Do you take the vestibular system into account when assessing scoliosis?

When we look at scoliosis, our attention usually focuses on structure: the Cobb angle, vertebral rotation, muscle balance…
But what if the origin wasn’t purely structural? What if the problem began long before the spine started to curve?

Scientific evidence is increasingly pointing toward a hidden — yet decisive — sensory factor: the vestibular system.

 ¿Qué nos dice la ciencia?

Recent studies have revealed that in many cases of adolescent idiopathic scoliosis (AIS) there are alterations in vestibular function:

Otolith dysfunctions (especially of the utricle and saccule), which compromise the perception of verticality.

Asymmetries in vestibulo-spinal integration, which can influence postural tone and the symmetrical organization of the body in space.

In animal models, unilateral vestibular lesions during development generate spinal curvatures, even without external mechanical intervention.

 Bibliografía esencial:

1. Hawasli, Hullar & Dorward (2015) –Idiopathic scoliosis and the vestibular system
   Revisión sistemática que concluye que existe una asociación significativa entre disfunción vestibular y AIS.
   DOI: 10.1007/s00586-014-3612-7
2. Hitier et al. (2019) – Asymmetric Vestibular Perception in AIS (Frontiers in Neurology)
   AIS se asocia a umbrales elevados y asimetría en la percepción del movimiento, incluso en pruebas visuales y galvanovestibulares.
   DOI: 10.3389/fneur.2019.00604
3. Gwizdała et al. (2024) – Peripheral Vestibular Dysfunction in AIS
   Encuentran relación entre disfunción vestibular periférica, mayor ángulo de Cobb y cinetosis.
   DOI: 10.3390/children11060723

How does this relate to clinical practice?

Many adolescents with scoliosis also have a history of:

• Motion sickness in childhood.

• Clumsiness or delays in motor milestones.

• Difficulties with coordination and balance.

• Spatial disorientation.

• Poor adaptation to postural changes.

And yet, their vestibular system is never evaluated.

What can you explore as a clinician?

• Tests for subjective visual vertical (SVV) perception.

• Static and dynamic balance tests under varied sensory conditions.

• Reaction to rotational movement.

• Observation of postural control.

• Sensory and early developmental history (motion sickness, tone, milestones, fine motor skills).

And what if scoliosis were not only “structural”?

An underdeveloped otolithic system can compromise the body’s spatial organization.
The spine does not twist by chance — it twists because the body is misorganized in relation to gravity.
If the vestibular system does not provide a clear and symmetrical signal, the body seeks adaptations… and scoliosis may be one of them.

And you?

• Do you include vestibular assessment in your scoliosis evaluation?

• Have you considered the sensory influence on body organization?

• And what if your postural treatment could also start by rewiring the perception of space?

Si quieres formarte más en evaluación vestibular aplicada a la pediatría tienes un curso específico próximamente.