Layout 1 New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 Scoliosis encompasses a range of pathologies marked by alterations in the shape and positioning of the spinal column, thorax, and trunk and it is a condition characterized by a complex, three-dimensional deformity of the spine, which includes lateral curvature and vertebral rotation. This deformity affects the frontal, coronal, and sagittal planes.1 Adolescent Idiopathic Scoliosis (AIS)2 stands as the most prevalent type of structural spinal deformity, with a doc- umented prevalence in the literature ranging from 0.47% to 5.20%. It is defined by a radiological lateral Cobb angle equal to or exceeding 10 degrees.3 The Cobb’s angle is the angle formed by the extension lines of the upper-end plate of the most inclined vertebral body within the curved seg- ment and the lower end plate of the most inclined vertebral body below. This measurement is taken from posteroante- rior X-rays of the spine, conducted in an up-right position, encompassing both the pelvis and temporomandibular joint.4 The female-to-male ratio ranges from 5:1 to 3:1 and it increases substantially with aging.5 The etiology of AIS is multifactorial involving genetic factors and environmental influences that negatively af- fecting some features of the quality of life.6 Individuals with AIS commonly exhibit chest deformities, protuber- ances, and asymmetries.7,8 Despite these conditions, pa- tients may be asymptomatic, particularly when the curvature is mild.9 Various non-invasive, radiation-free techniques have been suggested for assessing scoliosis without harmful effects, such as Moiré topography, infrared thermography, 3D scanning. These methods are generally restricted to labo- ratory settings and however, X-rays remain the gold stan- dard for diagnosing and monitoring scoliosis.10 The Italian Society of Scoliosis advises obtaining a two-view X-ray during the initial scoliosis evaluation and another X-ray at least a year later.11 Skeletal maturity is assessed using the Risser index, de- termined by the ossification degree of the iliac crest’s sec- ondary ossification core. The Risser index serves as a dependable indicator of the spine’s corresponding age.12 In girls, the age of menarche is often used as a rough Abstract The aim of the study is to compare improvement outcomes in patients (aged between 8 and 18 years old) with idiopathic scoliosis treated with a traditional technique with those treated with an innovative method. The study included 17 participants allocated into two groups: experimental (n=8) and control (n=9) groups. The first group was treated with a new method with PosturalSpine® D’Amanti method, twice a week for 30 min per session while the second group was treated with kinesitherapy and traditional tools three times week for 45 min per session. The two groups are similar in the anthropometric characteristics, in baseline Risser index and in the Cobb angles average and no statistically significant differences were found between the two groups. After one year of motor intervention, both treatment groups showed improvements in the progression of scoliotic curves and the PosturalSpine® group showed a significantly higher improvement than the control group. Our results therefore suggest that this new specific method with PosturalSpine® D’Amanti method could play a significant role in improving adolescent idiopathic scoliosis compared to traditional exercises. Key Words: kinesis; health; scoliosis; adolescent idiopathic scoliosis. Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Francesca Campoli,1,2 Maria Chiara Parisi,3 Antonino Zoffoli,4 Donatella Di Corrado,5 Vincenzo Francavilla,3 Elvira Padua,1 Giuseppe Messina1 1Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy; 2Sports Engineering Lab, Department Industrial Engineering, University Rome Tor Vergata, Rome, Italy; 3Department of Medicine and Surgery, Kore University, Enna, Italy; 4Department of Research, Italian Center Studies of Osteopathy, Catania, Italy; 5Department of Sport Sciences, Kore University, Cittadella Universitaria, Enna, Italy. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. - 33 - New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 guide: puberal spurt generally ends by the time of the menarche, and the spinal column ends its growth approx- imately two years later.13 Scoliosis worsens in the pronounced stages of devel- opment and becomes impossible to modify when the pro- liferation of the growth cartilages stops, therefore it is necessary to intervene promptly. Specific approaches differ between children/adolescents and adults due to differences in bone plasticity and skeletal maturity14 but the goal of treatment for all types of scolio- sis is the same: to slow down and/or stop the progression of the curve. Treatment involves different approaches: the observational approach, the orthopedic-kinesiological ap- proach and the surgical approach, both requiring specific involvement.15 The observational approach consists of periodic checks of the scoliotic curve and abstention from any type of treatment. This approach can be considered for all curves less than 10°, regardless of the degree of skeletal maturity. The orthopedic-kinesiological approach is based on the use of orthopedic braces or casts in asso- ciation with motor intervention and is adopted for curves between 10° and 45° and skeletal immaturity (Risser scale <3). This approach aims to control or stop its progression until skeletal maturity is reached. Surgical treatment is adopted for all curves greater than 45° and with a skeletal maturity grade <3, while it is considered for curves of slightly greater magnitude if a Risser value ≥3 is found.16 Scoliosis management also includes kinesitherapy, a set of Physiotherapy Exercises Specific to Scoliosis (PSSE) including active and passive mobilization, breathing ex- ercises and postural re-education, that can be used as an integral part of a therapeutic approach, alone or in combi- nation with bracing or surgery, depending on the individ- ual needs and indications of the patient. According to literature progression it is defined by an enhancement of 5 to 10 degrees in Cobb’s angle.17 Among adolescents with a scoliotic curvature exceeding 20° combined with imma- ture bone status, the likelihood of progression may be 70% or higher.18,19 The PosturalSpine D’Amanti method belongs to the field of kinesiotherapy management of scoliosis and it is an in- novative method of postural re-education that consists of combinations of 3D corrective movements, global and segmental muscle rebalancing exercises, selective breath- ing exercises, self-stretching exercises, anti-gravity exer- cises, proprioceptive exercises, body awareness exercises on both static and dynamic planes with oscillations on the concave areas of the deformity performed on a special bench. The PosturalSpine® bench was born in 2017, to- gether with an exercise protocol (D’Amanti method), its penultimate prototype was the subject of study at the sci- entific laboratory of the Master in Posturology and Biome- chanics of the University of Palermo and is a mechanical device with predefined oscillations. The aim of the study is to compare the improvement re- sults in patients with idiopathic scoliosis treated with tra- ditional kinesitherapy with those treated with the innovative PosturalSpine® D’Amanti method. We hypothesize that this new approach can induce signif- icant improvements in this pathology in shorter treatment times and with a more playful approach than traditional exercises. This perspective aligns with recent findings highlighting the need for improved adherence to conser- vative scoliosis treatments, as suggested by Maccarone et al. in their retrospective analysis of treatment strategies during the pandemic era.20 Similarly, Paramento et al. un- derscore the importance of neurophysiological, balance, and motion evidence in understanding AIS, advocating for a holistic approach in managing this condition.²¹ Materials and Methods Participants The participants were recruited from the Kinesis study, lo- cated in Ragusa, Italy. Out of more than 40 patients with idiopathic scoliosis aged between 8 and 18 years, the pres- ent study ultimately included 17 subjects. This reduction was due to the exclusion of male participants and the ab- sence of follow-up radiographs for some patients after the treatment period. The final sample consisted exclusively of female participants (mean age: 14±3 years; weight: 45.7±10.1 kg; height: 152.1±9.9 cm). The 17 subjects were randomly divided into an experimental group and a control group. The experimental group, called Postural- Spine group, included 8 subjects (13.1±2.6 years, Risser index 1.7±1.1, 44.7±10.2 kg, H 150.1±9.3 cm) who per- formed a postural work protocol with the use of the Pos- tural Spine bench and the control group included 9 subjects (14.8±3.2 years, Risser index 2.2±1.7, 46.5±10.6 kg, H 153.8±10.6 cm) who performed a postural work protocol. Scoliosis cases were diagnosed through orthope- dic and physiatric evaluations supported by Cobb angle measurements from radiographs. Male gender was not considered due to the small number of participants. Inclu- sion criteria were: scoliosis cases with detailed radio- graphic measurements and with up to two scoliotic curves (thoracic and lumbar) at most 40 degrees Cobb and a Risser index of less than 5. Exclusion criteria were: sco- liosis cases identified only by postural examination, sub- jects with three scoliotic curves, 5 Risser indices scoliotic curves greater than 40 degrees Cobb. The procedures were conducted in accordance with the ethical principles set out in the Declaration of Helsinki and were performed with the ethical approval of the university. The study design was approved by the Departmental Research Committee (approval number: UKE-IRBPSY-12.11.23). Before the start of the study, each participant received a full expla- nation of the study procedures and signed a written con- sent form to provide their data. For participants under 18 years of age, a consent form was signed by the parents. Procedures The control group performed traditional postural gym- nastics, based on exercises from the main re-educational methods: self-elongation, translation, derotation, breath- ing, stretching, proprioception and toning. The equip- ment used included wall bars, Bobath balls, Fit benches, six benches, Hyper benches, inclined benches, flat benches, Pivetta benches, Medusa, dynaso, Bobath - 34 - New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 swing, Daedalus, self-orthopedic, straps, wedges, cubes, mats, proprioceptive rollers, proprioceptive balls, bal- ance mats, chest shaper, elastic bands with various ten- sions, pulley systems and weights ranging from 1 to 5 kg. The PosturalSpine group, throughout the treatment, strictly followed the same principles as the control group, including body awareness, breathing, self-stretch- ing, muscle chain stretching, proprioception and trans- lation, but with the use of the PosturalSpine® bench. The PosturalSpine® equipment was the only tool used, taking advantage of its multisensory, biomechanical and pro- prioceptive features, including anti-gravity cushion, si- multaneous backrest, backrest and shoulder rest, adjustable straps and angles (Figure 1). Posturalspine® was created to accelerate postural recovery and is de- fined as: “Portable Multi-sensory Postural Gym”. The carefully calibrated corner games, the central slot, the anti-gravity cushion and the double mirrored structure induce the correction of scoliosis.22 Subjects with scoliotic curves greater than 20 degrees Cobb, in the PosturalSpine group and control group, wear the Chê- neau brace during treatment and in daily life activities. The work protocols were designed based on the Risser index, the Cobb angle and the type of scoliosis and lasted one year for both groups. The control group performed 12 sessions per month lasting 45 minutes each, the Posturl- Spine group performed 8 sessions per month lasting 30 minutes including 6 exercises lasting 5 minutes for each exercise. The exercise protocols were adapted every 12 sessions to maintain motivation and monitor training pro- gression. Measurements Considering each patient, the Cobb’s angles (both Thora- cic and Lumbar) were measured by RX technique in the beginning and at the end of the treatment. Considering the sum of the differences between the final Cobb’s angle and the initial Cobb’s angle for Thoracic and Lumbar one, it was possible to compute the total improvement of the treatment in terms of Cobb’s angle. Statistical analysis The results are expressed as mean±SD. A two-way ANOVA is used to determinate determine pre-post treat- ment differences. The significance level was performed of p<0.05. Statistical analyses were performed using the statistical software (SPSS for Windows version). Results The two groups are similar in anthropometric character- istics, baseline Risser index, and Cobb angles average before treatment, and no statistically significant differ- ences were found between the two groups. After one year of motor intervention, the progression of the scoliotic curves in adolescent subjects suffering from idiopathic scoliosis improved in both work groups. Results for each group are presented in Table 1. In the PosturalSpine group, a significant improvement in the thoracic curve was observed, with a reduction in the Cobb angle from a mean value of 22°±6.6° to 9.1°±8.7°. This re- sult, statistically significant (p=0.001), demonstrates the ef- fectiveness of the proposed motor intervention in reducing the severity of thoracic scoliosis. On the contrary, in the con- trol group, no statistically significant improvement occurred, despite the specific treatment of the condition. Regarding the lumbar curve, both groups showed im- provements, but the extent of the improvement in the PosturalSpine group was significantly greater. In particu- lar, in the PosturalSpine group, an 87% reduction in the Cobb angle occurred (p=0.02), while in the control group, a 23% reduction was observed (p=0.02). Al- though both results are statistically significant, the dif- ference in the rate of improvement between the two groups highlights the superior efficacy of the treatment proposed in the PosturalSpine group. - 35 - Figure 1. PosturalSpine® bench. (a) Anti-gravity pillow. (b) PosturalSpine® bench way of using the arms, with the button it is possible to increase or decrease the oscillations. (c) Full PosturalSpine® bench. New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 Discussion The results of our study, which compared patients with id- iopathic scoliosis treated with a traditional technique with those treated with the PosturalSpine® D’Amanti method, supported the initial hypothesis that both methodologies could induce improvements, but the treatment proposed to the PosturalSpine group produced significantly greater improvements than the control group, both in thoracic and lumbar scoliotic curves. Several studies support the importance of postural exer- cise-based treatments to improve scoliotic curves, particu- larly in the lumbar regions. Studies conducted by Monticone et al.23 have shown that targeted exercises, combined with constant clinical surveillance, can signifi- cantly reduce the Cobb angle in juvenile idiopathic sco- liosis. Other studies have also highlighted the effectiveness of non-invasive treatments in the manage- ment of scoliosis. Schreiber et al.24 demonstrated that daily exercises lasting 30-45 minutes, performed at home with weekly supervision, resulted in an improvement in the Cobb angle between 3.5° and 5.9° over 6 months. Ho- wever, compliance with treatment played a key role, as patients were responsible for independently performing the exercises. It is worth noting that while comparisons with these prior studies are valuable, our study population differed in patient demographics and severity levels of scoliosis, which may have influenced the outcomes. For example, our cohort included patients with a broader range of curve severities and a structured, supervised treat- ment environment, potentially reducing variability in ad- herence compared to the largely self-directed protocols in the Schreiber study. Polak’s study25 emphasized the role of muscle contraction in the pathogenesis and treatment of scoliosis, but it lacked long-term follow-up to evaluate the sustainability of post- treatment correction, an aspect that our study addressed with a one-year evaluation. Patient compliance was also crucial in our study, as the playful and interactive ap- proach of the PosturalSpine D’Amanti method likely im- proved adherence to treatment, contributing to better results. The 61% reduction in the PosturalSpine group rep- resents a very significant improvement. While this figure exceeds the reductions reported in other studies (where re- ductions in the Cobb angle typically range from 10% to 40%, depending on the severity and duration of interven- tion),26,27 it is crucial to contextualize these results. The clinical implications of this reduction, such as improve- ments in quality of life, functional capacity, or reduced risk of long-term complications like chronic pain, warrant further investigation to strengthen the impact of these findings. The overall results show that the motor intervention in the PosturalSpine group had a significantly greater positive ef- fect than in the control group, especially in reducing the lumbar curvature, where the improvement was almost three times higher. The treatment therefore seems particu- larly effective in reducing the progression of scoliotic curves, especially in the lumbar areas, although it also offers significant benefits in the thoracic region. The im- portance of lumbar curve correction has also been high- lighted by recent research, as the progression of untreated lumbar curves can lead to long-term functional problems, including chronic low back pain and mobility limitations.24 Despite the promising results, this study has some limita- tions. First, the one-year duration may not be sufficient to evaluate the long-term effects of the motor treatment on scoliosis. Longer follow-up studies could provide clearer data on the durability of these improvements. Further- more, it would be useful to investigate whether the ob- served improvements can be maintained or enhanced with a prolongation of the intervention. Future research could focus on larger population samples and include additional parameters, such as quality of life, pain perception, and motor function, to obtain a more comprehensive picture of the treatment’s impact. Estab- lishing the broader clinical significance of the 61% im- provement observed in the PosturalSpine group would be particularly valuable, as it could confirm the method’s po- tential to improve patients’ overall well-being and func- tional outcomes. Conclusions In conclusion, this study compared the improvement re- sults in patients with idiopathic scoliosis treated with a traditional technique to those treated with the Postual- - 36 - Table 1. Data are mean±SD Cobb degrees. ∆ p Pre Post Post/pre (%) Post/pre PosturalSpine group Toracic curve 22±6.6 9.1±8.7 -142 0.001 Lumbar curve 22.8±9.5 12.2±13.7 -87 0.02 Control group Toracic curve 19.9±5.5 9.1±7.9 -4 0.3 Lumbar curve 22.1±4.4 18±5.1 -23 0.02 New horizons for adolescent idiopathic scoliosis treatment through PosturalSpine® D’Amanti Method Eur J Transl Myol 35 (1) 13313, 2025 doi: 10.4081/ejtm.2025.13313 Spine® D’Amanti method. Exercises performed with Pos- tural Spine D’Amanti method led to an improvement in adolescent idiopathic scoliosis for both thoracic and lum- bar curves, unlike the traditional method which stabilizes the thoracic curve without improving it. Thanks to the shorter duration of each session (30 minutes instead of 45) and the lower number of sessions needed per week (twice instead of three), the PosturalSpine® D’Amanti method could increase patient compliance and tolerance to scolio- sis treatment. These findings highlight the potential of this innovative approach as a viable, efficient, and effective method for managing idiopathic scoliosis in adolescents, with significant clinical implications for improving both curve severity and patient adherence. Contributions Conceptualization, DDC and VF; methodology, VF, MCP, and AZ; formal analysis, FC, MCP and DDC; data curation, FC, MCP and DDC; writing—original draft preparation, FC, MCP and DDC; writing—review and editing, VF and DDC; supervision, EP and GM. All au- thors have read and agreed to the published version of the manuscript. Funding This research was funded by PLAB RESEARCH INSTI- TUTE, Via Sant’Agostino 31 - Palermo 90134, CF.97369770827. Conflicts of interest The authors declare no conflicts of interest. Ethics approval The study was conducted in accordance with the Decla- ration of Helsinki and the recommendations of the Ethical Code of the University of Palermo. The Code of Ethics approved by the General Assembly of the Italian Associ- ation of Psychology held on 27 March 2015. The study design obtained ethical permission from the University Enna Kore Internal Committee for research (approval number: UKE-IRBPSY-12.11.23). Informed consent Informed consent was obtained from all subjects involved in the study. Corresponding author Francesca Campoli, Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy. ORCID ID: 0009-0004-1342-5881 E-mail: francesca.campoli@uniroma5.it Co authors Maria Chiara Parisi ORCID ID: 0000-0001-9934-250X E-mail: mariachiara.parisi@unikore.it Antonino Zoffoli ORCID ID: 0009-0001-4255-4584 E-mail: antonino_zoffoli@hotmail.it Donatella Di Corrado ORCID ID: 0000-0001-8223-6671 E-mail: donatella.dicorrado@unikore.it Vincenzo Francavilla ORCID ID: 0000-0002-7337-392X E-mail: vincenzo.francavilla@unikore.it Elvira Padua ORCID ID: 0000-0001-5227-2567 E-mail: elvira.padua@uniroma5.it Giuseppe Messina ORCID ID: 0000-0003-0033-0117 E-mail: giuseppe.messina@uniroma5.it References 1. ANNS Scoliosis. Last accessed 20/11/2024. Available from:https://www.aans.org/Patients/Neurosurgical- Conditions-and-Treatments/Scoliosis 2. 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