Non-Surgical Treatment For Scoliosis May Not Be Cost Effective

New Study Discovers High Cost-Benefit Ratio for Treating Scoliosis Non-Surgically
News 4-22-10 Scoliosis Treatment Image

Scoliosis is not a disease or diagnosis in itself, rather it is a term used to describe an abnormal curvature of the spine. The condition can be caused by a number of factors-congenital, developmental, or degenerative problems-although the majority of cases have no apparent cause and thus are termed "idiopathic" scoliosis.

The condition typically develops in the upper back, but may also be found in the mid-back or low back. The curvature of the spine is side to side, and may be present as a single C-shaped curve or a double S-shaped curve.

Growing children can often be treated with a back brace, but due to their skeletal maturity, treatment for adults is more complicated. A new study presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons showed that two years of non-surgical treatment in adult patients resulted in high expenditures and yielded little to no improvement in health status.

The study included 123 patients (mean age 53 years) with a primary diagnosis of idiopathic scoliosis, primary Cobb angle greater than 30 degrees, and no history of prior scoliosis surgery. Participants were divided into three subgroups based on the pretreatment Oswestry Disability Index (ODI): high-symptom (n=24), mid-symptom (n=43), and low-symptom (n=56). Observations for the two-year period were measured using a health related quality of life (HRQOL) scale.

The most commonly used treatments included medication, exercise therapy, modality physical therapy, chiropractic care, and injections. Sixty-eight patients received at least one of the treatments while 55 patients received no treatment. Surveys demonstrated no significant benefit based on change in HRQOL measures over the two-year period.

The only statistically significant difference noted was in the Scoliosis Research Society pain sub-score: the low-symptom group demonstrated a 0.14-point improvement while the mid-symptom and high-symptom groups demonstrated a 0.23-point and 0.17-point deterioration, respectively (p = 0.002).

Other outcomes noted a difference in SRS activity sub-score, with a 0.06-point improvement in the non-treatment group compared to a 0.14-point deterioration in the treatment group (p = 0.038).

Treatment costs were evaluated using the most current Medicare fee schedule. Comparisons were made based on estimated treatment costs for each modality depending on the symptom level subgroups. The mean treatment cost for non-surgically treated patients was $10,815 over the 2-year period.

Surgery for scoliosis in adults may be recommended if the spinal curvature is greater than 50 degrees. The goal of this type of surgery is to reduce the curvature and prevent the curvature from continuing to progress. Severe curvature (70 to 90 degrees) is not only severely disfiguring, but can cause cardiopulmonary issues as the space around the heart and lungs closes down.

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