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Scheyerer MJ, Rohde A, Stuermer KJ, Kluenter HD, Bredow J, Oikonomidis S, Klußmann JP, Eysel P, Eysel-Gosepath K. Impact of the Vestibular System on the Formation and Progression to Idiopathic Scoliosis: A Review of Literature. Asian Spine J 2020; 15:701-707. [PMID: 33189104 PMCID: PMC8561148 DOI: 10.31616/asj.2020.0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
The physiopathogenesis of adolescent idiopathic scoliosis remains unknown. However, a multifactorial pathogenesis is being assumed. Besides biomechanical, biochemical, and genetic factors, some studies have focused on congenital or acquired abnormalities in the vestibular organ with consecutive development of scoliosis. This study aims to analyze a possible correlation between any vestibular organ congenital or acquired pathologies and scoliosis based on the current literature. Therefore, we conducted a literature search in three databases, with search terms such as “scoliosis,” “organ of balance,” “idiopathic scoliosis,” “vestibular organ,” “spine,” and “balance.” Fifteen studies were selected and used for research. The relationship between scoliosis and vestibular organ abnormalities was recorded from all included works. Seven studies demonstrated a direct correlation between vestibular organ anatomical abnormalities and the form of the scoliotic spine. Another study confirmed the influence of the pathology of the vestibular organ on scoliosis but questioned whether it had an impact on the formation or the progression of the curvature. Others demonstrated a temporal overlap of the embryonic development of the vestibular organ and the beginning of pre-scoliotic characteristics, but their relationship remained questionable. In three studies, the correlation remained unclear, and any context has been denied. It seems unlikely that an isolated vestibular disorder can trigger structural scoliosis. However, the vestibular system pathologies may certainly occur in the multifactorial genesis of idiopathic scoliosis. Whether the correlation refers to the expression or the progression of scoliosis or may even have an influence on both remains unclear. New treatment options could be derived from these findings with a positive influence on the course of the deformity.
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Affiliation(s)
- Max Joseph Scheyerer
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Axel Rohde
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Konrad Johannes Stuermer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Heinz-Dieter Kluenter
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Stavros Oikonomidis
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kathrin Eysel-Gosepath
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Duesseldorf University Hospital, Duesseldorf, Germany
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Godzik J, Frames CW, Smith Hussain V, Olson MC, Kakarla UK, Uribe JS, Lockhart TE, Turner JD. Postural Stability and Dynamic Balance in Adult Spinal Deformity: Prospective Pilot Study. World Neurosurg 2020; 141:e783-e791. [PMID: 32535057 DOI: 10.1016/j.wneu.2020.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We sought to evaluate dynamic balance and postural stability in patients with adult spinal deformity (ASD) compared with published age-matched normative data. METHODS Eleven patients with ASD were prospectively enrolled. Postural stability was tested using static and dynamic posturography; patients stood on a movable platform with an integrated force plate and performed standardized sensory organization testing (SOT), evaluating the influence of sensory processing on postural stability under 6 conditions, and motor control testing, assessing reflexive postural reactions to an external perturbation. Patient performance was compared with that of published age-matched controls. Quality of life metrics included scores on the Scoliosis Research Society-22 questionnaire, SF-36, and Morse Fall Scale. Correlations between postural stability and radiographic measurements were performed. RESULTS ASD patients demonstrated significantly lower SOT scores (P ≤ 0.03) in 5 of 6 conditions tested and greater latency of limb movement during backward translation (P = 0.04) compared with controls. Lower SOT scores were associated with a history of falls. ASD patients who self-reported falling in the previous 6 months, when compared with nonfallers, demonstrated significantly lower SOT scores (P = 0.04) and significantly lower Scoliosis Research Society-22 self-image subscores (P = 0.003). Thoracic kyphosis and mediolateral sway (predictor of falls) were positively correlated in the eyes-open and eyes-closed conditions (P ≤ 0.04). CONCLUSIONS ASD patients demonstrated impaired postural stability, diminished sensory integration, and delayed response to external perturbations compared with normal control data. Postural stability and quality of life metrics correlated with self-reported falls. These findings suggest that ASD patients have abnormal postural stability and may be at elevated risk of falls.
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Affiliation(s)
- Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Christopher W Frames
- School of Biological and Health Systems Engineering, Biological Design Program, Arizona State University, Tempe, Arizona
| | - Victoria Smith Hussain
- School of Biological and Health Systems Engineering, Biological Design Program, Arizona State University, Tempe, Arizona
| | - Markey C Olson
- School of Biological and Health Systems Engineering, Biological Design Program, Arizona State University, Tempe, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Thurmon E Lockhart
- School of Biological and Health Systems Engineering, Biological Design Program, Arizona State University, Tempe, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
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Hatzilazaridis I, Hatzitaki V, Antoniadou N, Samoladas E. Postural and muscle responses to galvanic vestibular stimulation reveal a vestibular deficit in adolescents with idiopathic scoliosis. Eur J Neurosci 2019; 50:3614-3626. [PMID: 31336391 DOI: 10.1111/ejn.14525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 05/14/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022]
Abstract
One of the most appealing hypotheses around the aetiopathogenesis of adolescent idiopathic scoliosis attributes the development of the spine deformity to an imbalance in the descending vestibulospinal drive to the muscles resulting in a differential mechanical pull on the spine during the early life stages. In this study, we explored this hypothesis by examining postural and muscle responses to binaural bipolar galvanic vestibular stimulation (GVS) of randomly alternating polarity. Adolescents diagnosed with idiopathic scoliosis (n = 12) and healthy age-matched controls (n = 12) stood quietly with feet together (stance duration 66-102 s), eyes closed and facing forward, while 10 short (2s), transmastoidal, bipolar square wave GVS pulses (0.3-2.0 mA) of randomly alternating polarity were delivered at varying time intervals. Responses depicted in the electromyographic (EMG) activity of bilateral axial and appendicular muscles, vertical reaction forces and segment kinematics were recorded and analysed. Scoliotic patients demonstrated smaller ankle muscle responses and a delayed postural shift to the right relative to controls during anode right/cathode left GVS. When GVS polarity was reversed, patients had a greater soleus short-latency response on the left anodal side, while the rest of the muscle and postural responses were similar between groups. Vestibular stimulation also evoked greater head and upper trunk sway in scoliotic compared with healthy adolescents irrespective of stimulus polarity. Results provide new preliminary evidence for a vestibular imbalance in adolescents with idiopathic scoliosis that is compensated by somatosensory, load-related afferent feedback from the lower limbs during the latter part of the response.
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Affiliation(s)
- Ioannis Hatzilazaridis
- Laboratory of Motor Behavior and Adapted Physical Activity, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilia Hatzitaki
- Laboratory of Motor Behavior and Adapted Physical Activity, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoleta Antoniadou
- Laboratory of Motor Behavior and Adapted Physical Activity, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthimios Samoladas
- Orthopeadics Division of Genimatas Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fortin C, Pialasse JP, Knoth IS, Lippé S, Duclos C, Simoneau M. Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis. Clin Neurophysiol 2019; 130:1752-1761. [PMID: 31401484 DOI: 10.1016/j.clinph.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims at examining the cortical dynamics of sensorimotor information processing related to balance control in participants with adolescent idiopathic scoliosis (AIS) and in age-matched controls (CTL). METHODS Cortical dynamics during standing balance control were assessed in 13 girls with AIS and 13 age-matched controls using electroencephalography. Time-frequency analysis were used to determine frequency power during ankle proprioception alteration (ankle tendons co-vibration interval) or reintegration of ankle proprioception (post-vibration interval) with or without vision. RESULTS Balance control did not differ between groups. In the co-vibration interval, a significant suppression in alpha (8-12 Hz) and beta (13-30 Hz) band power and a significant increase in theta (4-7 Hz) band power were found respectively in the vision and non-vision condition in the AIS group compared to the CTL group. In the post-vibration interval, significant suppressions in beta (13-30 Hz) and gamma (30-50 Hz) band power were observed in the AIS group in the non-vision condition. CONCLUSION Participants with AIS showed brain oscillations differences compared to CTL in the sensorimotor cortex while controlling their balance in various sensory conditions. SIGNIFICANCE Future study using evaluation of cortical dynamics could serve documenting whether rehabilitation programs have an effect on sensorimotor function in AIS.
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Affiliation(s)
- Carole Fortin
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada.
| | - Jean-Philippe Pialasse
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
| | | | - Sarah Lippé
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada; Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Cyril Duclos
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Institut de Réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada
| | - Martin Simoneau
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, Québec, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada
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Yagi M, Ohne H, Kaneko S, Machida M, Yato Y, Asazuma T. Does corrective spine surgery improve the standing balance in patients with adult spinal deformity? Spine J 2018; 18:36-43. [PMID: 28549902 DOI: 10.1016/j.spinee.2017.05.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/06/2017] [Accepted: 05/19/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of corrective spine surgery on standing stability in adult spinal deformity (ASD) has not been fully documented. PURPOSE To compare pre- and postoperative standing balance and posture in patients with ASD. STUDY DESIGN/SETTING This study is a prospective case series. PATIENT SAMPLE Standing balance before and after corrective spine surgery was compared in 35 consecutive female patients with ASD (65.6±6.9 years, body mass index 22.3±2.7 kg/m2, Cobb angle 50.2±19.2°, C7 plumb line 9.3±5.6 cm, and pelvic incidence-lumbar lordosis mismatch 40.8±23.3°). OUTCOME MEASURES The Scoliosis Research Society Patient Questionnaire, the Oswestry Disability Index, and force-plate analysis were used to evaluate the patient outcomes. MATERIALS AND METHODS We reviewed patient charts and X-rays and compared standing balance before and after corrective spine surgery. All subjects were assessed by force-plate analysis using optical markers while standing naturally on a custom-built force platform. The spinal tilt, pelvic obliquity, pelvic tilt, and joint angle were calculated. The lower leg lean volume was obtained by whole-body dual X-ray absorptiometry to assess muscle strength. RESULTS ASD patients showed significant differences between the left and right sides in ground reaction force (dGRFs), hip (dHip), and knee angle (dKnee) while standing (dGRF 15.1±8.7%, dHip 7.1±6.6°, dKnee 5.9±5.5°). The recorded center-of-gravity (CoG) area was not improved after surgery, whereas the dGRF, dHip, and dKnee all decreased. The spinal tilt, pelvic obliquity, and pelvic tilt were all significantly improved after surgery. We found significant correlations between the radiographic trunk shift and the postoperative coronal CoG distance and recorded CoG area, and between the sagittal CoG distance and the age and the lean volume of the lower extremities (trunk shift R=0.33, 0.45; age R=0.32; lean volume R=0.31). CONCLUSIONS Corrective spinal surgery improved the spinal alignment and joint angles in patients with ASD but did not improve the standing stability. A correlation found between the sagittal CoG distance and the lean volume of the lower extremities indicated the importance of the leg muscles for stability when standing, whereas a correlation found between the coronal CoG distance and trunk shift reflected the attenuated postural response in the ASD patients.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Hideaki Ohne
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Shinjiro Kaneko
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Masafumi Machida
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Takashi Asazuma
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
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Abstract
STUDY DESIGN A prospective case series. OBJECTIVE The aim of this study was to compare the standing balance and posture between patients with adult spinal deformity (ASD) and healthy volunteers (HVs). SUMMARY OF BACKGROUND DATA The effect of ASD on standing posture and balance has not been fully documented. METHODS Forty consecutive female patients with ASD (65.4 ± 6.7 yrs, Cobb angle 48.6 ± 20.2°, C7PL 9.1 ± 6.4 cm, and PI-LL 41.1 ± 25.2°) and 33 matched HV (72.4 ± 4.6 yrs) were included. We reviewed charts and x-rays from ASDs and categorized the patients as having a PI-LL mismatch that was severe (>20°) or moderate (10°<PI-LL<20°). We compared the standing balance with that of 33 matched HVs. All subjects underwent motion analysis while standing naturally on a custom-built force platform using optical markers on the ear canal and on all joints and spinal processes. The distances from the center of gravity (CoG) to the head, heel, and sacrum were also measured, and the spinal tilt, pelvic obliquity, and pelvic tilt were calculated. RESULTS There were significant differences between the ASDs and HVs in the recorded CoG area (RecCoG), and the left-to-right differences in ground reaction force (dGRF), hip angle (dHip), and the knee angle (dKnee) while standing. The sagittal CoG distance, head-CoG distance, and sacrum-CoG distance were significantly worse in ASDs. Multiple regression analysis showed a significant correlation between two-dimensional head deviation and hip angle, thoracolumbar kyphosis, spinal tilt, and head-sacrum distance in the severe PI-LL mismatch group and in knee angle, pelvic obliquity, and pelvic retroversion in the moderate PI-LL mismatch group. CONCLUSION ASDs had significantly worse standing balance, and were found to compensate for spinal malalignment mostly through the knee and pelvis in both the coronal and sagittal planes to maintain the CoG. As a surrogate of this compensation, we observed significant head deviation, pelvic shift, and truncal sway in ASDs. LEVEL OF EVIDENCE 4.
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