Associations Between Different Exercise Approaches and Brain Structure in Adolescent Idiopathic Scoliosis: An Exploratory Neuroimaging Study

Study DesignRandomized Controlled Trial.Background and ObjectivesThe Schroth method has emerged as a promising rehabilitation approach for Adolescent Idiopathic Scoliosis (AIS). This study compared the effects of Schroth and conventional exercise programs on spinal curvature, cortical thickness, and white matter pathways using structural MRI and Diffusion Tensor Imaging (DTI).MethodsThirty-six individuals with AIS were randomly assigned to a Schroth Exercise Group (SEG) or a Traditional Exercise Group (TEG). A healthy control group (n = 18) was also included. The sample size was calculated to provide 80% power (d = 0.60), and post hoc analysis indicated strong power (>0.99) for the observed treatment effect (d = 3.59). Both exercise groups completed supervised home-based programs for four months. Post-intervention MRI and DTI analyses were performed. The study was registered at ClinicalTrials.gov (NCT06410456).ResultsAfter adjusting for baseline severity, the SEG showed a significantly greater improvement in Cobb angle compared to the TEG (adjusted mean difference = 8.07°, <i>P</i> < .001). Although the SEG achieved a significantly lower post-treatment Cobb angle compared to the TEG, residual curvature remained significantly different from the healthy controls (<i>P</i> < .001), reflecting the structural nature of scoliosis. Additionally, after adjusting for age and intracranial volume, cortical thickness in sensorimotor regions and tractography metrics of the right corticospinal tract in the SEG were comparable to controls and significantly different from the TEG.ConclusionSchroth exercises were associated with brain structural features suggestive of adaptive neuroplastic responses. These exploratory findings highlight potential neurobiological mechanisms and support further longitudinal research.