Alexandros Kastrinis

Adolescent Idiopathic Scoliosis (AIS) with curves exceeding 50° Cobb is commonly associated with a high risk of progression and is often managed surgically. However, conservative treatment outcomes in such severe cases remain clinically relevant, particularly when combining rigid bracing with Physiotherapeutic Scoliosis-Specific Exercises (PSSE). This case study aims to evaluate the effectiveness of a revised conservative management strategy in a patient with severe AIS. A 17-year-old female with AIS presented with a 66° Cobb angle of the primary thoracic curve, following 8 months of prior brace treatment. Despite prolonged bracing, the curve magnitude remained high. Consequently, the conservative management strategy was revised. The patient was fitted with a new 3D, Schroth-compatible, corrective brace made by Scoliosis and initiated a structured Schroth-based physiotherapeutic program with a frequency of two sessions per week. The intervention protocol included Schroth-specific mobilization techniques followed by exercises focusing on three-dimensional correction, postural control, and curve-specific breathing mechanics. This case demonstrates that even in severe AIS curves, a combined approach of optimized bracing and long-term Schroth therapy may lead to substantial in-brace correction and marked clinical improvement. These findings support the role of individualized conservative management as a viable option in selected cases of severe scoliosis, potentially offering an alternative to surgical intervention.

Bracing is the primary conservative treatment for Adolescent Idiopathic Scoliosis (AIS), aiming to arrest curve progression. Therapeutic success relies on initial in-brace correction and patient compliance. This study compares the symmetric Boston brace and the asymmetric 3D Scoliosis Brace (SB) regarding immediate correction, compliance, and one-year outcomes in Cobb and Raimondi angles. A retrospective observational study involved 135 adolescents (Boston: n=54, SB: n=81) with AIS (Cobb 20-45°). Outcomes included percentage of in-brace correction, compliance (wear time %), and changes in Cobb and Raimondi angles at 1-year follow-up. The SB group achieved significantly higher initial in-brace correction (47.8% ± 14.4) compared to the Boston group (39.0% ± 13.5, p<0.001). Compliance was also significantly higher in the SB group (89.6%) versus the Boston group (72.9%, p<0.001). At one year, both groups improved significantly, but the SB group showed superior Cobb angle reduction (from 27.06° to 22.44°) compared to the Boston group (from 26.17° to 24.02°, p=0.007). Both braces effectively maintained rotational stability, preventing clinically significant progression. The Scoliosis Brace demonstrated superior immediate correction and higher patient compliance, contributing to better Cobb angle reduction at one year. Both designs successfully stabilized the rotational component. These findings support the efficacy of asymmetric 3D CAD/CAM designs in optimizing AIS treatment outcomes.

Adolescent Idiopathic Scoliosis (AIS) impacts both trunk morphology and body image. While the Cobb angle and photogrammetric metrics (ATSI, POTSI) objectively measure physical deformity, they may not reflect the patient’s subjective perception. This study investigated the correlation between these objective indices and self-perceived appearance using the Spinal Appearance Questionnaire (SAQ). A retrospective observational study included 30 female adolescents with AIS (mean age 14.47 ± 1.90 years; Cobb >10°). Trunk asymmetry was objectively evaluated via photogrammetric calculation of ATSI and POTSI scores. Subjective perception was assessed using the Greek version of SAQ. Spearman’s rank correlations were used to analyze relationships between the objective indices and SAQ scores. Participants had a mean Cobb angle of 30.77° ± 9.51° and a mean SAQ Total score of 52.07 ± 7.98. The analysis revealed no statistically significant correlations between the total SAQ score and ATSI (r = -0.014, p = 0.943), POTSI (r = 0.113, p = 0.552), or the Cobb angle (r = 0.049, p = 0.796). Objective measures of trunk deformity, both radiographic and photogrammetric, do not correlate with self-perceived spinal appearance in adolescents with AIS. This highlights that body image is a multidimensional construct distinct from physical severity, necessitating the routine clinical use of Patient-Reported Outcome Measures (PROMs) alongside objective parameters.

Sarcopenia, characterized by progressive loss of skeletal muscle mass, strength, and function, is a major contributor to disability, falls, and reduced quality of life in older adults. Degenerative scoliosis is also increasingly prevalent with aging and is associated with spinal instability, postural imbalance, and chronic pain. Despite their frequent coexistence, the interaction between sarcopenia and scoliosis remains poorly explored. Thus, this study aimed to highlight the bidirectional relationship between sarcopenia and scoliosis in older adults and to discuss its clinical and rehabilitative implications. A narrative synthesis of current literature was conducted, focusing on age-related changes in muscle composition, spinal alignment, trunk muscle function, and postural control. Emphasis was placed on studies examining muscle degeneration, spinal deformity progression, balance impairment, and functional outcomes. Emerging evidence suggests that older patients with degenerative lumbar scoliosis tend to have higher sarcopenia prevalence and lower skeletal muscle mass (appendicular/trunk) than controls or other spinal conditions. Sarcopenia may exacerbate spinal deformity by reducing trunk muscle strength and endurance, thereby compromising spinal stability and alignment. Conversely, scoliosis-related pain, asymmetry, and altered biomechanics may accelerate physical inactivity and muscle wasting, contributing to sarcopenia progression. The coexistence of both conditions appears to increase the risk of falls, mobility limitations, and functional dependence. Sarcopenia and scoliosis may form a vicious cycle that amplifies musculoskeletal decline in older adults. Integrated assessment strategies and targeted physiotherapy interventions addressing muscle strength, postural control, and spinal alignment are essential. Future research should focus on longitudinal designs and intervention studies to clarify causality and optimize rehabilitation strategies.

The conservative management of Adolescent Idiopathic Scoliosis (AIS) with rigid bracing imposes a significant psychological burden. This study investigated the convergence or divergence of views between female adolescents with AIS and their parents concerning body image and brace-related stress. A cross-sectional study of 50 pairs (n=100) of female adolescents (mean age 14.26±1.77) and one of their parents was conducted. Participants independently completed the Greek versions of the Bad Sobernheim Stress Questionnaire (GR-BSSQ-Brace) and the Spinal Appearance Questionnaire (GR-SAQ). Parents reported significantly higher brace-related stress than adolescents (p=0.010). While absolute agreement for total scores was moderate (ICC=0.698), item-level agreement was insufficient across all BSSQ items (kappa < 0.40). For body image (SAQ), total scores did not differ significantly, but agreement was poor-to-moderate (ICC=0.460), with parents consistently evaluating specific aesthetic deformities more negatively than the patients themselves (p < 0.05). A distinct perception gap exists, where parents tend to overestimate the psychological distress and aesthetic burden experienced by their children. Clinical management should incorporate targeted parental counseling to align expectations and improve family-centric adherence. Furthermore, the observed lack of agreement underscores the necessity for the development and validation of assessment tools specifically tailored for parents to ensure accurate representation of their perspective.

Background: Adolescent idiopathic scoliosis (AIS) is often associated with central nervous system disorders and deficits in sensorimotor function. While the Schroth method is a common clinical intervention, research evidence regarding its effectiveness in enhancing sensorimotor control remains limited. This study aimed to evaluate the impact of the Schroth method on sensorimotor control and quality of life (QoL) in AIS patients. Methods: Sixty female participants (mean age 13.4 years) with Cobb angles between 10° and 45° were divided into an intervention group (n = 30), receiving Schroth exercises and bracing for 10 weeks, and a control group (n = 30), receiving bracing alone. Outcome measures included static and dynamic balance, spine lateral flexion joint position sense (JPS), upper-limb functional proprioception, and the GR-BSSQ Brace questionnaire. Results: Statistical analysis using two-way mixed ANOVA revealed significant Group × Time interactions across several parameters. The Schroth group showed significant improvements in static and dynamic balance, with ellipse area reduction (p = 0.005) and reduced Fukuda test distance (p = 0.007), respectively. Significant enhancements were noted in spine lateral flexion JPS (Bilateral p = 0.008) and upper-limb proprioception (Bilateral p = 0.000). Furthermore, the intervention group reported a significant improvement in QoL scores compared to the control (p = 0.000). Conclusions: The findings demonstrate that the Schroth method was associated with enhanced sensorimotor control, supporting its use as a targeted approach to improve functional outcomes in individuals with AIS. These results highlight the clinical value of the method, beyond spinal curve correction.

Conservative treatment with a brace has shown significant improvement in patients with idiopathic scoliosis. Initial in-brace correction can serve as a predictive factor for the treatment outcome. Additionally, significant data highlight the effectiveness of Schroth exercises. There is also evidence that the combination of Schroth and Bracing can provide a better treatment outcome. The study aimed to investigate the effect of a Schroth exercise program on the initial in-brace correction and in a 6-month follow-up in-brace radiological evaluation. Fifty children aged 10-17 years, diagnosed with idiopathic scoliosis were divided into two groups: a treatment group (n = 25) and a control group (n = 25). The treatment group used a brace combined with a specialized Schroth exercise program. The control group used only bracing. Schroth-compatible braces were used by all the participants and bracing was prescribed for 18-22 hours daily. Schroth exercise was performed twice a week under supervision and 4 times at home. For the statistical analysis, 2-way ANOVA and paired t-test were used. The statistical analysis has shown a statistically significant group * time interaction (p = 0.015). According to the findings, a significant improvement was demonstrated in in-brace correction in the intervention group over a 6-month period. This indicates the effect of Schroth exercises in enhancing in-brace correction values over time.

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS progression based on the patient’s age at diagnosis—particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders skeletal maturity staging system, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient’s age at onset—whether in infancy, childhood, or adolescence—as well as in both untreated and braced AIS patients. Additionally, the apical convex rib–vertebra angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression. In conclusion, this concise and selective overview of predictor factors for progression in IS highlights the current understanding of IS progression factors. It also introduces the Rib and Segmental Rib Index—a rib cage deformity parameter—as a predictor of IS progression.

This report provides a concise selective representative overview of the predictor-factors for progression in Idiopathic Scoliosis. The Cobb angle method, rib hump deformity, and imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for idiopathic scoliosis (IS) progression based on the patient's age at diagnosis—particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders Skeletal Maturity Staging System, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient’s age at onset—whether in infancy, childhood, or adolescence—as well as in both untreated and braced AIS patients. Additionally, the apical convex rib-vertebral angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression."

Background/Aims: Classification for scoliosis is of significant importance for clinicians to organise the therapy plan and to decide the appropriate treatment. The aim of this study was to investigate the validity and reliability of the Schroth Classification using visual observation only, as this is an equally important part that guides therapists in their final decisions for conservative treatment in scoliosis. Methods: Three therapists certified in the Schroth Method evaluated the accuracy and reliability of this classification system. They studied photographs of 68 patients with idiopathic scoliosis. For validity testing, the choices of the three therapists were compared with the classification according to the Schroth Method, which the independent investigator, a certified instructor of the method, had concluded after examining the patients, which included all relevant tests, observations, Schroth flexibility tests and X-ray radiographs. Reliability was measured using Kappa value to evaluate intra-examiner and inter-examiner level of agreement Results: Concerning the validity with the use of Kappa value, the most experienced examiner (Examiner A) had k=0.68 regarding the Schroth Classification, Examiner B had k=0.45 and Examiner C had k=0.38. Test–retest reliability was good to substantial for the three examiners with Kappa value ranging from 0.74 to 0.94. The experienced examiner showed the highest level of agreement. Inter-examiner reliability was lower with Kappa values ranging from 0.24 to 0.85 Conclusions: The Schroth Classification is reliable for classifying patients with scoliosis when used by experienced qualified assessors. Although it is always wise to gain an image of the X-ray to confirm both the diagnosis and the pattern, the Schroth Classification appears to be reliable in situations where there is no access to X-rays and classification is performed by visual observation only. Implications for practice: The findings of the study indicate that experienced and properly trained therapists have the capability to accurately classify scoliosis solely through visual observation. This observation bears significant practical implications for clinical settings where radiographic imaging is unavailable, thereby enabling clinicians to make decisions concerning Schroth therapy strategies and initiate appropriate treatment. Radiographic imaging and the Schroth flexibility tests remain indispensable and critical instruments for conducting a comprehensive and secure evaluation. Additional training may be requisite for less experienced therapists to enhance the precision of classification.