Rehabilitation in adult spinal deformity

Abstract

Adult spinal deformity causes significant health-related problems such as pain and disability in adults. Currently, there are several non-operative management strategies such as pain medications, physical modalities, exercises, bracing or interventional procedures. Specific exercises including strengthening of back and abdominal muscles, neuromuscular re-education for daily tasks, and active self-correction are vital to improve postural control and spinal stability. Bracing for a few hours a day can help reduce pain and provide spinal stability in adults. In case of severe disability and pain unresponsive to non-operative treatments, spinal fusion with instrumentation is an alternative. Postoperative rehabilitation can help to reduce pain and disability and improve return to activity or work. Protecting the spine early after surgery and timing of initiation of exercises with respect to osseointegration and bone remodeling phases are important principles of postoperative rehabilitation. In this review, rehabilitation in adult spinal deformity is discussed in the light of the literature.

Keywords: Adult spinal deformity; bracing; degenerative scoliosis; exercise; rehabilitation; spinal fusion.

Figure 1. X-ray of the lumbar spine, anteroposterior view, showing left lumbar scoliosis with apex at L3 in an 82-year-old woman.

Figure 2. Inspection of standing posture and spinal alignment, lateral view, showing flat back and stooping forward implying sagittal imbalance.

Figure 3. X-ray of whole spine, lateral view, showing proximal junctional kyphosis above the proximally fused vertebra seven months after T10-L5 posterior spinal fusion.

Figure 4. Abdominal hollowing exercises with neutral spine in a supine hook-lying position, in which difficulty of exercises is gradually increased, as the stability improves; (a) abdominal hollowing alone, (b) with arm raise, (c) with leg raise.

Figure 5. Upper limb strengthening exercises to increase stability of lumbar spine through the thoracolumbar fascia; (a) bilateral shoulder extension contracting latissimus dorsi, (b) unilateral shoulder extension.

Figure 6. Advanced core stabilization exercises after trunk control is improved; (a) simultaneous raise of contralateral arm and leg in a supine hook-lying position, (b) hip extension in four-point kneeling (bird dog).

Figure 7. Advanced exercises with elastic exercise bands and ball after proper trunk control and stability is achieved; while sitting on an exercise ball, (a) simultaneous raise of contralateral arm and leg, (b) bilateral shoulder horizontal abduction.