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Gál-Pottyondy A, Petró B, Takács M, Négyesi J, Nagatomi R, Kiss RM. Compensatory muscle activation and spinal curve changes in response to fatigue among adolescent male athletes. BMC Sports Sci Med Rehabil 2023; 15:57. [PMID: 37055780 PMCID: PMC10103397 DOI: 10.1186/s13102-023-00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND The prone plank test has been often used to assess the strength and endurance of trunk muscles. We aimed to develop a new measurement protocol to objectively monitor the changes in spinal curves and muscle activity simultaneously. METHODS Eleven adolescent male basketball athletes (13-17 years) performed a one-minute plank test. Spinal curvatures (thoracic kyphosis (TK) and lumbar lordosis (LL)) were determined at each time point by optical tracking of markers placed on the spinous processes of 10 vertebrae. Eleven muscles were measured by surface electromyography to determine muscle fatigue via changes in median frequency. RESULTS TK significantly increased (p = 0.003) from the first to the last 10 s of the plank test; changes in LL were mixed within the group. Only the rectus abdominis showed consistent and significant fatigue (p < 0.001). The increased spinal curves significantly correlated with the fatigue of biceps femoris (TK: r = -0.75, p = 0.012; LL: r = -0.71, p = 0.019) indicating a compensatory muscle activation and spinal curve changes in response to fatigue. CONCLUSION Our protocol may support future researches that aim to objectively evaluate the prone plank test and which posture-related muscles need strengthening for the individual.
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Affiliation(s)
- Anna Gál-Pottyondy
- Doctoral School of Sport Sciences, Hungarian University of Sports Science, Budapest, Hungary
| | - Bálint Petró
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | | | - János Négyesi
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Fit4Race Kft, Budapest, Hungary
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rita M Kiss
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary.
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Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations. Spine (Phila Pa 1976) 2022; 47:1303-1313. [PMID: 35797644 DOI: 10.1097/brs.0000000000004411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations. SUMMARY OF BACKGROUND DATA The Roussouly classification was validated for adults. Alignment types may vary during growth. MATERIALS AND METHODS Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression. RESULTS The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age. CONCLUSION Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4. LEVEL OF EVIDENCE Level III.
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Hou C, Chen K, Chen Y, Zhou T, Yang M, Li M. Assessment of sagittal spinopelvic alignment in asymptomatic Chinese juveniles and adolescents: a large cohort study and comparative meta-analysis. J Orthop Surg Res 2021; 16:656. [PMID: 34727958 PMCID: PMC8561890 DOI: 10.1186/s13018-021-02773-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 01/10/2023] Open
Abstract
STUDY DESIGN Retrospective study and comparative meta-analysis. OBJECTIVE To document the sagittal spinopelvic alignment in a large cohort study in asymptomatic Chinese juveniles and adolescents, and to explore whether these parameters were different from various regions using meta-analysis. METHODS Medical records of 656 asymptomatic Chinese juveniles and adolescents were reviewed, whose mean age was 13.14 ± 3.41 years old, including 254 male and 402 female volunteers. Demographic and lateral radiological parameters were evaluated. Furthermore, a systematic online search was performed to identify eligible studies. Weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate whether these sagittal parameters were different from various regions. RESULTS The mean value of sagittal spinopelvic alignment in this study was calculated and analyzed respectively. Significant differences of PI (34.20 ± 4.00 vs. 43.18 ± 7.12, P < 0.001) and PT (3.99 ± 6.04 vs. 8.42 ± 7.08, P < 0.001) were found between juveniles and adolescents. A total of 17 studies were recruited for meta-analysis. For juvenile populations, TK, PI and SS of Caucasians were significantly larger than those of our study (all P < 0.001). As for adolescent populations, PI (P = 0.017), TK (P = 0.017) and SS (P < 0.001) of Caucasians was found to be greater when compared with that of our study. All in all, TK, PI and SS in Chinese pre-adult populations were significantly smaller than those populations in Caucasian regions (all P < 0.001). CONCLUSION Our study was the first large-scale study that reported the mean values of sagittal parameters in asymptomatic Chinese juveniles and adolescents. There were significant differences in TK, PI and SS between our study and other previous reported populations, which reminded us for using specific mean values in different populations when restoring a relatively normal sagittal spinopelvic balance in spinal deformity.
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Affiliation(s)
- Canglong Hou
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Kai Chen
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 200040, Shanghai, China
| | - Tianjunke Zhou
- Basic Medicine College, Navy Medical University, Shanghai, 200433, China
| | - Mingyuan Yang
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China.
| | - Ming Li
- Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, 200433, China.
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Negrini A, Vanossi M, Donzelli S, Zaina F, Romano M, Negrini S. Spinal Coronal and Sagittal Balance in 584 Healthy Individuals During Growth: Normal Plumb Line Values and Their Correlation With Radiographic Measurements. Phys Ther 2019; 99:1712-1718. [PMID: 31504925 DOI: 10.1093/ptj/pzz123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/16/2018] [Accepted: 05/05/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Plumb line distances (PDs) are widely used in conservative clinical practice to evaluate the sagittal shape of the spine. OBJECTIVE The objective was to assess the normative values of PDs in a large, healthy population in an age range representative of the adolescent population with spinal deformities, and to correlate it with x-ray measurements. DESIGN This was a cross-sectional study. METHODS Participants were 584 healthy individuals (341 females) with x-rays showing no spine deformities. The whole sample (OVERALL) was divided into 5 groups: 6 to 9 years old (n = 106); >10 years, Risser 0 with triradiate cartilage open (n = 129) or closed (n = 104); Risser 1 to 2 (n = 126); and Risser 3 to 5 (n = 119).PDs were taken by maintaining a tangent to the thoracic kyphosis apex at C7, T12, L3, and S2. Sagittal index (C7 + L3), and sagittal and coronal balances (C7 related to S2) were calculated. RESULTS In OVERALL, PDs at C7, T12, L3, and S2 were 39.9 ± 16.7, 21.4 ± 15.3, 39.9 ± 15, 20.6 ± 17.0 mm, respectively. Sagittal index was 79.8 ± 26.8, sagittal balance was 19.3 ± 17 mm anterior to S2 plumb line; 13.5% had a coronal imbalance of 11.4 ± 5.4 mm to the right and 24.7% of 13.2 ± 6.0 mm to the left. C7 and L3 PDs, sagittal index, and sagittal balance were significantly lower in ages 6 to 9 compared to older patients in Risser 1 to 2 group. C7 and S2 PDs and sagittal index were significantly larger in males. Sagittal index correlated with thoracic kyphosis Cobb degrees (r = 0.47). LIMITATIONS The participants were not randomly chosen from the general population; and they had an x-ray because of spine pathology suspicion. CONCLUSIONS This study shows normative data to be used in clinical practice. Sagittal spinopelvic alignment has gained more and more importance in the last decades because of its high correlation to Health-Related Quality of Life scores in adults. 1.
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Affiliation(s)
- Alessandra Negrini
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Massimiliano Vanossi
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Sabrina Donzelli
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Fabio Zaina
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Michele Romano
- Italian Scientific Spine Institute (ISICO), Via Roberto Bellarmino 13/1, 20141 Milano MI, Italy
| | - Stefano Negrini
- Clinical and Experimental Sciences Department, University of Brescia, Brescia, Italy; and IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Preoperative Sagittal Spinal Profile of Adolescent Idiopathic Scoliosis Lenke Types and Non-Scoliotic Adolescents: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2019; 44:134-142. [PMID: 29927859 DOI: 10.1097/brs.0000000000002748] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE This study aims to determine the differences in sagittal spinopelvic parameters between adolescent idiopathic scoliosis (AIS) Lenke types and non-scoliotic controls through a systematic review and meta-analysis of the available literature. SUMMARY OF BACKGROUND DATA AIS classification mainly focuses on frontal curve differences; however, the variations in the sagittal spinopelvic alignment in the current classification system is not fully established. METHODS Following preferred reporting items for systematic reviews and meta-analyses guidelines, searches were performed for sagittal spinal and pelvic parameters of Lenke types and non-scoliotic controls in PubMed, Scopus, EMBASE, and Cochrane databases. Selection criteria were: (1) age range 10 to 21 years; (2) Lenke types 1-6 (for AIS group) or non-scoliotic adolescents (for the control group); (3) preoperative data for T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA). (4) Written in English language. PI-LL mismatch was calculated from the weighted average of PI and LL. Publication bias between studies and within studies quality were assessed. A meta-regression compared each measured variable between groups. Thoracic (Lenke1 and 2) and thoracolumbar/lumbar (Lenke 5 and 6) scoliosis were combined and statistically compared with the control group. RESULTS Meta-analysis, including 81 AIS and 18 control studies, showed no significant differences in sagittal parameters between Lenke types and controls for LL, PI, PI-LL mismatch, SS, and SVA (P > 0.05). Publication bias was significant in Lenke 1 TK, Control LL, and Lenke 1, and 5 SVA. Stratification based on deformity region (thoracic vs. thoracolumbar/lumbar) showed no significant differences in sagittal spinopelvic parameters (P > 0.05). CONCLUSION No definitive difference was found between non-scoliotic adolescents and Lenke types in sagittal spinal and pelvic parameters. Future studies on developing a sagittal classification specific to AIS patients with a goal to improve surgical planning and outcome prediction are highly encouraged. LEVEL OF EVIDENCE 4.
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Sagittal Spinopelvic Alignment After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2019; 44:41-52. [PMID: 29889799 DOI: 10.1097/brs.0000000000002736] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The aim of this study was to determine the differences in the sagittal spinopelvic parameters between the nonscoliotic controls, preoperative, and different time points postoperative in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The postoperative changes in the sagittal profile of Lenke 1 and 5 AIS at varying time points after posterior spinal fusion (PSF) has not been rigorously demonstrated; studies performed have had conflicting results. METHODS Sagittal spinal and pelvic parameters, T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA), for Lenke 1 and 5 preoperatively, at immediate, less than 2-year, and more than 2-year postoperatively, and for nonscoliotic adolescents were searched. Differences in the sagittal spinopelvic parameters between preoperative and the follow-ups and between the nonscoliotic and pre- and postoperative AIS subtypes were calculated through meta-analysis. RESULTS A total of 22 studies on Lenke1 (1229 patients), 13 studies on Lenke5 (437 patients), and 18 studies on controls (1636 patients) were reviewed. Among all the measured variables, only PI in Lenke1 was significantly different between the final follow-up and controls, P < 0.05. In Lenke 1, SVA was significantly more anterior at the immediate postoperative than preoperative, but continued moving posteriorly up to 2-year postoperative resulting in no significant difference in the SVA position between the final follow-up and preoperative, P > 0.05. In Lenke 5, SVA was significantly more posterior at the immediate postoperative and more anterior at the final follow-up than the preoperative measurements, p < 0.05. CONCLUSIONS Continuous changes in the sagittal spinal parameters should be expected after PSF. Normalization of the sagittal spinal parameters appears to be the rule after PSF, and watchful waiting appears to be appropriate in this population when viewing the lateral X-ray postoperatively. LEVEL OF EVIDENCE 4.
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Brink Y, Louw Q, Grimmer K. The amount of postural change experienced by adolescent computer users developing seated -related upper quadrant musculoskeletal pain. J Bodyw Mov Ther 2018; 22:608-617. [PMID: 30100285 DOI: 10.1016/j.jbmt.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improved techniques of measuring sitting posture have not led to a more comprehensive understanding of poor posture, nor its association with pain. There is also an evidence gap regarding critical thresholds of sitting postural change over time related to pain production. This paper describes postural angle changes over a 12-month period, and describes the process of placing defensible cut-points in the angle change data, to better understand associations between posture change over time, and onset of upper quadrant musculoskeletal pain (UQMP). METHODS This paper reports on data captured at baseline and 12-month follow-up, in adolescents in school using computers. Four sitting postural angles, head flexion (HF), neck flexion (NF), craniocervical angle (CCA) and trunk flexion (TF), and self-reported seated UQMP in the previous month were captured at each time-point. Research questions were: 1) What is the magnitude and direction of change in each postural angle over 12 months? 2) What are best cut-points in the continuous posture change distribution to most sensitively test the association between posture change and UQMP? 3) Is gender-specific cut-points required? The 12-month posture angle change data was divided into quintiles (0-20th%; 21-40th%, 41-60th%, 61-80th%, >80th%), and the odds of UQMP occurring in each posture change quintile were calculated using logistic regression models. RESULTS Two hundred and eleven students participated at baseline, of which 153 were followed-up at one year. Both males and females with postural change into extension (which represents lesser flexion range) were more at risk for the development of UQMP, than any other group. The best cut-point for HF was 40th% (≤-3.9°), NF was 20th% (≤-2.9°) and TF was 40th% (≤-1.1°). For CCA however, change at or beyond 40th % for extension or beyond 60% for flexion was associated with UQMP. CONCLUSIONS Identification of critical postural angle change cut-points assists in considering the pain-producing mechanisms for adolescents using desk top computers.
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Affiliation(s)
- Yolandi Brink
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 19063, Tygerberg 7505, South Africa.
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P O Box 19063, Tygerberg 7505, South Africa.
| | - Karen Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia.
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Wang WJ, Liu F, Zhu YW, Sun MH, Qiu Y, Weng WJ. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone Joint Res 2016; 5:198-205. [PMID: 27231331 PMCID: PMC4921054 DOI: 10.1302/2046-3758.55.2000538] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 04/05/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Methods Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test. Results Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p < 0.001) compared with controls. In addition, patients with FI of 10° (n = 23) showed reduced lumbar lordosis and significant forward spinal inclination compared with controls, whereas those with FI > 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP. Conclusions The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population. Cite this article: W. J. Wang, F. Liu, Y.W. Zhu, M.H. Sun, Y. Qiu, W. J. Weng. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone Joint Res 2016;5:198–205. DOI:10.1302/2046-3758.55.2000538.
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Affiliation(s)
- W J Wang
- Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China
| | - F Liu
- Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China
| | - Y W Zhu
- Nanjing University Medical School, Nanjing 210008, China
| | - M H Sun
- Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China
| | - Y Qiu
- Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China
| | - W J Weng
- Nanjing University Medical School, Drum Tower Hospital, Nanjing 210008, China
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Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
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Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
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