Persistence of Primitive Reflexes as Possible Predictive Factors for Progression, Prevention, and Early Rehabilitation Intervention in Idiopathic Scoliosis

<i>Background and objectives</i>: Idiopathic scoliosis is a three-dimensional spinal deformity characterized by a lateral curvature exceeding 10 degrees in the frontal plane accompanied by vertebral rotation in the transverse plane. Despite extensive research on genetic and neurological factors, its etiology is uncertain. This prospective observational study aims to investigate the relation between the primitive reflexes, specifically, the asymmetric tonic neck reflex (ATNR), symmetric tonic neck reflex (STNR), and spinal Galant reflex (SGR), which play key roles in early motor development and postural control and the severity of idiopathic scoliosis (measured via the Cobb angle and the Nash-Moe rotational quota. Additionally, the study evaluated whether the retention of primitive reflexes correlates with increased progression risk over 12 months of conservative treatment. <i>Materials and Methods</i>: Our study cohort included 162 patients, aged 7-19 years, diagnosed with idiopathic scoliosis, who underwent clinical examination and assessment of retained primitive reflexes using standardized grading systems. <i>Results</i>: A total of 162 patients (95 girls, 67 boys; mean age: 12.73 ± 2.74 years) met the inclusion criteria. In 73.5% of the cases, scoliosis was detected, with the majority occurring in the dorsal region (40.1%). The mean initial Cobb angle was 13.49° ± 7.14°, with no significant change after 12 months of conservative treatment (<i>p</i> = 0.584). Nash-Moe rotation scores were 1 in 52.5% and 2 in 22% of the cases. Retention of the following primitive reflexes were identified at baseline: Moro (19.1%), ATNR (38.3%), STNR (44.4%), and GSR (27.8%). GSR retention significantly correlated with the Cobb angle (<i>p</i> = 0.011; R = 0.233). All the reflex scores decreased significantly after 12 months, but no correlation existed between the retained reflexes and scoliosis progression. Patients with a history of quadrupedal locomotion had significantly lower ATNR (<i>p</i> = 0.002), STNR (<i>p</i> < 0.001), and GSR (<i>p</i> = 0.017) retention. <i>Conclusions</i>: These findings suggest that primitive reflex testing could serve as an early screening tool in scoliosis risk stratification, being a cost-effective, non-invasive instrument for identifying at-risk children before clinically significant deformity develops.