OBJECTIVE: To investigate the effect of spinal manipulation (SM) on degenerative scoliosis by evaluating patients' visual analog scale (VAS) scores,Cobb angles,sagittal vertical axis (SVA),and apical vertebral rotation (AVR) and to explore factors that influence treatment effect.METHODS: A total of 55 patients with degenerative scoliosis received 4 weeks of SM.After treatment,patients were divided into two groups: the remission group (VAS score ＜ 40 mm) and the non-remission group (VAS score ≥ 40 mm).Pre-versus post-treatment VAS scores,Cobb angles,SVA,and AVR were compared in each group and in the total population.Baseline data (sex,age,symptom characteristics,duration of symptoms,VAS score,Cobb angle,SVA,and AVR) were compared between groups.Factors influencing the post-treatment VAS score were explored with multiple linear regression analysis.RESULTS: No changes were found in the Cobb angle (P =0.722) or AVR (P =0.424) after intervention in the overall population.However,the SVA (P ＜0.001) and VAS score (P =0.000) changed significantly after treatment.Similar changes were observed in the remission group (n =29).Multiple linear regression revealed that the only factors influencing treatment effect were symptom characteristics,SVA,and VAS score.CONCLUSION: SM relieved pain and improved sagittal imbalance in patients with degenerative scoliosis.It did not lessen the severity of coronal curvature or vertebral rotation.Factors influencing the effect of SM included symptom characteristics,VAS score,and SVA.A larger randomized trial is needed to further confirm our results.