Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis: A Prospective Controlled Cohort Study

Abstract

Study design: A prospective controlled cohort study.

Objective: The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window.

Summary of background data: Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role.

Methods: We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared.

Results: The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups (P < 0.05).

Conclusion: For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond.

Level of evidence: 2.

Figure 1

A subject participating in the XTS training. (A and B) Clinical image and radiographs before therapy. (C) The Scolioscan 3D ultrasound imaging system. (D) The subject being checked for correcting the daily life postures. (E) The example of intensive corrective exercises by stretching action movements. (F) The volume projection images obtained by Scolioscan before the training. (G)Volume projection images obtained by Scolioscan with the XTS corrective training.

Figure 2

Group A example case. (A–F). x-Rays showing changes from before treatment through 4 years of follow-up show the Cobb angle decreased from 20° (Risser grade 0) at age 7 to 8° at age 11 (Risser grade 0).

Figure 3

Group B example case. (A–E) x-Rays showing changes from before treatment through 2 years of follow-up show the Cobb angle decreased from 14° (Risser grade 0) at age 12 to 8° at age 14 (Risser grade 3).

Figure 4

Group C example case. (A–F) x-Rays showing changes from before treatment through 5 years of follow-up show the Cobb angle decreased from 22° (Risser grade 3) at age 12 to 10° at age 18 (Risser grade 5).

Figure 5

Rapid progression example case. (A–C) x-Rays showing that the Cobb angle increased from 16° to 30° within 7 months (Risser grade 0 for both time points).