Postoperative Rehabilitation in Adolescent Idiopathic Scoliosis

Overview

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity occurring in growing individuals. In cases with progressive curvature, posterior spinal fusion and instrumentation (PSF) is considered the gold-standard surgical treatment for correcting the deformity and stabilizing the spine. Although surgery provides correction of the deformity, the loss of motion in the fused spinal segments may alter trunk biomechanics, potentially affecting postural control, balance mechanisms, and plantar pressure distribution. Although several studies have investigated balance and postural control parameters in individuals with AIS, no study has been identified that objectively examines the effects of postoperative rehabilitation programs on stabilometric balance, postural control, and plantar pressure distribution following PSF surgery. This study aims to investigate the effects of an exercise-based rehabilitation program on stabilometric balance, postural control, and plantar pressure distribution in individuals with AIS who have undergone PSF surgery. This randomized controlled trial is planned to include at least 42 individuals with AIS who have undergone PSF surgery and are being followed by the Department of Neurosurgery at Marmara University. Participants will be randomly assigned to an intervention group or a control group. The intervention group will participate in an exercise-based rehabilitation program consisting of two sessions per week for eight weeks. Consistent with routine practice, the control group will not participate in a structured rehabilitation program. Postural control, stabilometric balance, and plantar pressure distribution will be assessed using a stabilometric and baropodometric platform system. Assessments will be conducted before and after the rehabilitation period. The findings are expected to contribute to the scientific evidence regarding postoperative rehabilitation approaches. The results may also guide clinicians in planning exercise-based rehabilitation programs following scoliosis surgery and provide patients and their families with useful information regarding the postoperative recovery process.

Scoliosis is a complex three-dimensional deformity characterized by a lateral deviation of the spine of at least 10 degrees in the coronal plane (Choudhry et al., 2016). Idiopathic scoliosis is a structural form of scoliosis for which no specific etiology has been identified. When it develops between the onset of puberty and the closure of the growth plates, it is classified as adolescent idiopathic scoliosis (AIS) (Winter, 1994; Weinstein et al., 2008). Current treatment options for scoliosis include observation, bracing, and surgical intervention. Selection of the most appropriate treatment approach depends on factors such as the patient's age, menarcheal status, curve location and magnitude, and risk of progression (Zhang et al., 2020). Although skeletally immature children with curves reaching 40-50 degrees are generally considered candidates for surgical treatment, other factors-including curve pattern, rate of progression, the presence of additional deformities, and failure to respond to conservative treatment-may also influence the decision to perform surgery (Bridwell, 1999; Kim et al., 2009; Pourfeizi et al., 2014). Among the various surgical procedures used to treat scoliosis, posterior spinal fusion and instrumentation (PSF) is the most commonly used approach and is regarded as the gold-standard surgical technique in the literature (Lonner et al., 2007). This technique eliminates motion in the involved spinal segments by creating a fusion to correct the deformity, achieve a balanced spine, and prevent further curve progression (Upasani et al., 2015). Alterations in balance control, postural stability, and postural sway parameters have been reported in individuals with AIS due to the three-dimensional spinal deformity. Impairments in sensorimotor integration mechanisms involving the trunk and changes in plantar pressure distribution have also been reported (Beaulieu et al., 2009; Sahli et al., 2013; Karimi et al., 2016; Dufvenberg et al., 2018). Following surgical correction, the elimination of motion in certain spinal segments may increase loading on the remaining mobile segments, leading to changes in trunk biomechanics and new adaptations in postural control mechanisms. However, the limited evidence regarding the effects of these changes and adaptations in individuals with scoliosis remains inconsistent. Previous studies have reported postoperative reductions in spinal flexibility and mobility, as well as chronic pain (Danielsson et al., 2001; Engsberg et al., 2003; Maruyama et al., 2008), decreased trunk muscle endurance (Danielsson et al., 2006), adverse effects on balance- and postural control-related parameters, or a lack of improvement in these parameters following surgery (McCance et al., 1998; de Santiago et al., 2013; Osuka et al., 2023). Studies addressing the postoperative period have suggested that physiotherapist-supervised rehabilitation programs may be important for preventing secondary spinal problems and supporting postoperative recovery (Weiss, 2002; Laurentowska et al., 2009; Bazancir et al., 2023; Çetinkaya et al., 2025). Nevertheless, only a limited number of studies have investigated postoperative rehabilitation in individuals with AIS. Laurentowska et al. reported that a four-week endurance-based rehabilitation program initiated one to three years after surgery significantly improved exercise capacity and emphasized that rehabilitation should continue after spinal fusion in individuals with scoliosis (Laurentowska et al., 2009). Weiss demonstrated that a pain-management-based inpatient rehabilitation program could reduce chronic pain in patients who had undergone surgery at least 10 years earlier (Weiss, 2002). Short-term inpatient rehabilitation programs implemented after scoliosis surgery have also been reported to support postoperative recovery and improve quality of life (Bazancir et al., 2023). In addition, a physiotherapist-supervised telerehabilitation program initiated from the sixth postoperative month was reported to improve trunk endurance and flexibility and positively affect quality of life (Çetinkaya et al., 2025). Although these studies have addressed postoperative rehabilitation approaches, there remains a notable lack of research examining the effects of rehabilitation on biomechanical variables such as postural control mechanisms, stabilometric balance parameters, and plantar pressure distribution following surgery. Changes in postural control and balance mechanisms may affect individuals' activities of daily living and their participation in social and physical activities. Participation in physical activity and social life is particularly important during adolescence because of its contribution to overall health and quality of life. Therefore, it is important to investigate postoperative rehabilitation approaches aimed at supporting functional capacity and facilitating the reorganization of postural control mechanisms. Further research is also needed to establish evidence-based rehabilitation programs that support the biomechanical adaptation of the fused spine and the postoperative recovery process. Accordingly, this study aims to investigate the effects of an exercise-based postoperative rehabilitation program on stabilometric balance, postural control, and static plantar pressure distribution in individuals who have undergone PSF surgery for AIS, using objective biomechanical assessment methods. The findings are expected to contribute to the development of postoperative rehabilitation approaches and to support individuals' functional independence and quality of life. The results are also expected to provide evidence regarding the effectiveness of the exercise program and to offer guidance for clinicians working in this field, as well as for patients and their families.