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Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation
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Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 31 October 2025 | Viewed by 2760

Special Issue Editor

Dr. Theodoros B. Grivas

E-Mail Website
Guest Editor
Department of Orthopaedics and Traumatology, "Tzaneio" General Hospital of Piraeus, Zanni and Afendouli 1, GR-185 36 Piraeus, Greece
Interests: spinal deformity; idiopathic scoliosis; diagnosis; school screening; bracing; physiotherapeutic specific scoliosis exercises (PSSEs); growth modulation; operative treatment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The unclear understanding of the etiology of idiopathic scoliosis (IS) is the main reason for study of this deformity within the wider scope of its management. This management includes prevention, including school scoliosis screening, non-surgical treatment in the form of physiotherapeutic specific scoliosis exercises (PSSEs), bracing or a combination of these two, and finally surgical treatment. All these areas of study are relevant to this Special Issue, and any progress experienced within the above areas is useful for individuals with scoliosis. The quality of life of children and adolescents with IS has recently resulted in a number of publications based on its management. Due to the advancements mentioned above, it is expected that new articles based on the most sophisticated types of treatment will be submitted, as well as new relevant questionnaires to assess the QoL.In all publications, IS is described as a three-dimensional deformity. In reality, it is four-dimensional if the survival time parameter is considered, as individuals with the deformity will have the deformity until death. The importance of this comment is particularly pertinent in operated patients, as this group—treated with the current very powerful posterior spinal fusion systems—show a significant percentage of the so called “adjacent level disease” in long term follow-up, often leading to a revision of these operations. Furthermore, the reported complications, using any other modern surgical technique, may encourage the study of IS etiology of so that the treatment will eventually be etiological rather than symptomatic as it is today, minimizing complications, procedures, hospitalizations, and the burden on families.

In this Special Issue entitled “Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation”, we welcome the submission of articles pertinent to the above topics.

I look forward to receiving your contributions.

Dr. Theodoros B. Grivas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • idiopathic scoliosis
  • spinal deformity
  • diagnosis
  • physiotherapeutic specific scoliosis exercises (PSSEs)
  • surgical treatment
  • non-surgical treatment

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Published Papers (5 papers)

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Research

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11 pages, 839 KB  
Article
Quantification of Thoracic Volume and Spinal Length of Pediatric Scoliosis Patients on Chest MRI Using a 3D U-Net Segmentation
by Romy E. Buijs, Dingina M. Cornelissen, Dimo Devetzis, Peter P. G. Lafranca, Daniel Le, Jiaxin Zhang, Mitko Veta, Koen L. Vincken and Tom P. C. Schlösser
Healthcare 2025, 13(18), 2327; https://doi.org/10.3390/healthcare13182327 - 17 Sep 2025
Viewed by 169
Abstract
Background/Objectives: Adolescent idiopathic scoliosis (AIS) can lead to significant chest deformations. The quantification of chest deformity and spinal length could provide additional insights for monitoring during follow-up and treatment. This study proposes a 3D U-Net convolutional neural network (CNN) for automatic thoracic and [...] Read more.
Background/Objectives: Adolescent idiopathic scoliosis (AIS) can lead to significant chest deformations. The quantification of chest deformity and spinal length could provide additional insights for monitoring during follow-up and treatment. This study proposes a 3D U-Net convolutional neural network (CNN) for automatic thoracic and spinal segmentations of chest MRI scans. Methods: In this proof-of-concept study, axial chest MRI scans from 19 girls aged 8–10 years at risk for AIS development and 19 asymptomatic young adults were acquired (n = 38). The thoracic volume and spine were manually segmented as the ground truth (GT). A 3D U-Net CNN was trained on 31 MRI scans. The seven remaining MRI scans were used for validation, reported by the Dice similarity coefficient (DSC), the Hausdorff distance (HD), precision, and recall. From these segmentations, the thoracic volume and 3D spinal length were calculated. Results: Automatic chest segmentation was possible for all chest MRIs. For the chest volume segmentations, the average DSC was 0.91, HD was 51.89, precision was 0.90, and recall 0.99. For the spinal segmentation, the average DSC was 0.85, HD was 25.98, precision was 0.74, and recall 0.99. Chest volumes and 3D spinal lengths differed by on average 11% and 12% between automatic and GT, respectively. Qualitative analysis showed agreement between the automatic and manual segmentations in most cases. Conclusions: The proposed 3D U-Net CNN shows a high accuracy and good predictions in terms of HD, DSC, precision, and recall. This suggested 3D U-Net CNN could potentially be used to monitor the progression of chest deformation in scoliosis patients in a radiation-free manner. Improvement can be made by training the 3D U-net with more data and improving the GT data. Full article
(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)
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20 pages, 3523 KB  
Article
Telerehabilitation After Surgery in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial
by İrem Çetinkaya, Tuğba Kuru Çolak, Mehmet Fatih Korkmaz and Mehmet Aydoğan
Healthcare 2025, 13(16), 2063; https://doi.org/10.3390/healthcare13162063 - 20 Aug 2025
Viewed by 718
Abstract
Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns [...] Read more.
Background: Structured postoperative rehabilitation is not routinely provided for individuals with adolescent idiopathic scoliosis (AIS) after surgery, with physiotherapy typically limited to the immediate inpatient period. Telerehabilitation offers an accessible and supervised option to address persistent functional limitations, pain, and quality-of-life concerns in this population. Objectives: This study aimed to evaluate the effects of a synchronous telerehabilitation program—designed to support post-surgical recovery in individuals with adolescent idiopathic scoliosis (AIS)—on trunk muscle endurance, trunk flexibility, functional capacity, pain severity, perception of appearance, and quality of life. Methods: Thirty-two individuals with AIS, who had undergone surgery 6 months to 2 years prior, were randomly assigned to either an intervention group or a control group. The intervention group participated in a supervised telerehabilitation program twice weekly for eight weeks, while the control group received no exercise intervention. All outcome measures were assessed before and after the intervention. Results: The telerehabilitation group demonstrated significant improvements across all outcome measures compared with the control group (p < 0.05). Post-intervention, the telerehabilitation group had superior trunk muscle endurance, flexibility, and quality-of-life scores, as well as reduced pain intensity (p < 0.05). However, no significant differences were observed between the groups in functional capacity or perception of appearance (p > 0.05). Conclusions: A supervised telerehabilitation program initiated six months after surgery can effectively improve trunk muscle endurance, flexibility, pain intensity, and quality of life in individuals with AIS. These findings emphasize the value of structured post-surgical rehabilitation and raise awareness of the potential benefits of remotely delivered exercise programs in this population. Full article
(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)
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12 pages, 622 KB  
Article
Improving the Effectiveness of Conservative Treatment of Idiopathic Scoliosis Through Active Parental Participation During Inpatient Rehabilitation
by Marianna Białek, Justyna Pękala, Ewelina Białek-Kucharska, Małgorzata Poczynek, Paulina Poświata and Tomasz Kotwicki
Healthcare 2025, 13(13), 1551; https://doi.org/10.3390/healthcare13131551 - 29 Jun 2025
Viewed by 785
Abstract
Background/Objectives: This is a study of adolescents with idiopathic scoliosis (IS), treated by the Functional Individual Therapy of Scoliosis (FITS) method. The hypothesis was that active parental involvement in the treatment process enhances the outcomes of therapy. Materials and Methods: A total of [...] Read more.
Background/Objectives: This is a study of adolescents with idiopathic scoliosis (IS), treated by the Functional Individual Therapy of Scoliosis (FITS) method. The hypothesis was that active parental involvement in the treatment process enhances the outcomes of therapy. Materials and Methods: A total of 208 adolescent girls with IS were examined and divided into two groups. Only in Group I were the parents present. Trunk morphology before and after was evaluated by measuring change of the Anterior Trunk Symmetry Index (ATSI), Posterior Trunk Symmetry Index (POTSI), Posterior Trunk Symmetry Index in Correction (POTSI COR), and the angle of trunk rotation (ATR). Results: Statistically significant improvements in ATSI values were observed in both groups (Group I: p < 0.001; Group II: p = 0.001). POTSI values showed improvement only in Group I (p < 0.001). Similarly, POTSI COR values improved significantly in Group I (p < 0.001). ATR improved significantly better in Group I. Conclusion and Significance: Children with IS who underwent specific physiotherapy demonstrated better outcomes when their parents actively participated in the therapy. Full article
(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)
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Review

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17 pages, 543 KB  
Review
The Application of Biologic and Synthetic Bone Grafts in Scoliosis Surgery: A Scoping Review of Emerging Technologies
by Nikolaos Trygonis, Ioannis I. Daskalakis and Christos Tsagkaris
Healthcare 2025, 13(18), 2359; https://doi.org/10.3390/healthcare13182359 - 19 Sep 2025
Abstract
Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these [...] Read more.
Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these defects, traditionally relying on autologous bone. However, limitations such as donor site morbidity and insufficient graft volume have made urgent the development and adoption of biologic substitutes and synthetic alternatives. Additionally, innovations in three-dimensional (3D) printing offer emerging solutions for graft customization and improved osseointegration. Objective: This scoping review maps the evidence of the effectiveness of the use of biologic and synthetic bone grafts in scoliosis surgery. It focusses on the role of novel technologies, particularly osteobiologics in combination with 3D-printed scaffolds, in enhancing graft performance and surgical outcomes. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published within the last 15 years. Inclusion criteria focused on clinical and preclinical research involving biologic grafts (e.g., allografts, demineralized bone matrix-DBM, bone morphogenetic proteins-BMPs), synthetic substitutes (e.g., ceramics, polymers), and 3D-printed grafts in the context of scoliosis surgery. Data were extracted on graft type, clinical application, outcome measures, and complications. The review followed PRISMA-ScR guidelines and employed the Arksey and O’Malley methodological framework. Results: The included studies revealed diverse grafting strategies across pediatric and adult populations, with varying degrees of fusion success, incorporation rates, and complication profiles. It also included some anime studies. Emerging 3D technologies demonstrated promising preliminary results but require further validation. Conclusions: Osteobiologic and synthetic bone grafts, including those enhanced with 3D technologies, represent a growing area of interest in scoliosis surgery. Despite promising outcomes, more high-quality comparative clinical studies are needed to guide clinical decision-making and standardize practice. Full article
(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)
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Other

Jump to: Research, Review

11 pages, 1681 KB  
Opinion
The Contribution of the Double Rib Contour Sign and the Rib Index to the Study of Scoliogeny, Thoracic Deformity, Progression, Outcome of Treatments and Costoplasty for Idiopathic Scoliosis
by Theodoros B. Grivas, Anastasios G. Christodoulou, Evangelos A. Christodoulou, Galateia Katzouraki, Marios G. Lykissas, Panayiotis J. Papagelopoulos, Elias C. Papadopoulos, Sotirios Papastefanou, Nikolaos Sekouris, Panayotis N. Soucacos, Konstantinos C. Soultanis and Elias Vasiliadis
Healthcare 2025, 13(9), 1014; https://doi.org/10.3390/healthcare13091014 - 28 Apr 2025
Viewed by 560
Abstract
This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by [...] Read more.
This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by the first author in this report. The introduction of the Segmental Rib Index (SRI) and its relation to spinal deformity is also discussed. The RI has been confirmed to be a strong surrogate for scoliometric readings in idiopathic scoliosis (IS). The clinical applications of the RI are analyzed for the following: (a) the documentation of deformity; (b) the assessment of physiotherapy outcomes (PSSEs); (c) the documentation of the outcomes of brace treatment; (d) the documentation of the pre- and post-operative assessment of thoracic deformity correction in different types of instrumentation; (e) its usage in prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis (AIS) curves of 40–50 degrees; and (f) its usage in the recognition of the proper rib level for thoracoplasty/costoplasty. The emerging etiological–scoliogenic implications from the use of the DRCS and RI are described. The rotation of the trunk and vertebral bodies as interrelated, but distinct parameters are finally analyzed. Full article
(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)
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