Digital neuromodulation in the rehabilitation of adolescent idiopathic scoliosis: A systematic review and comparative analysis of virtual reality and surface electromyography biofeedback versus conventional kinesitherapy

Adolescent idiopathic scoliosis is a complex three-dimensional spinal deformity with multifactorial biomechanical and neurophysiological etiology, manifesting during periods of accelerated skeletal growth. Despite the established clinical efficacy of scoliosis-specific physiotherapeutic exercises and orthotic management, limitations persist, including the absence of objective biofeedback, variability in motor performance, and suboptimal neuromotor re-education within conventional frameworks. Virtual reality and surface electromyography biofeedback represent a promising technological extension aimed at addressing these gaps through real-time sensorimotor feedback and adaptive motor training. The objective of this systematic review was to evaluate the scientific evidence on the effectiveness of kinesitherapeutic interventions using virtual reality and surface electromyography biofeedback compared with standard kinesitherapy in adolescents with idiopathic scoliosis, and to assess the mechanisms underlying their potential clinical benefit. Methodologically, the review followed the principles of evidence-based medicine, the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the Oxford Centre for Evidence-Based Medicine hierarchy of evidence, and the Grading of Recommendations Assessment, Development and Evaluation system for certainty assessment; the literature was searched in major biomedical databases (2005–2026) using a structured population, intervention, comparison, and outcomes framework, and included randomized controlled trials, controlled clinical studies, and prospective cohort studies of adolescents aged 10–18 years with radiographically confirmed idiopathic scoliosis who had not undergone spinal surgery; study quality was assessed with the Physiotherapy Evidence Database scale, and risk of bias with the Cochrane Risk of Bias 2 tool and the Risk Of Bias In Non-randomized Studies of Interventions tool. Results indicated that conventional approaches, namely scoliosis-specific exercise methods such as the Schroth method and rigid thoracolumbosacral orthotic bracing, retained the strongest evidence base for structural control, with moderate to-high certainty of evidence for Cobb angle stabilization and prevention of progression. Studies of surface electromyography documented asymmetric paraspinal muscle activity in idiopathic scoliosis, whereas evidence for the effect of biofeedback training was limited to small and qualitative studies. Direct evidence for virtual reality in adolescent idiopathic scoliosis was scarce, and evidence from neurological and orthopedic populations was indirect and of low certainty. Combined digital protocols could not be evaluated formally because of the small number of studies and methodological heterogeneity, so no meta-analysis was performed. In conclusion, virtual reality and surface electromyography biofeedback do not replace established treatment standards for idiopathic scoliosis, but they may serve as an adjuvant strategy targeting neuromotor re-education and therapy adherence, which requires confirmation; future multicenter randomized controlled trials with long-term follow up are recommended to confirm structural outcomes and cost-effectiveness.