Yoga and Botulinum Toxin Reduce Adolescent Idiopathic Lumbar Scoliosis – A Control, Randomized Study
Background: Approximately 90% of scoliosis is adolescentidiopathic (AIS). From 10–14 years of age until 20, the spine is most vulnerable. An effective non-surgical means of remediation is welcome. Design: Randomized, controlled, three-arm study assessing safety and efficacy of yoga with incobotulinum injections to reverse lumbar and thoracolumbar AIS. Methods: Private clinic setting. Non-pregnant, healthy 12–20-year-olds with AIS performed either a “placebo” yoga pose (Group 1), the side plank (Vasisthasana) with placebo injection (Group 2) or side plank with incobotulinum injections (Group 3). In Group 3, 33 IU of incobotulinumtoxin were injected into the concave-side lumbar paraspinals, quadratus lumborum at curve’s apex, and psoas with needle entry at L3–4; Group 2 received equal volumes of normal saline solution at the same locations. Random.org provided randomization. Objective: Determine safety and efficacy of increasing muscular strength symmetry in AIS. Results: Each group had 10 patients. All completed the three-month study period. Mean self-reported daily side plank time = 155 s. The mean initial lumbar curvatures for groups 1, 2 and 3 were 29.8, (SD 6.6), 37.8 (SD 8.0) and 33.0 (SD 6.31) degrees, respectively. Curves were reduced at 3 months by +1.8 (2.4), -7.8° (7.1) and -12.2°(8.79) respectively, with (p <0.001) improvement in Group 2 vs. Group 1 and Group 3 vs. Group 1. Group 3 showed the greatest improvement. Harms: one patient in Group 2, one in Group 3, with transient shoulder pain that resolved by using the forearm in the pose. Conclusion: Muscle strength asymmetry appears to be relevant to AIS treatment. Side planks performed with the convex side downward alone and side planks combined with incobotulinum injections on the concave side appeared more effective in reversing lumbar AIS than placebo exercises. Incobotulinum injections with yoga appeared to be the most effective.
