Abstract / Summary
Abstract Background Idiopathic scoliosis is a three-dimensional spinal deformity commonly managed with conservative treatments such as observation, bracing, or physiotherapeutic scoliosis-specific exercises. Spinal manipulative therapy may improve spinal biomechanics and flexibility, whereas Schroth training can reduce asymmetric paraspinal muscle activity. However, evidence regarding segmental spinal manipulative correction combined with Schroth training remains limited. This retrospective study evaluated whether the combined intervention was associated with improvements in the Cobb angle and pelvic obliquity in patients with mild to moderate idiopathic scoliosis. Pelvic obliquity (coronal-plane pelvic tilt) was included because the pelvis serves as the biomechanical foundation of the spine, and its alignment influences overall coronal balance. Objective To evaluate the potential benefits of segmental spinal manipulative correction combined with Schroth training for idiopathic scoliosis. Methods This retrospective single-arm case series included 16 patients with idiopathic scoliosis who were treated at our institution from 2017 to 2019 (mean age, 12.5 ± 3.0 years; 10 females and 6 males). Inclusion criteria were a diagnosis of idiopathic scoliosis, age 8–18 years, Cobb angle 10–40°, Risser sign 0–5, and completion of at least 3 months of combined treatment. Exclusion criteria included secondary scoliosis and previous spinal surgery. Patients received combined treatment for a mean of 6.4 ± 2.8 months, consisting of segmental spinal manipulative correction (3 times per week during the first 2 weeks and once weekly thereafter) combined with Schroth training (60 min of supervised training after manual therapy and at least 30 min of daily home training). Standing posteroanterior full-spine radiographs were obtained before and after treatment. Two independent assessors, blinded to the time point, measured the Cobb angle and pelvic obliquity angle. Inter-rater reliability was excellent (ICC > 0.90). The Shapiro-Wilk test indicated that pre-post differences were not normally distributed; therefore, the Wilcoxon signed-rank test was used as the primary method for pre-post comparisons, with paired-samples t tests as supplementary analyses. A Cobb angle change ≤ 5° was considered within measurement variability, while a change > 5° was considered to exceed both measurement error and the minimal clinically important difference (MCID) threshold. Results The Cobb angle decreased significantly after treatment, with a median reduction of 5.00° (Z = − 3.48, p < 0.001). Pelvic obliquity also improved, with a median reduction of 1.00° (Z = − 2.88, p = 0.002). Individual response stratification revealed that 7 patients (43.75%) achieved Cobb angle improvements exceeding 5°, representing change beyond both measurement error and the MCID threshold. Two patients (12.5%) showed exactly 5° improvement (at the MCID threshold but within measurement error), six patients (37.5%) showed improvement of less than 5° (within measurement error and below MCID), and one patient (6.25%) showed curve worsening of 2°. Conclusion This retrospective case series provides hypothesis-generating evidence that segmental spinal manipulative correction combined with Schroth training may be associated with reductions in the Cobb angle and pelvic obliquity in patients with mild to moderate idiopathic scoliosis. Stratification of individual responses revealed considerable variability, with 43.75% of patients achieving clinically meaningful improvement exceeding 5°. However, the observed reduction in pelvic obliquity, while statistically significant, is of uncertain clinical significance in the absence of patient-reported functional outcomes. Given the retrospective design, absence of a control group, and lack of long-term follow-up, these findings should be regarded as preliminary. Prospective controlled trials with patient-reported outcomes and long-term follow-up are needed before this combined approach can be recommended for clinical practice.