Improvement After Hardware Removal in Post-Fusion Adult AIS: A Unique 35-Year Case Study Using Schroth-Based Physiotherapy and Bracing

<b>Background:</b> Adult scoliosis following spinal fusion and subsequent hardware removal presents complex challenges, especially when deformity progresses in both the sagittal and coronal planes. Revision surgery is often recommended but it entails considerable risks. Conservative approaches, including Schroth-based physiotherapy and bracing, offer promising alternatives for select patients, particularly older adults with comorbidities or those who decline further surgery. <b>Case Presentation:</b> A woman with adolescent idiopathic scoliosis (diagnosed at age 13) underwent spinal fusion with Harrington rod instrumentation and costoplasty at age 24. She was de-instrumented two years later due to infection and developed progressive thoracic hyperkyphosis, coronal imbalance, and 12 cm loss of height over two decades. At age 47, she chose conservative management instead of revision surgery. <b>Methods:</b> She completed a 28-month program combining Schroth-based physiotherapy supervised by a certified therapist and part-time bracing. Outcomes included radiographs, inclinometry, spirometry, spinal-muscle ultrasound, height/posture measures, and SRS-22 and ODI scores. <b>Results:</b> Substantial clinical improvements were observed. Thoracic kyphosis decreased from 80° to 45° (44%) and the coronal thoracic curve was reduced from 48° to 32° (33%). Lumbar lordosis increased by 6°, standing height rose by 4 cm, and forced vital capacity improved by 900 mL (33%). The Oswestry Disability Index (ODI) score improved from 4% to 0%, and SRS-22 domains (pain, function, self-image, mental health, satisfaction) showed meaningful gains. The patient returned to full physical activity and avoided further surgery. <b>Conclusion:</b> This case highlights the potential of Schroth-based physiotherapy with bracing to reverse postural and functional decline in complex post-fusion scoliosis. It offers a viable non-surgical option when revision surgery poses a high risk or is declined and aligns with modern rehabilitative goals focused on long-term quality of life.