Weiss Hans-Rudolf, Nan Xiaofeng, Potts Matthew A
Schroth Best Practice Academy, Neu-Bamberg, Germany.
Nan Xiaofeng's Spinal Orthopedic Workshop, Xi 'an, China.
S Afr J Physiother. 2021 Oct 4;77(2):1569. doi: 10.4102/sajp.v77i2.1569. eCollection 2021.
High-quality evidence exists to support physiotherapy and brace treatment for scoliosis and other spinal deformities. However, according to previous systematic reviews, it seems that no evidence exists for surgery. Nevertheless, the number of research articles focussing on spinal surgery highly exceeds the number of articles focussing on conservative treatment.
The purpose of this study is to conduct an updated search for systematic reviews providing high-quality evidence for spinal surgery in patients with spinal deformities.
A narrative review including PubMed and the Cochrane database was conducted on April 12, 2020, with the following search terms: (1) spinal deformities, surgery, systematic review and outcome; (2) kyphosis, surgery, systematic review and outcome; (3) Scheuermann's disease, surgery, systematic review and outcome, and (4) scoliosis, surgery, systematic review and outcome.
No reviews containing prospective controlled or randomised controlled studies were found providing evidence for surgery.
A general indication for spine surgery just based on the Cobb angle is not given. In view of the long-term unknown variables and the possible long-term complications of such treatment, a surgical indication for patients with spinal deformities must be reviewed on an individual basis and considered carefully. A current systematic review appears necessary in order to be able to draw final conclusions on the indication for surgery in patients with spinal deformities.
In view of the increasing number of surgeons with an affiliation to industry, the indication for surgery needs to be given by independent conservative specialists for spinal deformities in order to provide an objective recommendation.
有高质量证据支持物理治疗和支具治疗脊柱侧弯及其他脊柱畸形。然而，根据以往的系统评价，似乎没有证据支持手术治疗。尽管如此，专注于脊柱手术的研究文章数量远远超过专注于保守治疗的文章数量。
本研究的目的是更新检索，以寻找为脊柱畸形患者脊柱手术提供高质量证据的系统评价。
2020年4月12日对PubMed和Cochrane数据库进行了叙述性综述，检索词如下：（1）脊柱畸形、手术、系统评价和结果；（2）后凸畸形、手术、系统评价和结果；（3）休门氏病、手术、系统评价和结果；（4）脊柱侧弯、手术、系统评价和结果。
未发现包含前瞻性对照或随机对照研究的综述能为手术提供证据。
不能仅基于 Cobb 角给出脊柱手术的一般指征。鉴于此类治疗存在长期未知变量及可能的长期并发症，脊柱畸形患者的手术指征必须个体化评估并谨慎考虑。目前似乎有必要进行系统评价，以便能够就脊柱畸形患者的手术指征得出最终结论。
鉴于附属行业的外科医生数量不断增加，脊柱畸形手术指征应由独立的保守治疗专家给出，以便提供客观建议。
