Proprioceptive and vestibular contributions to balance control in subjects with adolescent idiopathic scoliosis: a cross-sectional clinical study.
4 affiliations
- 1Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
- 2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
- 3Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China.
- 4Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
Abstract
Adolescent idiopathic scoliosis (AIS) is a multifactorial spinal deformity, often associated with impaired balance. While postural control depends significantly on sensorimotor integration, the specific roles of proprioceptive and vestibular inputs in AIS are not fully understood. This cross-sectional study aimed to investigate the influence of proprioception and vestibular function on balance performance in individuals with AIS, and to assess the clinical applicability of the Unterberger step test as a diagnostic proxy. The study included 34 patients diagnosed with AIS, 85.3% of whom were female, with a mean age of 17.5 years. We quantified postural balance by assessing center-of-pressure sway area during a one-minute, eyes-closed quiet standing task on a force platform. Proprioceptive function was evaluated using repositioning accuracy tests for the trunk, neck, elbow, and knee with a three-dimensional motion capture system. Vestibular function was assessed via the bucket test to determine subjective visual vertical (SVV). Participants also completed the Unterberger step test to measure step displacement and rotational movement. We determined spinal curvature severity by measuring the major Cobb angle on standing radiographs. Participants had a mean major Cobb angle of 31.5°. The center-of-pressure sway area showed no significant isolated correlations with regional proprioceptive repositioning errors. However, the sway area was significantly associated with the major Cobb angle (r=-0.346, P=0.045) and SVV (r=0.342, P=0.047). Multivariable regression analyses, adjusting for potential confounders, identified significant relationships between balance performance and the major Cobb angle, trunk axial-rotation repositioning errors, and gender. Notably, SVV emerged as a unique and statistically significant predictor of balance when controlling for proprioceptive measures. Parameters derived from the Unterberger step test, such as displacement distance and degree of rotation, did not demonstrate significant associations with any proprioceptive or vestibular variables. Vestibular dysfunction was significantly associated with balance performance and may represent a clinically relevant vestibular-related factor in individuals with AIS. Although isolated proprioceptive repositioning errors were not independently associated with balance performance, they showed complex interactions with spinal curvature severity and postural stability, suggesting compensatory sensorimotor strategies.
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BibTeX
@article{lau2026proprioceptive,
title = {{Proprioceptive and vestibular contributions to balance control in subjects with adolescent idiopathic scoliosis: a cross-sectional clinical study.}},
author = {Kenney Ki Lee Lau and Kenny Yat Hong Kwan and Jason Pui Yin Cheung and Karlen Ka Pui Law and Arnold Yu Lok Wong and Daniel Hung Kay Chow and Kenneth Man Chee Cheung},
journal = {Journal of spine surgery (Hong Kong)},
year = {2026},
month = sep,
doi = {10.21037/jss-2026-0196},
url = {https://europepmc.org/article/MED/42996622},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Proprioceptive and vestibular contributions to balance control in subjects with adolescent idiopathic scoliosis: a cross-sectional clinical study.
AU - Kenney Ki Lee Lau
AU - Kenny Yat Hong Kwan
AU - Jason Pui Yin Cheung
AU - Karlen Ka Pui Law
AU - Arnold Yu Lok Wong
AU - Daniel Hung Kay Chow
AU - Kenneth Man Chee Cheung
PY - 2026
DA - 2026/09/29
JO - Journal of spine surgery (Hong Kong)
DO - 10.21037/jss-2026-0196
UR - https://europepmc.org/article/MED/42996622
AB - Adolescent idiopathic scoliosis (AIS) is a multifactorial spinal deformity, often associated with impaired balance. While postural control depends significantly on sensorimotor integration, the specific roles of proprioceptive and vestibular inputs in AIS are not fully understood. This cross-sectional study aimed to investigate the influence of proprioception and vestibular function on balance performance in individuals with AIS, and to assess the clinical applicability of the Unterberger step test as a diagnostic proxy. The study included 34 patients diagnosed with AIS, 85.3% of whom were female, with a mean age of 17.5 years. We quantified postural balance by assessing center-of-pressure sway area during a one-minute, eyes-closed quiet standing task on a force platform. Proprioceptive function was evaluated using repositioning accuracy tests for the trunk, neck, elbow, and knee with a three-dimensional motion capture system. Vestibular function was assessed via the bucket test to determine subjective visual vertical (SVV). Participants also completed the Unterberger step test to measure step displacement and rotational movement. We determined spinal curvature severity by measuring the major Cobb angle on standing radiographs. Participants had a mean major Cobb angle of 31.5°. The center-of-pressure sway area showed no significant isolated correlations with regional proprioceptive repositioning errors. However, the sway area was significantly associated with the major Cobb angle (r=-0.346, P=0.045) and SVV (r=0.342, P=0.047). Multivariable regression analyses, adjusting for potential confounders, identified significant relationships between balance performance and the major Cobb angle, trunk axial-rotation repositioning errors, and gender. Notably, SVV emerged as a unique and statistically significant predictor of balance when controlling for proprioceptive measures. Parameters derived from the Unterberger step test, such as displacement distance and degree of rotation, did not demonstrate significant associations with any proprioceptive or vestibular variables. Vestibular dysfunction was significantly associated with balance performance and may represent a clinically relevant vestibular-related factor in individuals with AIS. Although isolated proprioceptive repositioning errors were not independently associated with balance performance, they showed complex interactions with spinal curvature severity and postural stability, suggesting compensatory sensorimotor strategies.
SN - 2414-469X
SN - 2414-4630
ER -