The Effect of Postoperative Rehabilitation on Stabilometric Balance, Postural Control, and Plantar Pressure Distribution in Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial

Scoliosis is a complex three-dimensional deformity characterized by a lateral deviation of the spine of at least 10 degrees in the coronal plane (Choudhry et al., 2016). Idiopathic scoliosis is a structural form of scoliosis for which no specific etiology has been identified. When it develops between the onset of puberty and the closure of the growth plates, it is classified as adolescent idiopathic scoliosis (AIS) (Winter, 1994; Weinstein et al., 2008).

Current treatment options for scoliosis include observation, bracing, and surgical intervention. Selection of the most appropriate treatment approach depends on factors such as the patient's age, menarcheal status, curve location and magnitude, and risk of progression (Zhang et al., 2020). Although skeletally immature children with curves reaching 40-50 degrees are generally considered candidates for surgical treatment, other factors-including curve pattern, rate of progression, the presence of additional deformities, and failure to respond to conservative treatment-may also influence the decision to perform surgery (Bridwell, 1999; Kim et al., 2009; Pourfeizi et al., 2014). Among the various surgical procedures used to treat scoliosis, posterior spinal fusion and instrumentation (PSF) is the most commonly used approach and is regarded as the gold-standard surgical technique in the literature (Lonner et al., 2007). This technique eliminates motion in the involved spinal segments by creating a fusion to correct the deformity, achieve a balanced spine, and prevent further curve progression (Upasani et al., 2015).

Alterations in balance control, postural stability, and postural sway parameters have been reported in individuals with AIS due to the three-dimensional spinal deformity. Impairments in sensorimotor integration mechanisms involving the trunk and changes in plantar pressure distribution have also been reported (Beaulieu et al., 2009; Sahli et al., 2013; Karimi et al., 2016; Dufvenberg et al., 2018). Following surgical correction, the elimination of motion in certain spinal segments may increase loading on the remaining mobile segments, leading to changes in trunk biomechanics and new adaptations in postural control mechanisms. However, the limited evidence regarding the effects of these changes and adaptations in individuals with scoliosis remains inconsistent. Previous studies have reported postoperative reductions in spinal flexibility and mobility, as well as chronic pain (Danielsson et al., 2001; Engsberg et al., 2003; Maruyama et al., 2008), decreased trunk muscle endurance (Danielsson et al., 2006), adverse effects on balance- and postural control-related parameters, or a lack of improvement in these parameters following surgery (McCance et al., 1998; de Santiago et al., 2013; Osuka et al., 2023).

Studies addressing the postoperative period have suggested that physiotherapist-supervised rehabilitation programs may be important for preventing secondary spinal problems and supporting postoperative recovery (Weiss, 2002; Laurentowska et al., 2009; Bazancir et al., 2023; Çetinkaya et al., 2025). Nevertheless, only a limited number of studies have investigated postoperative rehabilitation in individuals with AIS. Laurentowska et al. reported that a four-week endurance-based rehabilitation program initiated one to three years after surgery significantly improved exercise capacity and emphasized that rehabilitation should continue after spinal fusion in individuals with scoliosis (Laurentowska et al., 2009). Weiss demonstrated that a pain-management-based inpatient rehabilitation program could reduce chronic pain in patients who had undergone surgery at least 10 years earlier (Weiss, 2002). Short-term inpatient rehabilitation programs implemented after scoliosis surgery have also been reported to support postoperative recovery and improve quality of life (Bazancir et al., 2023). In addition, a physiotherapist-supervised telerehabilitation program initiated from the sixth postoperative month was reported to improve trunk endurance and flexibility and positively affect quality of life (Çetinkaya et al., 2025). Although these studies have addressed postoperative rehabilitation approaches, there remains a notable lack of research examining the effects of rehabilitation on biomechanical variables such as postural control mechanisms, stabilometric balance parameters, and plantar pressure distribution following surgery.

Changes in postural control and balance mechanisms may affect individuals' activities of daily living and their participation in social and physical activities. Participation in physical activity and social life is particularly important during adolescence because of its contribution to overall health and quality of life. Therefore, it is important to investigate postoperative rehabilitation approaches aimed at supporting functional capacity and facilitating the reorganization of postural control mechanisms. Further research is also needed to establish evidence-based rehabilitation programs that support the biomechanical adaptation of the fused spine and the postoperative recovery process.