**4.2. Coronal offset**

**3.8. SRS-22**

104 Innovations in Spinal Deformities and Postural Disorders

ferent (*p* = 0.0016).

**4. Discussion**

as SRS-22 scores.

**4.1. Cobb angle**

as a reduction of 6° Cobb angle [30].

Comparing the baseline and the results at 9th month showed that there was no significant difference of scores in the function and pain domains (**Table 5**). There were, however, significant difference of scores for the self-image (*p* = 0.001), mental health (*p* = 0.004), and satisfaction/ dissatisfaction domains (0.018). The difference in SRS-22 total score was also statistically dif-

Overall, 9 months of home-based Schroth exercises significantly improved the Cobb angle, the ATR, the ATR during RAB, the sacral slope, the pelvic tilt, the sagittal vertical axis as well

The SBP exercise improved the Cobb angle very significantly. This is consistent with previous findings [17, 20, 21, 31, 32] in AIS patients. Curves of adult AIS patients can be reduced through multi-modal rehabilitation approaches [13, 14, 16]. SEAS (Scientific Exercise Approach to Scoliosis Exercises) [15, 17], Schroth [18] and side shift exercises [31] have been reported to reduce curve severity in adult AIS patients. Negrini et al. reported an adult AIS female, aged 25 with a double curve, treated by SEAS for 1 year. The main lumbar curve reduced from 47 to 28.5° [15]. Similarly, Yang et al. reported an AIS adult female with thoracic Cobb angle of 20.51°, treated by stretching, SBP, and strengthening exercises. In 8 weeks, the Cobb angle reduced to 16.35° [18]. Side shift exercises were also reported to reduce the Cobb angle of 69 patients with a mean age of 16.3 years. After an average follow up of 4.2 years, the mean Cobb angle reduced from 31.5 to 30.3° [31]. A retrospective cohort study also showed that curves of adult AIS patients can be reduced through SEAS. After 2 years of intervention, 68% experienced an improvement which averaged 4.6°. On average, the thoracolumbar curve reduced by 3° and the lumbar curve reduced by 3.6°. The improvement, however, was not statistically significant [17]. In comparison, our results showed that the improvement rate was 33.3%, when 6° curve reduction was regarded as an improvement. The average improvement was 4.2°. The findings closely matched that of the study by Negrini et al. [17]. It has, however, to be noted that not all of the patients in the present study had adult AIS.

Interestingly, nonscoliosis specific exercises have also been found to improve the Cobb angle in AIS and DLS patients [32]. Fishman et al. found that performing side plank yoga pose with the curve convexity facing downwards, for as long as possible once daily for 3–22 months resulted in an improvement of the Cobb angle [32]. The side plank yoga pose improved the Cobb angle in the 12 patients with DLS, from an average of 50.4–33.1° [32]. Yet, the study has a number of weaknesses and limitations. The study included patients with Cobb angle as small as 6°. Strictly speaking, these patients should not be regarded as suffering from scoliosis. Also, a reduction of 3° Cobb was regarded as improvement, though curve improvement is defined Glassman et al., in a study in 2005, showed that a coronal imbalance of 4 cm is associated with deterioration of pain and function scores in unoperated patients [12]. Similarly, Ploumis et al. showed that a coronal imbalance of 5cm is associated with a reduction in functionality [33]. Also, trunk shift is a predictor of surgery for patients with thoracolumbar and lumbar curvatures [34]. Lafage et al., however, showed no correlation between clinical outcomes and coronal global balance [35]. The magnitude of the coronal deformity did not impact pain and disability [35].

In the present cohort, the largest coronal offset was only 11.6 mm at baseline (**Table 2**). At ninth month, seven patients had an increase in coronal imbalance but five had an improvement. Yet, the change was small and was possibly clinically insignificant. The worsening of the coronal imbalance in some of the subjects is believed to be a result of the compensation to realign the spine by reducing the Cobb angle. The increase did not reach statistical significance.
