Objective:

2

To investigate the role of spinal manipulative therapy (SMT) in preventing progression and reducing the need for surgery in moderate-to-severe adolescent idiopathic scoliosis (AIS).

Methods:

2

This randomized controlled clinical trial was conducted at the First Affiliated Hospital of Zhejiang Chinese Medical University between January 1

2022

and December 31

2023. Overall

118 AIS patients were randomly divided into 2 groups by simple randomization: one receiving SMT combined with brace treatment (SMTB group

59 participants

SMT was given twice weekly

brace was worn for 23 h per day) and the other receiving brace treatment alone (BA group

59 participants

brace was worn for 23 h per day). The primary outcome measure was the success rate after 12-month treatment. The secondary outcomes related to scoliosis

including the Cobb angle

angle trunk rotation (ATR)

and Scoliosis Research Society-22 (SRS-22) score were measured. All the above indicators were subjected to subgroup analysis based on the degree of scoliosis (moderate and severe). Adverse events were observed and recorded.

Results:

2

Modified intention-to-treat analyses included 112 participants (SMTB group and BA group each had 56 participants

101 girls and 11 boys; 15.11±1.69 years). The success rate was significantly higher in the SMTB group [78.6% (44/56)

]

than in the BA group [51.8% (29/56)

P

<

0.01

]

. Among the secondary outcomes

SMTB group was more effective than BA group in reducing the Cobb angle (difference

–3.93; 95% confidence interval [CI

]

–6.11 to –1.74

P

<

0.05); SMTB group showed a greater reduction in ATR compared to BA group (difference

–2.34; 95% CI

–3.46

–1.22

P

<

0.05) and demonstrated superior efficacy to BA in improving SRS-22 score (difference

6.57; 95% CI

4.55 to 8.59

P

<

0.05). Subgroup analysis showed that SMT had similar efficacy in the treatment of moderate and severe AIS. Safety analyses did not differ significantly between the two groups (

P

>

0.05).

Conclusion:

2

SMT appears to be safe and beneficial for moderate-to-severe AIS. (Trial registration No. NCT06648005)