Bracing adults with chronic low back pain secondary to severe scoliosis: six months results of a prospective pilot study

Current Knowledge on the Different Characteristics of Back Pain in Adults with and without Scoliosis: A Systematic Review

Patients with scoliosis have a high prevalence of back pain (BP). It is possible that scoliosis patients present with specific features when experiencing back or leg pain pathology. The aim of this systematic review is to report the signs, symptoms and associated features of BP in patients with scoliosis compared to adults without scoliosis during adulthood. From inception to 15 May 2023, we searched the following databases: PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. We found 10,452 titles, selected 25 papers for full-text evaluation and included 8 in the study. We found that scoliosis presents with asymmetrical pain, most often at the curve's apex, eventually radiating to one leg. Radiating symptoms are usually localised on the front side of the thigh (cruralgia) in scoliosis, while sciatica is more frequent in non-scoliosis subjects. These radiating symptoms relate to rotational olisthesis. The type and localization of the curve have an impact, with lumbar and thoracolumbar curves being more painful than thoracic. Pain in adults with scoliosis presents specific features: asymmetrical localization and cruralgia. These were the most specific features. It remains unclear whether pain intensity and duration can differentiate scoliosis and non-scoliosis-related pain in adults.

Measuring Quality of Life in Adults with Scoliosis: A Cross-Sectional Study Comparing SRS-22 and ISYQOL Questionnaires

Idiopathic scoliosis is common in adulthood and can impact patients' physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from adolescence to adulthood. More recently, the Italian Spine Youth Quality of Life (ISYQOL) international questionnaire was developed, which performs better than SRS-22 in adolescent spinal deformities. However, the ISYQOL questionnaire has never been tested in adults. This study compares the construct validity of ISYQOL and SRS-22 with the Rasch analysis (partial credit model). We recruited 150 adults and 50 adolescents with scoliosis (≥30° Cobb). SRS-22, but not ISQYOL, showed disordered categories and one item not fitting the Rasch model. A 21-item SRS-22 version with revised categories was arranged and further compared to ISYQOL. Both questionnaires showed multidimensionality, and some items (SRS-22 in a greater number) functioned differently in persons of different ages. However, the artefacts caused by multidimensionality and differential functioning had a low impact on the questionnaires' measures. The construct validity of ISYQOL International and the revised SRS-22 are comparable. Both questionnaires (but not the original SRS-22) can return measures of disease burden in adults with scoliosis.

Brace Prescription for Adult Scoliosis - Literature Review

Purpose:

The 2021 SOSORT guidelines stipulated that braces be prescribed for adult scoliosis with chronic pain and progressive curve. Yet, there have been no objective protocols relating to the prescription of the brace. Therefore, this review investigates if there are any objective criteria or generally agreed on protocols for brace prescription in adult scoliosis patients.

Methods:

Relevant papers were searched in PUBMED. Only articles that are in English and cover the clinical aspect of adult scoliosis bracing are included.

Results:

A total of twelve papers were identified. They include different adult scoliosis braces, ranging from elastic belts to rigid braces. The treatment protocol varied tremendously. No objective criteria were found concerning the prescription of a brace, daily wearing time, duration of the intervention, and weaning protocol. The brace treatment was primarily employed to manage low back pain.

Conclusion:

Our search showed no objective criteria and clear indications for bracing and no consensus concerning the prescription of braces, daily wearing time, and duration of the intervention for patients with adult scoliosis.

The authors proposed prescription of a brace be based on more objective radiological criteria and severity of low back pain. Brace prescription should depend on the flexibility of the curve and can range from accommodative to rigid braces of corrective design. “Corrective” brace has to be worn at least 14 hours daily for six months or until the low back pain subsides to the extent that permits daily activities with minimal discomfort. “Accommodative” brace can be worn when required.