The Costs and Benefits of Nonoperative Management for Adult Scoliosis

STUDY DESIGN: A prospective cohort of adult scoliosis patients treated nonoperatively had a minimum of 2-year follow-up during which time data were collected on the type and quantity of nonoperative treatment used. OBJECTIVE: To quantify the use, cost, and effectiveness of nonoperative treatment for adult scoliosis. SUMMARY OF BACKGROUND DATA: A 2007 systematic review of nonsurgical treatment in adult scoliosis revealed minimal data, and concluded that evidence for nonoperative care was lacking. METHODS: Duration of use and frequency of visits were collected for 8 specific treatment methods: medication, physical therapy, exercise, injections/blocks, chiropractic care, pain management, bracing, and bed rest. Costs for each intervention were determined using the Medicare Fee schedule. Outcome measures were the SRS-22, SF-12, and ODI. Analysis was performed for the entire group, and for subsets of high (ODI, >40), mid (ODI = 21-40) and low (ODI, <or=20) symptom patients. RESULTS: A total of 123 patients (111 females, 12 males) with a mean age of 53. 3 (18-79) years were evaluated. In 55 scoliosis patients who received no treatment, the only significant change in HRQOL measures over the 2-year period was in SRS satisfaction subscore (0. 3 points, P = 0. 014). Among the 68 adult scoliosis patients who used nonoperative resources, there was no significant change in any of the HRQOL outcome parameters. Mean treatment cost over the 2-year period was 10, 815. Mean cost over the 2-year period averaged 9704 in the low symptom patients, 11, 116 in the mid symptom, and 14, 022 in the high symptom patients. CONCLUSION: This study questions the value of nonoperative treatment commonly used for adult scoliosis patients. Documented costs are substantial and no improvement in health status was observed. An important caveat is that treatment was not randomized and therefore the treatment group might have deteriorated if not for the treatment they received.