Bettany-Saltikov Josette, Weiss Hans-Rudolf, Chockalingam Nachiappan, Taranu Razvan, Srinivas Shreya, Hogg Julie, Whittaker Victoria, Kalyan Raman V, Arnell Tracey
School of Health and Social Care, University of Teesside, Victoria Road, Middlesbrough, Cleveland, UK, TS13BA.
Cochrane Database Syst Rev. 2015 Apr 24;2015(4):CD010663. doi: 10.1002/14651858.CD010663.pub2.
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.
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).
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.
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.
We found no RCTs or prospective controlled trials that met our inclusion criteria.
We did not identify any evidence comparing surgical to non-surgical interventions for AIS with severe curves of over 45 degrees.
AUTHORS' CONCLUSIONS: We cannot draw any conclusions.
青少年特发性脊柱侧凸（AIS）是一种脊柱的三维畸形。虽然AIS在生长过程中可能进展并导致体表畸形，但通常没有症状。然而，如果最终脊柱侧弯超过某个临界阈值，健康问题和侧弯进展的风险就会增加。预防AIS进展的干预措施包括特定的脊柱侧弯锻炼、支具治疗和手术。所有类型干预的主要目的是纠正畸形、防止侧弯进一步恶化、恢复躯干不对称和平衡，同时将发病率和疼痛降至最低，使患者恢复全部功能。通常建议对超过40至50度的侧弯进行手术，以阻止侧弯进展，以期实现更好的躯干平衡和美观效果。AIS患者手术治疗的短期结果表明手术能够改善各种结局指标。然而，关于AIS患者手术治疗的长期随访信息明显匮乏。
研究手术与非手术干预对AIS且侧弯严重超过45度患者的影响，重点关注短期（几个月）和长期（超过20年）的躯干平衡、脊柱侧弯进展、美观问题、生活质量、残疾、心理问题、背痛及不良反应。
我们检索了Cochrane背部综述组试验注册库、Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE及其他四个数据库，以及截至2014年8月的三个试验注册库，无语言限制。我们还查阅了相关文章的参考文献列表，并对灰色文献进行了广泛的手工检索。
我们检索了随机对照试验（RCT）和前瞻性对照试验，比较脊柱融合手术与非手术干预对Cobb角大于45度的AIS患者的效果。我们关注所有旨在提供侧弯矫正和脊柱稳定的融合器械手术干预类型。
我们未找到符合纳入标准的RCT或前瞻性对照试验。
我们未发现任何比较手术与非手术干预对严重侧弯超过45度的AIS患者效果的证据。
我们无法得出任何结论。
