Adult Scoliosis Isn’t Just a Curve Problem

Rib–pelvis impingement drives pain and limits mobility in non-surgical adults.

What’s Driving the Pain?

Iliocostal impingement (ICS) predominates in non-surgical adult scoliosis.

In a Mount Sinai cohort of 46 non-surgical adults with symptomatic scoliosis, iliocostal impingement emerged as the dominant clinical driver, reframing the approach to the management of adult scoliosis.

This was a frail, ambulatory population with limited operative options and poor tolerance of conventional prefabricated TLSOs.

Primary Indications at Intake (N = 46) Iliocostal Impingement (ICS) 83% Postural Collapse / Imbalance 63% Kyphosis 35% Complex Spine / PJK 7% Post-Fusion 7% Indications are not mutually exclusive; multiple may apply per patient.

Who Were These Patients?
A complex, non-surgical adult scoliosis cohort.

The Cohort (N=46)

  • Mean age 72 (34–96 yrs)

  • 91% female (42F / 4M)

  • Mean BMI 23 kg/m²

  • 85% Core Therapy

  • 11% Prior Brace

Inclusion Profile

  • Cobb ≥ 30°

  • Progression ≥ 5°/year

  • Non-surgical, ambulatory

Curve Pattern Distribution (N = 46) Thoracolumbar 57% (n=26) Thoracic 32% (n=15) Lumbar 16% (n=7) Note: Patients may have >1 curve type; n reflects the number of patients with each pattern.
Pain Severity Shifts In-Brace
67% improved by ≥1 severity grade; mean in-brace reduction ≈ 2 NRS points
Unbraced Braced 56% 33% 11% 13% 48% 39% Severity distribution shifts while braced Mild Moderate Severe Percent of cohort by pain severity category: unbraced vs. braced.

89% presented with moderate–severe pain at intake.

What This Means for Practice

Relieving the rib–pelvis interface mitigates pain in non-surgical adult scoliosis.

In this cohort of 46 complex, ambulatory adults, addressing iliocostal impingement was associated with meaningful shifts in pain severity and high initial brace tolerance.

All patients were fit with a digitally designed ICON Adult Scoliosis (L1007) orthosis, with no early discontinuations.

Design Lessons

  • Phenotype-specific geometry reduces bulk and focal pressure

  • Digital design workflow enables scalable correction and customization

  • Preloaded lateral force improves midline balance across three planes

  • Adjustable tension allows daily modulation of corrective force

Clinical Insight

Adult scoliosis bracing should not focus solely on curve magnitude. Targeted rib–pelvis interface management may be central to improving pain response, postural balance, and wearability in non-surgical adults.

Full cohort analysis is ongoing.

References

[1] Glassman SD et al. Eur Spine 2005; 14(9):802-809.
[2] Brubaker M, Sinaki M. Prosthet Orthot Int. 2016; 40(3):384–7.[3] Schwab FJ et al. Spine 2010; 35(25):2224-2231.
[4] Maruyama T et al. Scoli Spinal Disord 2016; 11:15.
[5] Cho KJ, et al. Asian Spine J. 2014 Jun;8(3):371-81.
[6] McAviney J, et al. Eur Spine J. 2020 Dec;29(12):2960-2969.

Proceedings of the American Academy of Orthotists and Prosthetists Annual Meeting & Scientific Symposium, February 18-20, 2026, Nashville, TN

Digitally Designed Adult Scoliosis Orthosis:

A Phenotype-driven Method For Relieving Iliocostal Impingement Syndrome

Rauch, I.¹, Mucollari, O.², Kurapatti, M.², May, C³, Albin, B.³, and Lonner, B.²

¹Orthotic Consultants, Inc., New York, NY, ² Dept of Orthopaedics, Icahn School of Medicine, Mt. Sinai Hospital, New York, NY, ³mign, Inc., Charlotte, NC

AOPA 2025

Shifting the Shift:

A Novel Bracing Strategy For Iliocostal Impingement Syndrome in Senior Scoliosis

Rauch, I.¹, Mucollari, O.², Dix, E.³, May, C.³, and Lonner, B.²

¹Orthotic Consultants, Inc., New York, NY, ²Dept of Orthopaedics, Icahn School of Medicine, Mt. Sinai Hospital, New York, NY, ³mign, Inc., Charlotte, NC

Synopsis

Iliocostal impingement syndrome (ICS) is a common yet overlooked cause of pain and functional decline in older scoliosis patients. Static, compressive, bulky OTS bracing fails to address asymmetry, the mechanical leverage needed for postural shift, and may interfere with respiratory mechanics. The mign Adult Scoliosis Orthosis, a dynamic, phenotype-driven solution, facilitates midline correction, alleviates ICS pain, and restores function. These findings support digitally-designed bracing as a viable, patient-centered alternative for non-surgical adult scoliosis management.

Case Video: Ambulation with Orthosis

Ambulatory footage of the patient described in the case report, demonstrating improved posture and mobility while wearing the orthosis.

Video presented for scientific and educational purposes.

Diagram showing digital treatment plan for spinal correction: X-ray, postural bias photo, digitally corrected scan overlay, rendered brace, and a person wearing the custom brace on their back.

Digital Treatment Plan overview for Personalized Adult Scoliosis orthosis design.

Thank you for your interest in our work.

For further information regarding this case report, please complete the form.

Isabelle Rauch, CO

19 W 57th St #1514
New York, NY 10019
orthoticconsultantsinc@gmail.com