BACKGROUND There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. METHODS CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. RESULTS Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias. CONCLUSION There is evidence to suggest that spinal brace/orthosis treatment may have a positive short - medium term influence on pain and function in adults with either progressive primary (de novo) degenerative scoliosis or progressive idiopathic scoliosis. At this point in time the evidence is of low quality and has been focused primarily on female patients with thoracolumbar and lumbar curves. More granular statements regarding the efficacy of different brace types or manufacturers, or the effect of this therapy on different curve types cannot be determined based on the current literature. Properly constructed prospective trials are required to better understand the efficacy of bracing in adult scoliosis.

中文翻译：

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1967 年至 2018 年间成人脊柱侧弯脊柱支架/矫形器治疗的系统文献综述：临床结果和危害数据。

背景关于成人脊柱侧凸的保守治疗的文献很少。作者回顾并总结了 1967 年至 2018 年有关该亚群人群使用脊柱支架/矫形器的临床结果的文献。方法 从数据库建立到 2018 年 10 月 30 日，对 CINAHL、Embase、CENTRAL、PubMed 和 PEDro 进行检索。在检索中使用了与三个核心概念（成人、脊柱侧凸和支具/矫形器）相关的医学主题词和关键词的组合。搜索。如果 A) 临床结果收集自 B) ≥18 岁的参与者 C) 接受脊柱支架/矫形器治疗 D) 原发性退行性（从头）脊柱侧凸或进行性特发性脊柱侧凸，则研究被纳入。采用了逐步筛选过程，其中包括标题和摘要的相关性筛选，然后由两位作者进行全文资格评估。提取数据，并使用纽卡斯尔-渥太华量表对纳入的队列研究进行偏倚风险评估。鉴于现有证据的总体水平和质量，根据证据的定性总结得出结论。结果 纳入 10 项研究（4 例病例报告和 6 项队列研究），详细介绍了 339 名患有以下疾病的成年人使用软支撑（2 项研究）或刚性支撑（8 项研究）作为独立治疗或与物理治疗/康复相结合的临床结果各种类型的脊柱侧弯。大多数研究仅包括女性参与者。常见报告的结果是疼痛（7 项研究）、功能（3 项研究）和科布角（3 项研究），随访时间从 2 天到 17 年不等。佩戴支具的处方范围为每天 2 至 23 小时，并且报告的支具合规情况参差不齐。大多数研究报告称，随访时疼痛适度或显着减轻，功能得到改善。关于因支撑而导致的科布角变化，存在不同的结果。一项研究的参与者注意到与支撑相关的不适。六项队列研究中的每一项都显示出很高的偏倚风险。结论 有证据表明，脊柱支架/矫形器治疗可能对患有进行性原发性（从头）退行性脊柱侧凸或进行性特发性脊柱侧凸的成年人的疼痛和功能产生积极的短期至中期影响。目前，证据质量较低，主要集中于胸腰椎和腰椎弯曲的女性患者。关于不同支架类型或制造商的功效或该疗法对不同曲线类型的影响的更详细的陈述无法根据当前文献确定。需要正确构建的前瞻性试验才能更好地了解支具对成人脊柱侧凸的功效。