Scoliosis induced by asymmetric lordosis and rotation: an experimental study

Musculoskeletal and tendinous details of selected anomalies in the locomotor system of anurans

Previous studies on anuran anomalies predominantly examine isolated cases or focus on external and skeletal features. Our study analyzes a comprehensive sample collected from 1991 to 2017, examining the muscle-tendon system in 24 anuran species across adult, juvenile, and metamorphic stages. This extensive sample size allows us to investigate consistent anomaly patterns across different developmental stages and anuran families, exploring potential common developmental or genetic factors. Our detailed anatomical examination, encompassing musculature, tendons, and skeletal structures, revealed that 21% of the specimens displayed anomalies, a noteworthy finding considering the extensive sample size and duration of the studied sample. Of these anomalies, 17% affected the locomotor system, predominantly in the upper limbs. Key anomalies included, forelimbs and hindlimbs brachydactyly, rotation in forelimbs, partial kyphotic lordosis, and scoliosis. Notably, the digit 4 in the forelimbs and digits 4 and 5 in the hindlimbs were particularly susceptible to teratogenic effects, indicating possible prolonged exposure during development. Our study also uncovered combinations of anomalies and identified a phenotype similar to Poland syndrome. The findings validate the "Logic of Monsters" (LoMo theory) by Alberch, although the name itself may not be deemed appropriate, showing that developmental disruptions in tetrapods are not random but follow distinct sequences and patterns. The name, while unfortunate, accurately reflects the unusual nature of these developmental anomalies. This contributes to the evolving "Evo-Devo-Path" framework, highlighting the study's importance in understanding developmental disruptions in tetrapods.

Relationship between autophagy, apoptosis and endoplasmic reticulum stress induced by melatonin in osteoblasts by septin7 expression

Melatonin secreted by the pineal body is associated with the occurrence and development of idiopathic scoliosis. Melatonin has a concentration-dependent dual effect on osteoblast proliferation, in which higher concentrations can inhibit osteoblast proliferation and induce apoptosis; however, the underlying mechanism remains unclear. In the present study, flow cytometry was used to demonstrate that osteoblast cells treated with melatonin exhibited significantly increased early and late stage apoptotic rates as the concentration increased. Chromatin condensation in the nucleus and apoptotic body formation could be observed using fluorescent microscopy in osteoblast cells treated with 2 mM melatonin. Western blotting results showed that there was an upregulation in the expression of apoptosis marker proteins [poly (ADP-ribose) polymerase 1 (PARP-1)], endoplasmic reticulum stress [ERS; C/EBP homologous protein (CHOP) and glucose-regulated protein, 78 kDa (GRP78)] and autophagy [microtubule-associated protein 1 light chain 3β (LC3)-I/LC3II]. PARP-1 expression was not altered when treated with ERS inhibitor 4PBA and autophagy inhibitor 3MA, whereas 4PBA or 3MA in combination with 2 mM melatonin (or the three together) significantly increased PARP-1 expression. Furthermore, the use of septin7 small interfering RNA confirmed that increased expression of GRP78 and CHOP was related to septin7, and melatonin- mediated ERS was necessary for septin7 activation. These findings suggest that ERS and autophagy might occur in the early stage of treatment with a high concentration of melatonin, and each might play a protective role in promoting survival; in a later stage, ERS and autophagy might interact and contribute to the induction of apoptosis. Overall, the results indicated that septin7 may be a target protein of melatonin-induced ERS.

Effect of neurocentral cartilage destruction on spinal growth in immature rabbits

OBJECTIVE

This study was performed to observe the effect of neurocentral cartilage (NCC) destruction on spinal growth in immature rabbits.

METHODS

The NCC of the lumbar vertebrae of 24 4-week-old female rabbits was destroyed through posterolateral and anterior approaches, and three-dimensional computed tomography examinations were performed 3 months after the procedure.

RESULTS

Scoliosis was successfully induced in all rabbits of both the anterior and posterolateral approach groups. The scoliosis exceeded 10 degrees in three rabbits, which exhibited coronal scoliosis of the spine, unequal length and thickness of the bilateral pedicles, and rotation of the vertebrae. Scoliosis was not observed in the control group.

CONCLUSIONS

Destruction of the unilateral NCC in immature rabbits can induce structural scoliosis, similar to the pathological features of human scoliosis. The Cobb angles are similar after NCC destruction by a posterolateral approach and under direct vision via the anterior approach.

Disturbance of rib cage development causes progressive thoracic scoliosis: the creation of a nonsurgical structural scoliosis model in mice

BACKGROUND

The pathomechanism underlying idiopathic scoliosis remains unclear, and, to our knowledge, a consistent and relevant animal model has not been established previously. The goal of this study was to examine whether a disturbance of rib cage development is a causative factor for scoliosis and to establish a nonsurgical mouse model of progressive scoliosis.

METHODS

To examine the relationship between rib cage development and the pathogenesis of progressive scoliosis, a plastic restraint limiting anteroposterior rib cage development was placed on the chest of four-week-old mice. All mice were evaluated with whole-spine radiographs, and the severity of scoliosis was consecutively measured. The rib cage rotation angle and the anteroposterior chest dimension were measured with use of micro-computed tomography scanning. To examine whether the imbalanced load transmission through the ribs to the vertebral body was involved in our model, we performed a rib-neck osteotomy in a subgroup of the mice.

RESULTS

The thoracic restraint did not provoke spinal curvature immediately after it was applied, but nine of ten mice that wore the restraint but did not have rib osteotomy gradually developed progressive scoliosis. Radiographs and computed tomography images showed a right thoracic curvature, vertebral rotation, and narrow chest in the mice that had worn the restraint for eleven weeks but did not have rib osteotomy even after the restraint was removed. The anteroposterior chest dimension was significantly correlated with both the curve magnitude and the rib cage rotation angle. The progression of spinal deformity was observed only during the adolescent growth spurt, and it plateaued thereafter. The left-side rib osteotomy led to the development of progressive left-thoracic curvature, whereas the bilateral rib osteotomy did not cause scoliosis, even with restraint wear.

CONCLUSIONS

We established a nonsurgical experimental model of progressive scoliosis and also demonstrated that a rib cage deformity with an imbalanced load to the vertebral body resulted in progressive structural scoliosis.

The creation of scoliosis by scapula-to-contralateral ilium tethering procedure in bipedal rats: a kyphoscoliosis model

STUDY DESIGN

Randomized trial.

OBJECTIVE

To create a new scoliotic model.

SUMMARY OF BACKGROUND DATA

Although there were a lot of modeling techniques producing scoliosis, failed was the creation of a scoliotic animal model all characterized by the evident axial rotation of vertebrae body, the simulation of the human erect posture, and avoiding direct traumas to the spine, the spinal cord, ribs, or glands in modeling techniques.

METHODS

A total of 45 4-week-old female wistar rats were randomly divided into three groups. Group 1 underwent subcutaneous left scapula-to-contralateral ilium tethering procedure with a nonadsorbable suture, which made the spine convex toward right side, and then removed forelimbs and tails of rats to create the bipedal rats. Tethering sutures were cut at postoperative eighth week, and the spines of rats were then observed during 2 weeks. Group 2 was the same as group 1 but in which scapula-to-ipsilateral ilium tethering procedure was performed. Group 3 was the same as group 1 except that the bipedal rats were not created. All postoperative rats were fed separately in special high cages for groups 1 and 2 or in standard cages for group 3.

RESULTS

At 2 weeks after tether release, the incidence of vertebral rotation was significantly higher in group 1 than in group 2 (P = 0.004). The differences in degrees of scoliosis and kyphosis between groups at the time of initial tethering were not found to be significant (P > 0.05), whereas those at 2 weeks after tether release were significantly larger in group 1 than in group 3 (P < 0.01). There were no significant differences in postoperative first food-taking duration, body weight, spinal relative length, modeling mortality, the incidences of reoperation, and scoliosis between groups (all P > 0.05).

CONCLUSION

The scoliotic model created by scapula-to-contralateral ilium tethering procedure in bipedal rats can preferably simulate the human scoliosis.

Experimental animal models in scoliosis research: a review of the literature

BACKGROUND CONTEXT

Many animal species and an overwhelming variety of procedures that produce an experimental scoliosis have been reported in the literature. However, varying results have been reported on identical procedures in different animal species. Furthermore, the relevance of experimental animal models for the understanding of human idiopathic scoliosis remains questionable.

PURPOSE

To give an overview of the procedures that have been performed in animals in an attempt to induce experimental scoliosis and discuss the characteristics and significance of various animal models.

STUDY DESIGN

Extensive review of the literature on experimental animal models in scoliosis research.

METHODS

MEDLINE electronic database was searched, focusing on parameters concerning experimental scoliosis in animal models. The search was limited to the English, French, and German languages.

RESULTS

The chicken appeared to be the most frequently used experimental animal followed by the rabbit and rat. Additionally, scoliosis has been induced in primates, goats, sheep, pigs, cows, dogs, and frogs. Procedures widely varied from systemic to local procedures.

CONCLUSIONS

Although it has been possible to induce scoliosis-like deformities in many animals through various ways, this always required drastic surgical or systemic interventions, thus making the relation to human idiopathic scoliosis unclear. The basic drawback of all used models remains that no animal resembles the upright biomechanical spinal loading condition of man, with its inherent rotational instability of certain spinal segments. The fundamental question remains what the significance of these animal models is to the understanding of human idiopathic scoliosis.

Impact of visual and somatosensory deprivation on dynamic balance in adolescent idiopathic scoliosis

STUDY DESIGN

A cross-sectional study of balance control in adolescents with idiopathic scoliosis (AIS).

OBJECTIVE

To investigate the impact of visual and somatosensory deprivation on the dynamic balance in AIS patients and to discuss electromyographic (EMG) and posture sway findings.

SUMMARY OF BACKGROUND DATA

Most studies focus on posture sway in quiet standing controls with little effort on examining muscle-activated patterns in dynamic standing controls.

METHODS

Twenty-two AIS patients and 22 age-matched normal subjects were studied. To understand how visual and somatosensory information could modulate standing balance, balance tests with the Biodex stability system were performed on a moving platform under 3 conditions: visual feedback provided (VF), eyes closed (EC), and standing on a sponge pad with visual feedback provided (SV). Muscular activities of bilateral lumbar multifidi, gluteus medii, and gastrocnemii muscles were recorded with a telemetry EMG system.

RESULTS

AIS patients had normal balance index and amplitude and duration of EMG similar to those of normal subjects in the balance test. However, the onset latency of right gastrocnemius was earlier in AIS patients than in normal subjects. In addition, body-side asymmetry was noted on muscle strength and onset latency in AIS subjects. Under EC condition, lumbar multifidi, and gluteus medii activities were higher than those under SV and VF conditions (P < 0.05). Under SV condition, the medial-lateral tilting angle was less than that under VF and EC conditions. In addition, the active duration of right gluteus medius was shorter under SV condition (P < 0.05).

CONCLUSION

The dynamic balance control is particularly disruptive under visual deprivation with increasing lumbar multifidi and gluteus medii activities for compensation. Sponge pad can cause decrease in frontal plane tilting and gluteus medii effort. The asymmetric muscle strength and onset timing are attributed to anatomic deformation as opposed to neurologic etiological factors.

Scoliosis model created by pedicle screw tethering in immature goats: the feasibility, reliability, and complications

STUDY DESIGN

An in vivo model of scoliosis was established in immature goats.

OBJECTIVE

To assess the feasibility, reliability, and complications of the innovative animal model.

SUMMARY OF BACKGROUND DATA

Among the methods of creating a scoliotic model, posterior asymmetric tethering of spine yielded encouraging results. However, some shortcomings associated with the use of posterior asymmetric tether are apparent.

METHODS

Fourteen female goats (age: 5-8 weeks old, weight: 6-8 kg), were instrumented and tethered using unilateral pedicle screws and contralateral rib resections. Twelve of the goats were followed up for 8 weeks by serial radiography. Six goats were removed of the posterior load and no treatment was given. Two goats were selected randomly from the 6 animals and subjected to computed tomography (CT) three-dimensional reconstruction after another 8 weeks. All the 6 goats were killed and spine specimens were harvested for histologic study 16 weeks after observation.

RESULT

Radiographic observation showed that 12 goats developed scoliosis with convex toward the right side, and the curvature increased with time in 11 goats, and it remained unchanged in 1 animal. The angle immediately after the procedures averaged 29.0 degrees (23 degrees -38 degrees ) and increased to an average of 43.0 degrees (36.0 degrees -58.0 degrees ) over a period of 8 to 10 weeks, with average angle increment being 14.0 degrees (P < 0.001). The curvature ceased to increase in 6 goats during the subsequent 2 months after the tether were removed (P > 0.05). Three-dimensional CT reconstruction revealed that the vertebral bodies were wedged, the 2 sides of the thoracic skeleton were asymmetric, and the vertebrae in the major curve were rotated. Histologic study revealed that the goats remained in growth stage and the growth potential of 2 sides of the spine was not identical.

CONCLUSION

Radiography and three-dimensional CT reconstruction of vertebrae revealed that the architectural alterations found in the model were similar to those of idiopathic-type deformity observed in clinical practice.

The internal pressure and stress environment of the scoliotic intervertebral disc — a review

The aetiology, in terms of both initiation and progression, of the deformity in idiopathic scoliosis is at present unclear. Even in neuromuscular cases, the mechanisms underlying progression are not fully elucidated. It is thought, however, that asymmetrical loading is involved in the progression of the disease, with evidence mainly from animal studies and modelling. There is, however, very little direct information as to the origin or mechanism of action of these forces in the scoliotic spine. This review describes the concept of intervertebral disc pressure or stress and examines possible measurement techniques. The biological and mechanical consequences of abnormalities in these parameters are described. Future possible studies and their clinical significance are also briefly discussed.

Techniques of pressure measurement have culminated in the development of ‘pressure profilometry’, which provides stress profiles across the disc in mutually perpendicular axes. A hydrated intervertebral disc exhibits mainly hydrostatic behaviour. However, in pathological states such as degeneration and scoliosis, non-hydrostatic behaviour predominates and annular peaks of stress occur. Recent studies have shown that, in scoliosis, high hydrostatic pressures are seen with asymmetrical stresses from concave to convex sides. These abnormalities could influence both disc and endplate cellular activity directly, causing asymmetrical growth and matrix changes. In addition, disc cells could be influenced via nutritional changes consequent to end-plate calcification.

Evidence suggests that the stress environment of the scoliotic disc is abnormal, probably generated by high and asymmetrical loading of non-muscular origin. If present in the scoliotic spine during daily activities, this could generate a positive feedback of cellular changes, resulting in curve progression. Future advances in understanding may rely on the development of computer models owing to the difficulties of in-vivo invasive measurements.

Muscle study in experimental scoliosis in rabbits with costotransversectomy: evidence of ischemic process

Scoliosis involves the central nervous system diseases, ligaments, articulations and skeletal muscles, but there is no consensus on its pathogeny and progression of muscle abnormalities. In this study, we investigate the morphologic changes in the muscle of rabbit submitted to experimental scoliosis, with special emphasis on abnormalities related to blood supply. We studied 26 rabbits subjected to costotransversectomy by pulling out six transverse processes at thoracic level and six rabbits were used as controls. All the animals operated upon developed scoliosis showing an average angle of 29.1 degrees on the 60th day, with its apices located at T4 and T12 when they were subjected to paraspinal muscle biopsy on both sides. The muscle biopsies were subjected to histological stains and histochemical reactions, as well as to a morphometric study. On the concave side, the changes were not statistically significant regarding the control group. On the convex side conjunctive tissue proliferation, infiltration by adipose tissue, central nucleus excess, inflammatory reaction, segmental fibrosis, type 1 fiber hypertrophy, type 2 fiber hypertrophy and atrophic angular dark fibers in the unspecific esterase were statistically significant. The segmental fibrosis reached a circumscribed muscle segment, compatible with an ischemic phenomenon. The histological diagnoses on the concave side of the animals had unspecific alterations (atrophy and hypertrophy) in 13, myopathy in 3, denervation in 3 and normal in 7. The convex side diagnoses were myopathy in 14, denervation in 8, mixed in 3 and normal in 1. The procedure determined morphologic changes on the convex side indicating possible denervation or myopathy of ischemic origin.

Unilateral pedicle screws asymmetric tethering: an innovative method to create idiopathic deformity

OBJECTIVE

To evaluate the feasibility of the method that unilateral pedicle screws asymmetric tethering in concave side in combination with convex rib resection for creating idiopathic deformity.

SUMMARY OF BACKGROUND DATA

Various methods are performed to create idiopathic deformity. Among these methods, posterior asmmetric tethering of the spine shows satisfying result, but some drawbacks related to the current posterior asymmetric tether were still evident.

MATERIALS AND METHODS

Unilateral pedicle screws asymmetric tethering was performed to 14 female goats (age: 5-8 week-old, weight: 6-8 kg) in concave side in combination with convex rib resection. Dorsoventral and lateral plain radiographs were taken of each thoracic spine in the frontal and sagittal planes right after the surgery and later every 4 weeks.

RESULTS

All animals ambulated freely after surgery. For technical reasons, 2 goats were excluded (one animal died for anesthetic during the surgery, and one animal was lost for instrumental fail due to postoperative infection). Radiography showed that 11 goats exhibited scoliosis with convex toward to the right side, and as the curve increased with time, only 1 goat showed nonprogressive. The initial scoliosis generated in the progressors after the procedures measured 29.0 degrees on average (range 23.0 degrees -38.5 degrees ) and increased to 43.0 degrees on average (range 36.0 degrees -58.0 degrees ) over 8 to 10 weeks. The average progression of 14.0 degrees was measured. The curvature immediately after tethering surgery (the initial Cobb angle) did have a highly significant correlation with the final curvature (p < 0.001). The progressive goats showed an idiopathic-like deformity not only by radiography, but in general appearance.

CONCLUSION

Unilateral pedicle screws asymmetric tethering is a practical method to create experimental scoliosis, especially for those who would like to study the correction of this deformity.

Basic Science Research Related to Chiropractic Spinal Adjusting: The State of the Art and Recommendations Revisited

OBJECTIVE

The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research.

METHODS

PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project.

DISCUSSION

The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project.

CONCLUSIONS

The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.

The reciprocal relationship between thoracic and spinal deformity and its effect on pulmonary function in a rabbit model: a pilot study

STUDY DESIGN

Investigate the association between growth of the spine and thorax under conditions that create symmetric or asymmetric growth disturbances of the spine or thorax in a growing rabbit.

OBJECTIVE

Prove growth of the spine and growth of the thorax are directly related.

SUMMARY OF BACKGROUND DATA

Understanding the association between growth of the thorax and growth of the spine may explain the occurrence of thoracic insufficiency in patients with congenital scoliosis.

METHODS

Symmetric or asymmetric growth disturbances of the spine or thorax were established in 5-week-old rabbits. During growth of the rabbits, structural changes in the spine, thorax, and lung volume were assessed using serial CT scans. Measures of pulmonary function, spine, and thoracic deformity were related to one another across groups.

RESULTS

The mean Cobb angle and distortion of the thoracic cage were significantly greater for the unilateral tethered rib group. There were no significant differences in total lung volume among the experimental groups. However, the left/right lung volume ratio was significantly different for the unilateral tethered rib group compared with the control group.

CONCLUSIONS

Unilateral deformity of the spine or thorax induces both a scoliosis and thoracic cage deformity with asymmetric lung volumes.

Creation of an experimental idiopathic-type scoliosis in an immature goat model using a flexible posterior asymmetric tether

STUDY DESIGN

Longitudinal follow-up of animals after a surgically initiated scoliosis.

OBJECTIVE

To create a progressive, structural, idiopathic-type, lordoscoliotic curve convex to the right in the thoracic spine of the immature goat using a flexible posterior asymmetric tether with minimal disruption of the spinal elements along the curve.

SUMMARY OF BACKGROUND DATA

Our previous work created an experimental scoliosis model using a rigid posterior asymmetric tether to study the safety and efficacy of fusionless scoliosis treatments. Posterior asymmetric tethers, whether rigid or flexible, represent the most reliable method of creating an experimental deformity that approximates idiopathic scoliosis. Although our initial rigid model was unique in creating progressive structural scolioses without violation of the essential spinal elements along the curve, there were a number of shortcomings associated with the model. These included substantially stiff curves and unpredictability of curve progression.

METHODS

Scoliosis was created in 24 Spanish Cross X female goats (age, 6-8 weeks; weight, 8-12 kg) using a braided synthetic ligament as a left posterior asymmetric tether from T5 to L1. Convex rib resection and concave rib tethering from ribs 8 to 13 were performed without disruption of the spinal elements before tensioning of the posterior tether. All goats were followed over an 8-week period with serial radiographs to document progression of the deformity. At the end of 8 weeks, the 20 goats with progressive curves were randomized into treatment groups for a separate study. However, 6 of these 20 remained untreated in the subsequent study and, therefore, were followed for an additional 12 to 16 weeks.

RESULTS

There were two deaths in the early postoperative period due to pulmonary complications. Of the remaining 22 goats, 20 (91%) developed progressive, structural, idiopathic-type, lordoscoliotic curves convex to the right in the thoracic spine. Initial scoliosis after tethering measured 55.4 degrees on average (range, 37 degrees-75 degrees) and progressed to 74.4 degrees on average (range, 42 degrees-93 degrees) over 8 weeks. The average progression of 19.0 degrees (range, 5 degrees-33 degrees) was statistically significant (P < 0.001). The average initial lordosis after tethering measured -18.9 degrees (range, -13 degrees to -27 degrees) and progressed to -40.7 degrees on average (range, -28 degrees to -56 degrees) over 8 weeks. The average progression in lordosis of -21.8 degrees (range, -5 degrees to -43 degrees) was significant (P < 0.001).

CONCLUSIONS

This study demonstrated the effectiveness of a flexible posterior asymmetric tether in creating idiopathic-type deformities in a shorter tethering period than previously described. With substantial remaining spinal growth after the 8-week tethering period and preservation of the essential spinal elements in an undisturbed state, this model is suitable for the study of scoliosis progression and various fusionless scoliosis treatment methods.

The use of animal models in fusionless scoliosis investigations

STUDY DESIGN

Review article of current knowledge of animal models used in the investigations of fusionless scoliosis surgery.

OBJECTIVE

To provide a summary of available data on animal studies in the area of fusionless scoliosis surgery.

SUMMARY OF BACKGROUND DATA

Fusionless scoliosis surgery is an emerging treatment for patients with idiopathic scoliosis as it offers theoretical advantages over current forms of treatment. These advantages include correction of spinal deformity while preserving growth, motion, and function of the spine.

METHODS

Literature review of animal models used in the investigation of fusionless scoliosis surgery.

RESULTS

At present, the theoretical advantages of fusionless scoliosis surgery in the treatment of idiopathic scoliosis are unproven clinically. However, investigations using animal models have demonstrated promise for this new form of treatment. These studies have demonstrated the safety and efficacy of a variety of fusionless scoliosis implants in treating experimental scoliosis and in modulating spinal growth.

CONCLUSION

Fusionless scoliosis surgery offers theoretical advantages over brace treatment and surgery. Like bracing, fusionless treatments preserve growth, motion, and function of the spine. Like surgery, these treatments offer substantial correction of deformity. However, minimally invasive fusionless scoliosis surgery is less extensive than fusion surgery and may avoid adjacent segment degeneration and other complications related to fusion. Additional investigations are required to identify optimal implant strategies, to evaluate the effects of these implants of the spine and surrounding structures, and to define the appropriate patient population for these interventions.

Experimental scoliosis in an immature goat model: a method that creates idiopathic-type deformity with minimal violation of the spinal elements along the curve

STUDY DESIGN

Experimental scoliosis was created in an immature goat model.

OBJECTIVES

To create a progressive, structural, idiopathic-type, lordoscoliotic curve convex to the right in the thoracic spine of the immature goat while maintaining the anterior and posterior elements of the spine along the maximal curve in a pristine state.

SUMMARY OF BACKGROUND DATA

Progressive scoliotic curves in a small animal model have been created using a posterior asymmetric tether. However, attempts in larger animal models have had less success and typically required violation of the spinal elements.

METHODS

Scoliosis was created in 40 Spanish Cross X female goats (age 1-2 months, weight 8-12 kg) using a left posterior asymmetric tether from T5 to L1. Convex rib resection and concave rib tethering from T8 to T13 were performed before compression across the rigid construct. Goats were followed over a 6- to 15-week period with serial radiographs to document progression of the deformity.

RESULTS

Of the 40 goats that underwent posterior assymetric tethering with rib procedures, 7 (18%) encountered substantial complications (five deaths and two neurologic injuries). Of the 33 available for analysis, 27 goats (82%) developed progressive, structural, idiopathic-type, lordoscoliotic curves in convex to the right in the thoracic spine. All curves demonstrated characteristic radiographic features of idiopathic scoliosis including significant displacement of the apical vertebra from the midline, wedging of both the vertebral bodies and discs, rotation, and decreased flexibility. Initial scoliosis after posterior asymmetric tethering measured 42 degrees on average (range 33-50 degrees ) and progressed to 60 degrees on average (range 44-73 degrees ) over 6 to 15 weeks. The average progression of +18 degrees (range 6-37 degrees ) was statistically significant (P < 0.001).

CONCLUSIONS

This study establishes an experimental model for scoliosis that creates progressive, structural, idiopathic-type, lordoscoliotic curves convex to the right in the thoracic spine of the immature goat with high statistical significance (P < 0.001). In addition, this method of experimental scoliosis creation avoids violation of the spinal elements throughout the maximal portion of the curve providing an ideal opportunity subsequent study of the deformity.

Cell viability in scoliotic discs in relation to disc deformity and nutrient levels

STUDY DESIGN

Intervertebral disc tissue was analyzed during or removed at routine surgery for correction of scoliosis. Tissue was analyzed for glucose, lactate, oxygen, glycosaminoglycan, collagen concentrations, and cell viability.

OBJECTIVES

To investigate the cell viability of the scoliotic disc on the concave and convex sides and in relation to curve apex, and to relate cell viability to concentrations of nutrients, metabolites, and extracellular matrix components.

SUMMARY OF BACKGROUND DATA

Compositional differences have been measured in relation to the deformation of scoliotic discs. However, the causes of these in relation to cellular activity or viability are unknown.

METHODS

Oxygen concentration was measured at surgery using a microelectrode. A segment of disc then was removed and sections at defined locations measured for cell viability and glucose, lactate, glycosaminoglycan, and collagen concentrations. RESULTS Cell viability was lower toward the convex side of the curve, with the greatest difference between the sides in the apical disc. The apical disc had the lowest oxygen and highest lactate concentrations, and lowest total number of cells. Glucose concentration correlated with the number of live cells. Concentrations of glycosaminoglycans and collagen per dry weight of tissue were similar on both sides of the disc.

CONCLUSIONS

Differences in cell viability correlated with changes in nutrient and metabolite levels, and also with disc deformity (convex concave and distance from curve apex). Thus asymmetrical loads, tissue deformation, and nutrient supply may work separately or in combination to cause cell death. A loss of matrix macromolecules was not seen, possibly because the period between cell death and surgery was too short, as compared with long matrix turnover times. Cell death is expected eventually to have a deleterious effect on cell matrix and disc function.

Etiology of idiopathic scoliosis: current trends in research

Current population studies characterize idiopathic scoliosis as a single-gene disorder that follows the patterns of mendelian genetics, including variable penetrance and heterogeneity. The role of melatonin and calmodulin in the development of idiopathic scoliosis is likely secondary, with indirect effects on growth mechanisms. Reported abnormalities of connective tissue, skeletal muscle, platelets, the spinal column, and the rib cage are all thought to be secondary to the deformity itself. Although no consistent neurological abnormalities have been identified in patients with idiopathic scoliosis, it is possible that a defect in processing by the central nervous system affects the growing spine. The true etiology of idiopathic scoliosis remains unknown; however, it appears to be multifactorial.