Layout 1 Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 Scoliosis is a complex, three-dimensional deformity of the spine, characterized by a lateral curvature and vertebral rotation that affect all three anatomical planes: frontal, coronal, and sagittal.1 The most prevalent form is Adolescent Idiopathic Scoliosis (AIS), which occurs in approximately 0.47% to 5.20% of the population. It is diagnosed when the Cobb angle, measured on spinal radiographs, exceeds 10° – the standard threshold for clinical significance.2,3 According to the Italian Society of Scoliosis, periodic radiographic monitoring is essential to assess progression and to guide therapeutic decisions.4 AIS shows a substantial gender disparity, with a female- to-male ratio ranging from 3:1 to 5:1, and it often worsens during growth spurts.5 The condition’s etiology is multi- factorial, involving both genetic predisposition and envi- ronmental influences, which may contribute to its progression and impact on patients’ quality of life.6 Clin- ically, patients may present with visible postural asym- metries, such as shoulder elevation, chest wall deformities, and trunk shifts, although milder curves can remain asymptomatic.7,8 Skeletal maturity, a critical parameter for treatment plan- Abstract Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional spinal deformity that, if untreated, can impair posture, biomechanics, and quality of life. This case report aims to present the clinical outcomes of an innovative conservative treatment approach that combines the PosturalSpine® D’Amanti Method with the Chêneau brace, in an 8-year-old patient with thoracolumbar rotosco- liosis. This integrative method may represent a novel alternative to conventional bracing or phys- iotherapy-only protocols. An 8-year-old girl diagnosed with a 32° thoracolumbar rotoscoliosis likely of hereditary origin underwent a 36-month treatment program at Studio Kinesis in Ragusa. The intervention combined a Chêneau brace with the PosturalSpine® D’Amanti Method, which includes proprioceptive and biomechanical exercises. The protocol involved eight 30-minute ses- sions per month, focusing on spinal alignment, posture, breathing, and body awareness. Radio- graphic evaluations were conducted at baseline and 10th, 24th, and 35th months. The Cobb angle improved from 32° to 12°, with the most notable reduction occurring within the first 12 months. A slight increase was observed, which may correspond with a 12.5 cm growth spurt, suggesting the influence of rapid growth on treatment outcomes. The integration of PosturalSpine® D’Amanti Method with the Chêneau brace showed encouraging results in reducing spinal curvature and en- hancing postural alignment with a noticeable reduction of rib hump in a pediatric patient. This case highlights the potential of combining kinesiotherapy and bracing in scoliosis management. However, broader studies are necessary to validate these findings and optimize protocols for long- term care, particularly during growth phases. Key Words: PosturalSpine®, adolescent idiopathic scoliosis, posturology. Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 Effective treatment of adolescent idiopathic scoliosis with the PosturalSpine® D’Amanti method and Chêneau brace. A pediatric patient case report demonstrating postural and orthotic synergy Alfredo D’Amanti,1 Francesca Campoli,2,3 Carmelo D’Amanti,2 Lucio Caprioli,3 Dorota Kostrzewa-Nowak,4 Robert Nowak,5,6 Elvira Padua,2 Giuseppe Messina2 1School of Specialization in Physical and Rehabilitation Medicine, University of Florence, Italy; 2Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, Rome, Italy; 3Sports Engineering Lab, Department of Industrial Engineering, University of Rome Tor Vergata, Rome, Italy; 4Department of Clinical and Molecular Biochemistry, Pomeranian Medical University in Szczecin, Poland; 5Institute of Physical Culture Sciences, University of Szczecin, Poland; 6Department of Pathology, Pomeranian Medical University in Szczecin, Poland. 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. - 76 - Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 ning, is commonly assessed using the Risser index, in con- junction with physiological markers such as menarche onset.9,10 Treatment options are stratified based on curve severity and skeletal maturity: i) Observation for curves <10°, re- gardless of maturity; ii) Orthopedic-Kinesiological Man- agement — combining bracing and physiotherapy — for curves between 10° and 45° in skeletally immature in- dividuals (Risser <3); iii) Surgical intervention for curves >45° in immature skeletons, or slightly larger curves if maturity (Risser ≥3) has been reached.11,12 Kinesitherapy, particularly Physiotherapy Scoliosis-Spe- cific Exercises (PSSE), plays a central role in conservative treatment. These protocols involve active mobilization (derotation), targeted breathing techniques, and neuromus- cular re-education to stabilize the corrected posture and potentially reduce curve progression with an improvement of cosmetic appearance.13,14 PosturalSpine® D’Amanti Method is an innovative ap- proach that integrates three-dimensional self-correction, self-awareness, reinforcement, and maintenance under proprioceptive stimulation, and anti-gravity techniques using a specialized therapeutic bench.15 The system is de- signed to optimize patient engagement and therapeutic ef- ficiency by allowing precise, individualized postural adjustments. Preliminary studies conducted at the Biome- chanics Laboratory of the University of Palermo suggest its potential for improved outcomes in both alignment and functional recovery. This case report aims to detail the clinical presentation, management, and outcomes of an 8-year-old patient with idiopathic scoliosis treated with a combined and innova- tive approach integrating PosturalSpine® D’Amanti Method and full-time Chêneau bracing. The purpose is to explore the potential benefits of merging biomechanical bracing with proprioceptive-based kinesitherapy as a non- surgical alternative. Case Report Initial diagnosis and family history In November 2021, an 8-year-old female (W 24 kg, H 131 cm, Risser index 0) with a pertinent family history of idio- pathic scoliosis underwent an orthopedic evaluation, which exhibited a right rib hump of 20 mm. At radiographic eval- uation, she had a 32° thoracolumbar rotoscoliosis (T5-L3). The patient did not complain of pain, and she had a seden- tary lifestyle. The research involving human participants complied with all relevant national regulations and institutional policies, and was in accordance with the tenets of the Helsinki Dec- laration. It has been approved by the authors’ institutional review boards or equivalent committees. The study design was approved by the Departmental Research Committee (approval no. UKE-IRBPSY-12.11.23). Corrective treatment and rehabilitation In March 2022, the child began corrective treatment at Stu- dio Kinesis in Ragusa, Italy. The rehabilitation program in- cluded specific exercises for the correction of scoliosis, wearing the Chêneau brace, on an innovative device called PosturalSpine® (Figure 1). This device, which Prof. Car- melo D’Amanti patented, is designed to facilitate the tar- geted correction of scoliosis through specialized movements, adapted to individual needs (Figure 2). Procedure PosturalSpine® was the only tool used. It is defined as a "Portable multisensory postural gym” and was created to accelerate postural recovery. The principles of kinesiolog- ical work with PosturalSpine® are body awareness, breath- ing, self-stretching, stretching of muscle chains, proprioception, translation, decompression, correction, strengthening, maintenance, and verticalization. Postural- Spine® allows the user to take advantage of its multisensory, - 77 - Figure 1. PosturalSpine® bench. a) Anti-gravity pillow; b) PosturalSpine® bench: Using the arms with the button, one can adjust the oscillations to personal preferences; c) Full PosturalSpine® bench. Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 biomechanical, and proprioceptive features (Figure 1). The carefully calibrated angular oscillation, the central loop, the anti-gravity cushion, and the double mirror structure induce the correction of scoliosis.16 The child wore a full-time Chêneau brace throughout the treatment and during daily life activities. The work protocol lasted 36 months (31 months of actual work and 5 months of summer break) with 8 sessions per month lasting 30 minutes. During the session, the patient worked alone with the physiotherapist or at most in a small group of four patients. Each exercise lasted from 5 to 10 minutes. The rehabilitation protocol was divided into five phases, each consisting of approximately 16 sessions. In the first phase, the focus was primarily on raising awareness of the disharmony in both static and dynamic postures. During the second, third, and fourth phases, correction exercises were introduced, incorporating more challenging angular oscil- lations to promote derotation and translation. In the last phase, the focus was on stabilization exercises, which were performed in the corrected posture, emphasizing isometric contractions. The exercise protocols were adapted every 12 sessions to maintain motivation, ensure adherence, and monitor the progression of the treatment. Measurements Four erect anteroposterior spine X-rays were taken at base- line and 10th, 24th, and 35th months to measure the thoraco- lumbar Cobb angle (Figure 3). Results At the 35-month follow-up, the patient exhibited a 15 mm reduction in the rib hump. The radiography control showed a significant improvement in the right thoracolumbar Cobb angle, which improved from 32° to 12° (Figure 4). In particular, at the 12th month, the thoracolumbar Cobb angle was even lower (7°). These findings should be cor- related with changes in the patient’s anthropometric meas- urements (Table 1). Discussion The results obtained with the PosturalSpine® D’Amanti method combined with the Chêneau brace demonstrated a significant improvement in the correction of scoliosis in a pediatric patient. Over a 35-month treatment period, the Cobb angle decreased from 32° to 12°, indicating substan- tial spinal realignment and enhanced postural control. The most notable radiographic progress occurred during the first 12 months, showing a decrease of Cobb angle from 32° to 7°. However, during the following 24 months, a mild in- crease in the Cobb angle was noticed. It coincided with a 12.5 cm growth spurt. As suggested by Duval-Baupèere’s law, the evolution of the scoliotic curve is the greatest during puberty. There- fore, the onset of puberty is known to amplify the risk of curve progression, reinforcing the need for close monitor- ing and individualized therapeutic strategies.17,18 This highlights the need for flexible treatment protocols, espe- cially during pubertal growth, when scoliosis progression tends to accelerate.19 - 78 - Figure 2. Case study while performing exercises on PosturalSpine®. Figure 3. Periodic radiographic evaluations. Figure 4. Cobb angle progression at 12, 24, and 35 months. Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 In this context, recent evidence also emphasizes the impor- tance of maintaining adequate nutritional status and bal- anced physical activity to support bone metabolism and overall musculoskeletal health, particularly during periods of rapid growth and physiological stress such as puberty.20 As defined by the Scoliosis Research Society (SRS), ther- apeutic success in bracing is achieved when a reduction of 5 or more degrees in the Cobb angle is observed at the end of treatment, compared to the initial value. Comparing our results with SRS criteria, it is evident that this interesting case demonstrates a significant improvement, with a reduc- tion of 20 degrees. However, it should be noted that the treatment cannot yet be considered complete, as the latest radiograph indicates a Risser sign of 0.16 The integration of the Chêneau brace with the innovative PosturalSpine® device adheres to the principles of Physio- therapeutic Scoliosis-Specific Exercises (PSSE), including three-dimensional autocorrection, active stabilization through intensive symmetrical activation of all stabilizing muscles, neuromotor control, proprioceptive training, bal- ance reactions, and corrective breathing techniques. Ac- cording to the 2016 SOSORT guidelines, the combined approach of PSSE and bracing is supported by Level II ev- idence and a Grade B strength of recommendation.14 Thus, PosturalSpine® was central to the intervention, en- abling the integration of multisensory inputs, proprioceptive training, and biomechanical corrections. Its anti-gravity cushion, adjustable support system, and double-structure design encouraged adherence and conscious postural ad- justments, promoting effective spinal alignment. The active involvement of the entire rehabilitation team, in- cluding the physician (orthopedist or physiatrist), orthotist, physiotherapist, and, importantly, the patient and their family, is crucial for achieving significant improvements in outcomes for idiopathic scoliosis. Compared to the other conventional approaches, this method appears to yield quicker outcomes.21 The combina- tion of dynamic, targeted exercises with structured bracing support offers a promising alternative in non-surgical sco- liosis care. Nonetheless, as this is a single-case observation, broader clinical research is needed to confirm the overall effective- ness and reproducibility of the method. Continuous mon- itoring during adolescence remains crucial to prevent relapse and maintain postural improvements over time.22 Conclusions The present case report revealed that combining exercises on PosturalSpine® with the use of the Chêneau brace offers a promising and innovative approach to scoliosis treatment in children. Full adherence was achieved through an appro- priate adaptation of the exercise protocol and the employ- ment of PosturalSpine®. However, further follow-up evaluations must be carried out, especially 1-2 years after the completion of skeletal maturity, to assess the sustained correction. Integrating advanced biomechanical technologies with tra- ditional rehabilitation methods provides a robust strategy to achieve significant improvements in idiopathic scoliosis outcomes. Limitations This case report has several limitations that should be ac- knowledged. First, it describes a single patient, which limits the generalizability of the findings. Second, no con- trol group was used to compare outcomes against standard physiotherapy or bracing alone. Third, compliance with the home-based aspects of treatment, including full-time brace use, may vary and was not objectively measured. Future studies, preferably prospective and randomized, are needed to validate these preliminary findings and de- termine the reproducibility of the results in a broader pop- ulation. Contributions ADA, CDA, conceptualization; , DKN, CDA, and GM, methodology; FC and RN, formal analysis; FC and LC, data curation; FC and ADA, writing—original draft prepa- ration; ADA and FC, writing—review and editing; EP and GM, supervision. All authors 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. - 79 - Table 1. Anthropometric values during the control x-rays. X-rays Ag e(years/months) Risser index Weight (kg) Height (cm) 1st (November 2021) 8 0 24 128 2nd (September 2022) 8.6 0 24.9 131 3rd (November 2023) 8.10 0 25.7 133.5 4th (October 2024) 10 0 30 143 Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 Conflicts of interest The authors declare no conflicts of interest. Ethics approval The study was conducted in accordance with the Declara- tion of Helsinki and the recommendations of the Ethical Code of the University of Palermo. The Code of Ethics was approved by the General Assembly of the Italian Associa- tion of Psychology on 27 March 2015. The study design obtained ethical permission from the University Enna Kore Internal Committee for research (approval no. 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 Alfredo D’Amanti ORCID ID: 0009-0008-4019-0597 E-mail: alfredo.damanti@unifi.it Carmelo D’Amanti ORCID ID: 0009-0003-5932-1909 E-mail: carmelo.damanti@gmail.com Lucio Caprioli ORCID ID: 0009-0005-4049-5225 E-mail: lucio.caprioli@uniroma2.it Dorota Kostrzewa-Nowak ORCID ID: 0000-0001-7025-3087 E-mail: dorota.kostrzewa.nowak@pum.edu.pl Robert Nowak ORCID ID: 0000-0003-3037-644X E-mail: robert.nowak@usz.edu.pl Elvira Padua ORCID ID: 0000-0001-5227-2567 E-mail: elvira.padua@uniroma5.it Giuseppe Messina ORCID ID: 0000-0002-4628-1341 E-mail: giuseppe.messina@uniroma5.it References 1. ANNS Scoliosis Available from: https://www.aans. org/Patients/Neurosurgical-Conditions-and-Treat- ments/Scoliosis Accessed 20/11/2024 2. Schreiber S, Parent EC, Khodayari Moez E, et al. 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Rev Chir Orthop Reparatrice Appar - 80 - mailto:francesca.campoli@uniroma5.it mailto:alfredo.damanti@unifi.it mailto:carmelo.damanti@gmail.com mailto:lucio.caprioli@uniroma2.it mailto:dorota.kostrzewa.nowak@pum.edu.pl mailto:robert.nowak@usz.edu.pl mailto:elvira.padua@uniroma5.it mailto:giuseppe.messina@uniroma5.it https://www.aans Effective treatment of adolescent idiopathic scoliosis Eur J Transl Myol 35 (4) 14113, 2025 doi: 10.4081/ejtm.2025.14113 Mot 1970;56:59-76. 19. Weiss HR. The growing spine and scoliosis treatment. Eur Spine J 2011;20:1372–81. 20. Amato A, Baldassano S, Cortis C, et al. Physical activ- ity, nutrition, and bone health. Hum Mov 2018;19: 77318. 21. Weiss HR. Conservative management of scoliosis: State of the art. Studies Health Technol Informat 2008;135: 68–75. 22. Negrini S, Donzelli, S, Zaina F. Adolescent idiopathic scoliosis: Rehabilitation and outcomes. Physical Ther- apy Reviews 2018;23:85–92. Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their af- filiated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submitted: 3 July 2025. Accepted: 9 August 2025. Early access: 11 September 2025. - 81 -