up study","volume":"14","author":"McCarthy","year":"2014","journal-title":"Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","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":"Lecante","year":"2016","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_9","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."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1748-7161-4-7","article-title":"Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace","volume":"4","author":"Weiss","year":"2009","journal-title":"Scoliosis"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00586-022-07156-4","article-title":"Non-surgical treatment for adult spinal deformity: Results of an intensive combined physical and psychological programme for patients with adult spinal deformity and chronic low back pain\u2014A treatment-based cohort study","volume":"31","author":"Hoevenaars","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3120","DOI":"10.1007\/s00586-016-4528-y","article-title":"Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: Results of a randomised controlled trial","volume":"25","author":"Monticone","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2806","DOI":"10.1007\/s00586-025-08853-6","article-title":"Who benefits from home-based exercise for adult spinal deformity? A prospective multicenter study on clinical and radiographic predictors","volume":"34","author":"Taniwaki","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_14","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"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1227\/NEU.0000000000001116","article-title":"Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up","volume":"78","author":"Smith","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1001\/jamasurg.2025.0496","article-title":"Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up: A Nonrandomized Clinical Trial","volume":"160","author":"Smith","year":"2025","journal-title":"JAMA Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Finoco, M., Ould-Slimane, M., Marie-Hardy, L., De Seze, M., Chaleat-Valayer, E., Courtois, I., Bouyer, B., Charles, Y.P., Rannou, F., and Guigui, P. (2025). Comparison of quality of life between operated and non-operated adults with painful degenerative scoliosis: A 2-year prospective multicentered observational study. Eur. Spine J., 1\u201313.","DOI":"10.1007\/s00586-025-09056-9"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"McAviney, J., Mee, J., Fazalbhoy, A., Du Plessis, J., and Brown, B.T. (2020). A systematic literature review of spinal brace\/orthosis treatment for adults with scoliosis between 1967 and 2018: Clinical outcomes and harms data. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-3095-x"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/2192568217699182","article-title":"Effectiveness of Operative and Nonoperative Care for Adult Spinal Deformity: Systematic Review of the Literature","volume":"7","author":"Teles","year":"2017","journal-title":"Glob. Spine J."},{"key":"ref_20","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."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8864\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:14:37Z","timestamp":1765880077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":20,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248864"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248864","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]}}}