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

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 degrees. Fifteen patients had previous x-rays testifying scoliosis progression: the average curve progression (worsening) was 9.8 +/- 6.6 degrees at a median of 25 (range 17-48) years. The remaining were characterized by more severe curves, exceeding 40 degrees 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 degrees in 18 years (progression rate reduced from 0.5 degrees to 0.27 degrees per year). Patients improved 4.6 +/- 5.0 degrees 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.