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Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study.

Negrini A, Negrini MG, Donzelli S, Romano M, Zaina F, Negrini S - Scoliosis (2015)

Bottom Line: After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis.Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

View Article: PubMed Central - PubMed

Affiliation: ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, Milan, 20141 Italy.

ABSTRACT

Background: Scoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression.

Methods: We designed a retrospective cohort study. We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises.

Instrumentation: SEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min.

Outcome measures: Radiographic progression was the main outcome and it was analysed as a continuous variable.

Statistics: One way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05.

Results: The mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.

Conclusions: Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

No MeSH data available.


Related in: MedlinePlus

The postural component of scoliosis [19]. A scoliosis curve is made of many different components, including a postural one. Duval-Beaupére [19] described the case of three different radiographs: standing (SR), lying down (LR) and in correction e.g. using a cast (CR). The structural bony component can be measured with the CR; the structural ligamentous component comes from the difference between LR and CR; the postural component from the difference between SR and LR
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Fig2: The postural component of scoliosis [19]. A scoliosis curve is made of many different components, including a postural one. Duval-Beaupére [19] described the case of three different radiographs: standing (SR), lying down (LR) and in correction e.g. using a cast (CR). The structural bony component can be measured with the CR; the structural ligamentous component comes from the difference between LR and CR; the postural component from the difference between SR and LR

Mentions: There is an important question coming out from these results of improvement: how is it possible through “simple” scoliosis-specific exercises to obtain the reduction of scoliosis in ADIS? We do not have answers, but we do have a reasonable hypothesis. Duval-Beaupère [22] described the case of three different radiographs that, made at the same time in the same scoliosis patients, resulted in a curve magnitude that progressively decreased: standing (SR), lying down (LR) and in correction e.g. using a cast (CR) (Fig. 2). While only CR gives the fixed, not corrigible osteo-ligamentous deformity, the author describes the difference between SR and LR as a “postural collapse” that is the difference between the LR and CR values is seen as the “reducibility” due to concave ligament stretching. In other words, the classical SR gives the entire scoliosis, made up of some components including a postural one. This has also been quantified: in adolescents, regardless of curve magnitude. The mean difference between a standing radiograph and a supine one has been quantified as 9 ° Cobb [23], or around 20 % [24]. In ADIS it has been shown that in severe curves (mean Cobb angle: 60 degrees) performing an x-ray at different hours of the day [25] can give a measurement error due to the worsening of the curve as the days goes by ie from the morning to the evening: this can easily be attributed to the postural collapse of the spine. Accordingly, while the described reduction of scoliotic curve through SS exercises is certainly not due to a reduction of the bone deformity, it could easily be attributed or explained as the activity of the specific muscle acting either against gravity in standing or with gravity eliminated in lying down and a consequent recovery of the postural collapse, which is present in upright posture [26].Fig. 2


Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study.

Negrini A, Negrini MG, Donzelli S, Romano M, Zaina F, Negrini S - Scoliosis (2015)

The postural component of scoliosis [19]. A scoliosis curve is made of many different components, including a postural one. Duval-Beaupére [19] described the case of three different radiographs: standing (SR), lying down (LR) and in correction e.g. using a cast (CR). The structural bony component can be measured with the CR; the structural ligamentous component comes from the difference between LR and CR; the postural component from the difference between SR and LR
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537533&req=5

Fig2: The postural component of scoliosis [19]. A scoliosis curve is made of many different components, including a postural one. Duval-Beaupére [19] described the case of three different radiographs: standing (SR), lying down (LR) and in correction e.g. using a cast (CR). The structural bony component can be measured with the CR; the structural ligamentous component comes from the difference between LR and CR; the postural component from the difference between SR and LR
Mentions: There is an important question coming out from these results of improvement: how is it possible through “simple” scoliosis-specific exercises to obtain the reduction of scoliosis in ADIS? We do not have answers, but we do have a reasonable hypothesis. Duval-Beaupère [22] described the case of three different radiographs that, made at the same time in the same scoliosis patients, resulted in a curve magnitude that progressively decreased: standing (SR), lying down (LR) and in correction e.g. using a cast (CR) (Fig. 2). While only CR gives the fixed, not corrigible osteo-ligamentous deformity, the author describes the difference between SR and LR as a “postural collapse” that is the difference between the LR and CR values is seen as the “reducibility” due to concave ligament stretching. In other words, the classical SR gives the entire scoliosis, made up of some components including a postural one. This has also been quantified: in adolescents, regardless of curve magnitude. The mean difference between a standing radiograph and a supine one has been quantified as 9 ° Cobb [23], or around 20 % [24]. In ADIS it has been shown that in severe curves (mean Cobb angle: 60 degrees) performing an x-ray at different hours of the day [25] can give a measurement error due to the worsening of the curve as the days goes by ie from the morning to the evening: this can easily be attributed to the postural collapse of the spine. Accordingly, while the described reduction of scoliotic curve through SS exercises is certainly not due to a reduction of the bone deformity, it could easily be attributed or explained as the activity of the specific muscle acting either against gravity in standing or with gravity eliminated in lying down and a consequent recovery of the postural collapse, which is present in upright posture [26].Fig. 2

Bottom Line: After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis.Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

View Article: PubMed Central - PubMed

Affiliation: ISICO (Italian Scientific Spine Institute), Via R. Bellarmino 13/1, Milan, 20141 Italy.

ABSTRACT

Background: Scoliosis fusion surgery is generally considered the only means to stop the progression of adult idiopathic scoliosis (ADIS), but for patients refusing surgery there is lack of evidence in favour of conservative treatment. The aim of the present study was to verify the possible effectiveness of scoliosis-specific exercises when facing ADIS progression.

Methods: We designed a retrospective cohort study. We included 34 ADIS patients in treatment at our Institute (5 males and 29 females, mean age was 38.0 ± 11.0), exclusively treated with specific Scoliosis Specific SEAS exercises.

Instrumentation: SEAS exercises are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through an active self-correction. Postural integration is a key element, including the neuromotor integration of correct postures and an ergonomic education program. Therapy includes at least two weekly exercise sessions each lasting 45 min.

Outcome measures: Radiographic progression was the main outcome and it was analysed as a continuous variable.

Statistics: One way ANOVA and paired t-test were applied for continuous data, while chi-square test was applied for categorical data. Alpha was set at 0.05.

Results: The mean Cobb angle of the patients included into the present study, was 55.8 ± 13.2 °. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 ± 6.6 ° at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 ° Cobb (mean curvature 50.9 ± 13.6) but it was not possible to prove that the curves had progressed in these cases. After an average period of 2 years of treatment (range 1-18y), 68 % of the patients experienced an improvement in their scoliosis. However in one patient (3 %) the scoliosis worsened by 5 ° in 18 years (progression rate reduced from 0.5 ° to 0.27 ° per year). Patients improved 4.6 ± 5.0 ° Cobb (P < 0.05), with no differences based on the localization of the curve, gender, age, length of treatment, Cobb degrees at the start of observation or treatment.

Conclusions: Scoliosis Specific SEAS Exercises proved to be superior to natural history in ADIS, at least in individual cases and should be considered as a first line treatment especially in patients refusing scoliosis surgery.

No MeSH data available.


Related in: MedlinePlus