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Lim KBL, Mak HKW, Abdul Rahaman SH, Ong LL, Ooi SYJ, Lee NKL. A pilot study on the "ScoliBrace" in the treatment of adolescent idiopathic scoliosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1803-1809. [PMID: 38416233 DOI: 10.1007/s00590-024-03845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Bracing for adolescents with idiopathic scoliosis (AIS) is a treatment option to prevent curve progression to surgical level. This study aimed to assess the efficacy of a 3D fully customized over corrective brace, "ScoliBrace," an orthosis treatment for AIS. METHODS This was a prospective pilot study of AIS female patients with inclusion criteria followed recommended Scoliosis Research Society (SRS) Guidelines. Cobb angles measured at: baseline (T0), 21 months (T5-2), skeletal maturity (T6), 6 months post-brace (T7), along with hours of brace wear using a thermal sensor and health-related quality of life (HRQoL) using the SRS-22r questionnaire. RESULTS A total of 30 female AIS patients with mean age 11.85 ± 0.68 years, predominantly Risser 0 (70%), and median Cobb angle 29° were recruited; 21 patients were included for the final analysis. Results showed significant difference in Cobb angle between T0 and T5-2 (median = 22.5° vs. 28.5°, p = 0.0082). 57.14% had reduction in Cobb angle by ≥ 5° at skeletal maturity. Cobb angle reduced 0.794° for each additional hour of dosage (p = 0.036, 95% CI = - 1.532°, - 0.056°). Although pain level was increased at T6 (4.37 ± 0.51vs.4.70 ± 0.41, p = 0.014), patients reported significantly greater satisfaction with management of their condition (3.90 ± 0.90vs.3.29 ± 0.88, p = 0.020). CONCLUSION Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. Using "ScoliBrace" as a non-surgical treatment, maintained curves below surgical threshold and showed curve reduction, improving patient satisfaction with management.
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Affiliation(s)
- Kevin Boon Leong Lim
- Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Ling Ling Ong
- Speciality & Ambulatory Services Division, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shi Yang Jess Ooi
- Speciality & Ambulatory Services Division, KK Women's and Children's Hospital, Singapore, Singapore
| | - Nicole Kim Luan Lee
- Division of Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
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Pizones J, Chang DG, Suk SI, Izquierdo E. Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis. Spine Deform 2024; 12:247-255. [PMID: 37975988 DOI: 10.1007/s43390-023-00787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior. METHODS In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis. RESULTS The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis. CONCLUSION The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.
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Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
| | - Se-Il Suk
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
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Duncombe P, Izatt MT, Pivonka P, Claus A, Little JP, Tucker K. Quantifying Muscle Size Asymmetry in Adolescent Idiopathic Scoliosis Using Three-dimensional Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2023; 48:1717-1725. [PMID: 37432908 DOI: 10.1097/brs.0000000000004715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/29/2023] [Indexed: 07/13/2023]
Abstract
STUDY DESIGN This is a case-control study of prospectively collected data. OBJECTIVE To quantify paraspinal muscle size asymmetry in adolescent idiopathic scoliosis (AIS) and determine if this asymmetry is (i) greater than observed in adolescent controls with symmetrical spines; and (ii) positively associated with skeletal maturity using Risser grade, scoliosis severity using the Cobb angle, and chronological age in years. SUMMARY OF BACKGROUND DATA AIS is a three-dimensional deformity of the spine which occurs in 2.5% to 3.7% of the Australian population. There is some evidence of asymmetry in paraspinal muscle activation and morphology in AIS. Asymmetric paraspinal muscle forces may facilitate asymmetric vertebral growth during adolescence. METHODS An asymmetry index [Ln(concave/convex volume)] of deep and superficial paraspinal muscle volumes, at the level of the major curve apex (Thoracic 8-9 th vertebral level) and lower-end vertebrae ( LEV , Thoracic 10-12 th vertebral level), was determined from three-dimensional Magnetic Resonance Imaging of 25 adolescents with AIS (all right thoracic curves), and 22 healthy controls (convex=left); all female, 10 to 16 years. RESULTS Asymmetry index of deep paraspinal muscle volumes was greater in AIS (0.16±0.20) than healthy spine controls (-0.06±0.13) at the level of the apex ( P <0.01, linear mixed-effects analysis) but not LEV ( P >0.05). Asymmetry index was positively correlated with Risser grade ( r =0.50, P <0.05) and scoliosis Cobb angle ( r =0.45, P <0.05), but not age ( r =0.34, P >0.05). There was no difference in the asymmetry index of superficial paraspinal muscle volumes between AIS and controls ( P >0.05). CONCLUSIONS The asymmetry of deep apical paraspinal muscle volume in AIS at the scoliosis apex is greater than that observed at equivalent vertebral levels in controls and may play a role in the pathogenesis of AIS.
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Affiliation(s)
- Phoebe Duncombe
- School of Biomedical Sciences, The University of Queensland, Australia
| | - Maree T Izatt
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Andrew Claus
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Royal Brisbane and Women's Hospital, Tess Cramond Pain and Research Centre, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Centre for Children's Health Research, Queensland University of Technology, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Kylie Tucker
- School of Biomedical Sciences, The University of Queensland, Australia
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Alhelal F, Alissa S, Abaalkhail M, Alshehri A, Alsaeed A, Bindekhayel J. The Effect of Visual Impairment on Postural Stability After Lumbar Spine Fracture: A Case Report and Review of the Literature. Cureus 2023; 15:e49995. [PMID: 38179372 PMCID: PMC10766495 DOI: 10.7759/cureus.49995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
The role of vision in maintaining postural stability is crucial, and its loss, whether congenital or acquired, can significantly impact sensory-motor interactions, leading to musculoskeletal abnormalities and defective gait patterns. This case report discusses the complex interplay between visual impairment, post-traumatic kyphosis, and the development of spinal deformity in a 79-year-old blind patient. The patient sustained a simple fall resulting in an L1 compression fracture in 2016. Despite conservative treatment for the fracture, progressive spinal deformity became evident both clinically and radiographically. Further assessments, including evaluation of bone healing, facet arthroplasty, disc degeneration, and canal compromise, were performed. The patient's altered gait and postural abnormalities were indicative of the impact of visual impairment on postural stability. After addressing osteoporosis through endocrinology consultation and medical management, the patient underwent posterior spinal instrumentation and deformity correction, leading to a successful post-operative recovery with a return to baseline functional status. Visual impairment disrupts postural stability by limiting sensory input and prompting compensatory mechanisms, which may increase postural sway and instability. This abnormal gait further contributes to spinal deformities, and the fear of falling can exacerbate postural instability, limiting mobility. Over time, persistent postural imbalance leads to the creation of a state of continual asymmetric stress related to the spinal axis, which can progress to the development of spinal deformities, creating a self-perpetuating cycle. This case underscores the significance of vision in postural stability and the adverse effects of visual impairment on spinal alignment. The development of spinal deformities in visually impaired individuals, especially in the presence of risk factors like osteoporosis, emphasizes the need for early intervention and postural training to prevent irreversible deformities. Decisions regarding surgical or non-surgical interventions for spinal deformities in visually impaired patients must consider multiple factors, including clinical symptoms, appearance, pain, functional limitations, and social issues. Future research should explore effective interventions for improving postural stability in visually impaired individuals and preventing the development of spinal deformity.
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Affiliation(s)
- Fahad Alhelal
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, SAU
| | - Sami Alissa
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, SAU
| | - Majed Abaalkhail
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, SAU
| | - Abdullah Alshehri
- Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, SAU
| | - Abdullah Alsaeed
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Riyadh, SAU
| | - Joud Bindekhayel
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Lau RWL, Cheuk KY, Hung VWY, Yu FWP, Tam EMS, Wong LLN, Zhang J, Lee WYW, Cheng JCY, Lam TP, Lau AYC. Handgrip strength assessment at baseline in addition to bone parameters could potentially predict the risk of curve progression in adolescent idiopathic scoliosis. Front Pediatr 2023; 11:1258454. [PMID: 38027290 PMCID: PMC10655030 DOI: 10.3389/fped.2023.1258454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Adolescent idiopathic scoliosis (AIS) is characterized by deranged bone and muscle qualities, which are important prognostic factors for curve progression. This retrospective case-control study aims to investigate whether the baseline muscle parameters, in addition to the bone parameters, could predict curve progression in AIS. Methods The study included a cohort of 126 female patients diagnosed with AIS who were between the ages of 12 and 14 years old at their initial clinical visit. These patients were longitudinally followed up every 6 months (average 4.08 years) until they reached skeletal maturity. The records of these patients were thoroughly reviewed as part of the study. The participants were categorized into two sub-groups: the progressive AIS group (increase in Cobb angle of ≥6°) and the stable AIS group (increase in Cobb angle <6°). Clinical and radiological assessments were conducted on each group. Results Cobb angle increase of ≥6° was observed in 44 AIS patients (34.9%) prior to skeletal maturity. A progressive AIS was associated with decreased skeletal maturity and weight, lower trunk lean mass (5.7%, p = 0.027) and arm lean mass (8.9%, p < 0.050), weaker dominant handgrip strength (8.8%, p = 0.027), deranged cortical compartment [lower volumetric bone mineral density (vBMD) by 6.5%, p = 0.002], and lower bone mechanical properties [stiffness and estimated failure load lowered by 13.2% (p = 0.005) and 12.5% (p = 0.004)]. The best cut-off threshold of maximum dominant handgrip strength is 19.75 kg for distinguishing progressive AIS from stable AIS (75% sensitivity and 52.4% specificity, p = 0.011). Discussion Patients with progressive AIS had poorer muscle and bone parameters than patients with stable AIS. The implementation of a cut-off threshold in the baseline dominant handgrip strength could potentially be used as an additional predictor, in addition to bone parameters, for identifying individuals with AIS who are at higher risk of experiencing curve progression.
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Affiliation(s)
- Rufina Wing Lum Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ka Yee Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elisa Man Shan Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lyn Lee Ning Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jiajun Zhang
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Adam Yiu Chung Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Marchese R, Ilhan E, Pacey V. How Schroth Therapists Vary the Implementation of Schroth Worldwide for Adolescents with Idiopathic Scoliosis: A Mixed Methods Study. J Clin Med 2023; 12:6063. [PMID: 37763003 PMCID: PMC10532038 DOI: 10.3390/jcm12186063] [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: 08/14/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Schroth is a type of physiotherapeutic scoliosis specific exercise (PSSE) prescribed to adolescents with idiopathic scoliosis (AIS). Studies have investigated the effectiveness of Schroth but are yet to elucidate how Schroth is applied clinically and the factors that influence their prescription. (2) Methods: A mixed methods design was used comprising an anonymous survey and semi-structured interviews of Schroth therapists who treated AIS and who were publicly listed on the Barcelona Scoliosis Physical Therapy School or the International Schroth 3-dimensional Scoliosis Therapy School websites. The survey included 64 questions covering demographics, session and treatment characteristics, and whether therapists included other treatment modalities in their clinical practice. A convenience sample of survey participants were invited to participate in a semi-structured interview to further explore the factors that influenced their prescription of Schroth for AIS. Results from the survey were analyzed descriptively (n, %), whereas inductive thematic analysis was used for the interviews. (3) Results: of the 173 survey respondents (18% response rate), most were from Europe and North America (64.0%), female (78.6%), physiotherapists (96.0%), and worked in private settings (72.3%). Fifty-two per cent of participants used other types of PSSE as an adjunct to Schroth, the Scientific Exercise Approach to Scoliosis (SEAS) being the most frequently used (37.9%). Non-PSSE methods were used 'at some point' as an adjunct by 98.8% of participants, including massage and other soft tissue techniques (80.9%), Pilates (46.6%), and Yoga (31.5%). The Schroth techniques used by all survey respondents included breathing and pelvic corrections. Seven participants were interviewed, but data saturation was achieved after only four interviews. Thematic analysis revealed four, inter-related broad themes describing the factors that influenced Schroth prescription for AIS: (1) the adolescent as a whole, including physical, emotional and mental characteristics, and patient goals, (2) family, including parent relationship with the adolescent and the motivation of parents in regard to Schroth, (3) the systems within which the treatment was being offered, such as vicinity to the clinic and the presence of financial insurance support, and (4) therapist characteristics, such as their training and experience. (4) Conclusions: Schroth therapists worldwide use a variety of adjunctive methods to treat AIS. Therapists prescribing Schroth exercises to AIS consider the complex interplay of intra-, inter- and extra-personal factors in clinical practice. These considerations move beyond the three components of evidence-based practice of research, patient preferences, and clinical expertise, towards a systems-based reflection on exercise prescription.
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Affiliation(s)
- Rosemary Marchese
- ScoliCare, Sydney 2217, Australia;
- Department of Health Sciences, Macquarie University, Sydney 2109, Australia;
| | - Emre Ilhan
- Department of Health Sciences, Macquarie University, Sydney 2109, Australia;
| | - Verity Pacey
- Department of Health Sciences, Macquarie University, Sydney 2109, Australia;
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Nafo W, Guldeniz O, Jun H, Kim E. Ligamentous tethering and intradiscal pressure affecting the mechanical environment of scoliotic spines. Med Eng Phys 2023; 119:104035. [PMID: 37634912 DOI: 10.1016/j.medengphy.2023.104035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
Despite several theories have been proposed to explain the progression of Adolescent Idiopathic Scoliosis (AIS), there is no consensus on the mechanical factors that control the spinal deformities. Prominent biomechanical notions focus on the geometrical asymmetry and differential growth, however, the correlation between these phenomena remains unclear. We postulate that intradiscal pressure and its connection with the supporting ligamentous structures are the reasons behind the asymmetric growth in AIS. To investigate this hypothesis, a numerical 3D patient-specific model of a scoliotic spine is constructed to carry upper body weight. Four analyses are performed: control simulation with no ligaments followed by 3 simulations, in each, a different and stiffer set of ligaments is employed. The analyses showed that intradiscal pressure is relatively high in the spine's higher-deformity region. Moreover, the stiffness effect of the ligamentous tethering correlated directly to intradiscal pressure; the stiffer the ligaments, the higher the intradiscal pressure. Due to geometrical asymmetry, the pressure is eccentric toward the concave region of deformed vertebral units. As a result, the deformed annulus fibrosus generated uplifts in the convex side of deformed vertebral units. The eccentric pressure and the uplift are opposite in location and direction creating an imbalanced mechanical environment for the spine during growth.
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Affiliation(s)
- Wanis Nafo
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea.
| | - Ogulcan Guldeniz
- Orthopaedics and Traumatology Department, University of Hong Kong, Hong Kong SAR, China
| | - Hyungmin Jun
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea
| | - Eunho Kim
- Mechanical System Engineering Department, Jeonbuk Nationa University, Jeonju-si, Jeollabuk-do, South Korea
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Wang X, Zhang H, Sucato DJ. Unilateral thoracic spinal nerve resection creates early onset thoracic scoliosis in an immature porcine model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2975-2990. [PMID: 37330938 DOI: 10.1007/s00586-023-07804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/02/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To test whether multiple-level unilateral thoracic spinal nerves (TSN) resection can induce the initial thoracic cage deformity to cause early onset thoracic scoliosis in an immature porcine model; and 2) to create an early onset thoracic scoliosis in a large animal model that can be used to evaluate growth-friendly surgical techniques and instruments in growing spine researches. METHODS Seventeen one-month-old pigs were assigned to 3 groups. In group 1 (n = 6), right TSN were resected from T7 to T14 with the contralateral (left) paraspinal muscle exposing and stripping. In group 2 (n = 5), the animals were treated in the same way except the contralateral (left) side was intact. In group 3 (n = 6), bilateral TSN were resected from T7 to T14. All animals were followed up for 17-weeks. Radiographs were measured and analyzed the correlation between the Cobb angle and thoracic cage deformity. A histological examination of the intercostal muscle (ICM) was performed. RESULTS In the groups 1 and 2, an average 62 ± 12° and 42 ± 15° right thoracic scoliosis with apical hypokyphosis of a mean - 5.2 ± 16° and - 1.8 ± 9° were created, respectively, during 17-weeks follow up. All curves were located at the operated levels with the convexity toward the TSN resection side. Statistical analysis demonstrated that the thoracic deformities were strongly correlated with the Cobb angle. In group 3, no scoliosis was created in any animal, but an average thoracic lordosis of - 32.3 ± 20.3° was seen. The histological examination showed the ICM denervation on the TSN resection side. CONCLUSION Unilateral TSN resection induced the initial thoracic deformity toward the TSN resection side resulting in thoracic hypokyphotic scoliosis in an immature pig model. This early onset thoracic scoliosis model could be used to evaluate the growth-friendly surgical techniques and instruments in future growing spine researches.
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Affiliation(s)
- Xiaobin Wang
- Scottish Rite for Children, University of Texas Southwestern Medical Center, 2222 Welborn St, Dallas, TX, 75219, USA
- Department of Orthopaedice Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Hong Zhang
- Scottish Rite for Children, University of Texas Southwestern Medical Center, 2222 Welborn St, Dallas, TX, 75219, USA.
- Department of Orthopaedice Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Daniel J Sucato
- Scottish Rite for Children, University of Texas Southwestern Medical Center, 2222 Welborn St, Dallas, TX, 75219, USA
- Department of Orthopaedice Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Pepke W, Morani W, Schiltenwolf M, Bruckner T, Renkawitz T, Hemmer S, Akbar M. Outcome of Conservative Therapy of Adolescent Idiopathic Scoliosis (AIS) with Chêneau-Brace. J Clin Med 2023; 12:jcm12072507. [PMID: 37048593 PMCID: PMC10095099 DOI: 10.3390/jcm12072507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Chêneau-brace (C-Brace) is a potential tool for the treatment of adolescent idiopathic scoliosis (AIS) with a Cobb angle between 20° and 45° for the primary curve. The aim of the present study was (1) to estimate study cohorts with C-brace therapy success and therapy failure and (2) to analyze possible factors that influence the therapy outcome. Seventy-eight patients with AIS were assessed before the initiation of C-brace treatment. Each patient underwent radiography examinations before the brace, in-brace, and at the therapy end. Cobb angle was considered as increased when the value at the end of therapy was increased more than 5° (Δ > 5°), unchanged—when the value was unchanged within ± 5° and decreased- when the value was decreased more than 5° (Δ < −5°). The study cohort was stratified due to curve topography in the thoracic, thoracolumbar, and lumbar scoliosis groups. Global analysis revealed no statistically significant modification of the Cobb angle (Cobb angle pre-brace vs. Cobb angle post-brace: 30.8° ± 8.2 vs. 29.3° ± 15.2, p = 0.26). However, at the end of C-brace therapy, the primary Cobb angle was decreased by more than 5° in 27 patients (35%), unchanged (Δ within the range of ±5°) in 36 patients (46%), and increased more than 5° in 15 patients (19%). Sub-group analysis due to curve topography and skeletal maturity has shown higher rates of brace therapy failure in thoracic curves and in younger patients (Risser grade 0). Patients with higher Cobb angle correction with C-brace had lower rates of therapy failure. The C-brace can be useful for the prevention of scoliotic curve progression in patients with AIS. However, many factors influence the therapy effect.
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Affiliation(s)
- Wojciech Pepke
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - William Morani
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Tom Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120 Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Stefan Hemmer
- Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Michael Akbar
- Meoclinic, Friedrichstraße 71, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-2094-400
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Yoon SY, Lee SY. Effects of 3D Postural Correction and Abdominal Muscle Contraction on the Symmetry of the Transverse Abdominis and Spinal Alignment in Patients with Idiopathic Scoliosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5016. [PMID: 36981926 PMCID: PMC10048999 DOI: 10.3390/ijerph20065016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to investigate the effectiveness of 3D postural correction (3DPC) using corrective cushions (CCs) and abdominal muscle contraction (AMC) on the thickness symmetry of the transversus abdominis (TrA) and spinal alignment in patients with idiopathic scoliosis (IS). In the first experiment, ultrasound measurements were taken of the TrA thickness on both the convex and concave sides of the lumbar curve in the supine position during AMC and non-AMC without 3DPC, and during AMC and non-AMC with 3DPC using CCs, in 11 IS patients. In the second experiment, 37 IS patients participated in a four-week 3DPC exercise program that aimed to maintain TrA thickness symmetry based on the results of the first experiment. The study found that TrA thickness symmetry significantly increased after 3DPC using CCs and combined with AMC (p < 0.05). Additionally, the Cobb angles and trunk rotation angles showed significant decreases, and trunk expansion showed a significant increase (p < 0.05). These results indicate that the simultaneous application of 3DPC and AMC is the most effective way to achieve TrA thickness symmetry in IS patients. Therefore, 3DPC and AMC should be considered as crucial elements in exercise interventions for IS patients.
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Affiliation(s)
- Sung-Young Yoon
- Department of Physical Therapy, Busan Health University, Busan 49318, Republic of Korea;
- Department of Physical Therapy, Graduated School of Kyungsung University, Busan 48434, Republic of Korea
| | - Sang-Yeol Lee
- Department of Physical Therapy, Kyungsung University, Busan 48434, Republic of Korea
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Zaina F, Donzelli S, Negrini S. Idiopathic Scoliosis: Novel Challenges for Researchers and Clinicians. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010103. [PMID: 36670653 PMCID: PMC9856543 DOI: 10.3390/children10010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
Scoliosis is a three-dimensional deformity of the spine and trunk [...].
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Affiliation(s)
- Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy
- Correspondence:
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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de Reuver S, de Block N, Brink RC, Chu WCW, Cheng JCY, Kruyt MC, Castelein RM, Schlösser TPC. Convex-concave and anterior-posterior spinal length discrepancies in adolescent idiopathic scoliosis with major right thoracic curves versus matched controls. Spine Deform 2023; 11:87-93. [PMID: 36098947 PMCID: PMC9767993 DOI: 10.1007/s43390-022-00566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The apical deformation in adolescent idiopathic scoliosis (AIS) is a combination of rotation, coronal deviation and passive anterior lengthening of the spine. In AIS surgery, posterior-concave lengthening or anterior-convex shortening can be part of the corrective maneuver, as determined by the individual surgeon's technique. The magnitude of convex-concave and anterior-posterior length discrepancies, and how this needs to be modified to restore optimal spinal harmony, remains unknown. METHODS CT-scans of 80 pre-operative AIS patients with right convex primary thoracic curves were sex- and age-matched to 80 healthy controls. The spinal length parameters of the main thoracic curves were compared to corresponding levels in controls. Vertebral body endplates and posterior elements were semi-automatically segmented to determine the length of the concave and convex side of the anterior column and along the posterior pedicle screw entry points while taking the 3D-orientation of each individual vertebra into account. RESULTS The main thoracic curves showed anterior lengthening with a mean anterior-posterior length discrepancy of + 3 ± 6%, compared to a kyphosis of - 6 ± 3% in controls (p < 0.01). In AIS, the convex side was 20 ± 7% longer than concave (0 ± 1% in controls; p < 0.01). The anterior and posterior concavity were 7 and 22 mm shorter, respectively, while the anterior and posterior convexity were 21 and 8 mm longer compared to the controls. CONCLUSIONS In thoracic AIS, the concave shortening is more excessive than the convex lengthening. To restore spinal harmony, the posterior concavity should be elongated while allowing for some shortening of the posterior convexity.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Nick de Block
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rob C. Brink
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack C. Y. Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Moyo C. Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - René M. Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Catanzano AA, Newton PO, Bastrom TP, Bartley CE, Parent S, Miyanji F, Hoernschemeyer DG, Alanay A, Blakemore L, Neal K, Lonner B, Haber L, Shah SA, Yaszay B. Spontaneous Lumbar Curve Correction Following Vertebral Body Tethering of Main Thoracic Curves. J Bone Joint Surg Am 2022; 104:1629-1638. [PMID: 35852153 DOI: 10.2106/jbjs.21.01500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Growth modulation through anterior vertebral body tethering (AVBT) has emerged as a fusionless option for the treatment of progressive scoliosis. When tethering the main thoracic curve, the compensatory thoracolumbar/lumbar curve must correct indirectly as a result. The present study evaluated the response of these lumbar curves following AVBT of the main thoracic curves. METHODS Patients who underwent thoracic AVBT and who had a minimum follow-up of 2 years were included. Magnitudes of the thoracic and lumbar curves were recorded preoperatively and at the first-erect and 2-year postoperative visits. Lumbar curves were further stratified according to their lumbar modifier (A, B, or C). Analysis of variance (ANOVA) and repeated-measures ANOVA were performed to compare correction rates, and the Pearson coefficient was utilized to determine the correlation between the tethered thoracic curve and uninstrumented lumbar curve magnitudes. RESULTS A total of 218 patients were included. Thoracic curve correction was 40% at the first-erect visit and 43% at 2 years (p = 0.012). Lumbar correction was 30%, 26%, and 18% at the first-erect visit (p < 0.001 for all compared with preoperatively) and minimally changed at 31%, 26%, and 24% at 2 years for lumbar modifiers A, B, and C, respectively. A total of 118 patients (54%) showed thoracic curve improvement between the first-erect and 2-year visits. In a subgroup analysis, these patients had a correction in lumbar curve magnitude from preoperatively to the first-erect visit of 30%, 22%, and 16% for lumbar modifiers A, B, C, respectively, that increased to 42%, 34%, and 31% at 2 years, with strong correlation to thoracic correction at 2-year follow-up (r = 0.557, p < 0.001). CONCLUSIONS Although there was immediate lumbar correction following AVBT of a main thoracic curve, further improvement following initial correction was only observed among patients with growth modulation of the thoracic curve. Considering all patients, the uninstrumented lumbar curve corrected 30% at 2 years and the instrumented thoracic curve corrected 40%. As indications for AVBT are refined, these data will provide insight into the response of the uninstrumented lumbar curve. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anthony A Catanzano
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Peter O Newton
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Tracey P Bastrom
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Carrie E Bartley
- Division of Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California
| | - Stefan Parent
- Department of Orthopaedics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Laurel Blakemore
- Division of Pediatric Orthopedics, Pediatric Specialists of Virginia, Fairfax, Virginia
| | - Kevin Neal
- Department of Orthopedic Surgery, Nemours Children's Health, Jacksonville, Florida
| | - Baron Lonner
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY
| | - Lawrence Haber
- Department of Orthopedics, Ochsner Hospital for Children, Ochsner Medical Center, New Orleans, Louisiana
| | - Suken A Shah
- Department of Orthopedics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
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Predicting curve progression for adolescent idiopathic scoliosis using random forest model. PLoS One 2022; 17:e0273002. [PMID: 35951527 PMCID: PMC9371275 DOI: 10.1371/journal.pone.0273002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional (3D) spinal deformity characterized by coronal curvature and rotational deformity. Predicting curve progression is important for the selection and timing of treatment. Although there is a consensus in the literature regarding prognostic factors associated with curve progression, the order of importance, as well as the combination of factors that are most predictive of curve progression is unknown.
Objectives
(1) create an ordered list of prognostic factors that most contribute to curve progression, and (2) develop and validate a Machine Learning (ML) model to predict the final major Cobb angle in AIS patients.
Methods
193 AIS patients were selected for the current study. Preoperative PA, lateral and lateral bending radiographs were retrospectively obtained from the Shriners Hospitals for Children. Demographic and radiographic features, previously reported to be associated with curve progression, were collected. Sequential Backward Floating Selection (SBFS) was used to select a subset of the most predictive features. Based on the performance of several machine learning methods, a Random Forest (RF) regressor model was used to provide the importance rank of prognostic features and to predict the final major Cobb angle.
Results
The seven most predictive prognostic features in the order of importance were initial major Cobb angle, flexibility, initial lumbar lordosis angle, initial thoracic kyphosis angle, age at last visit, number of levels involved, and Risser "+" stage at the first visit. The RF model predicted the final major Cobb angle with a Mean Absolute Error (MAE) of 4.64 degrees.
Conclusion
A RF model was developed and validated to identify the most important prognostic features for curve progression and predict the final major Cobb angle. It is possible to predict the final major Cobb angle value within 5 degrees error from 2D radiographic features. Such methods could be directly applied to guide intervention timing and optimization for AIS treatment.
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Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet Orthot Int 2022; 46:383-391. [PMID: 35320151 DOI: 10.1097/pxr.0000000000000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.
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Morphological changes of Intervertebral Disc detectable by T2-weighted MRI and its correlation with curve severity in Adolescent Idiopathic Scoliosis. BMC Musculoskelet Disord 2022; 23:655. [PMID: 35818045 PMCID: PMC9275276 DOI: 10.1186/s12891-022-05561-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Our previous studies found disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves in adolescent idiopathic scoliosis (AIS) patients. Subsequent studies showed wedging of vertebral bodies (VB) had less contribution than intervertebral discs (IVD) to the anterior–posterior vertebral column length discrepancy in severe-AIS. However, the exact morphological changes of IVD were not clearly defined. This study aimed to evaluate the morphological and pathological changes of IVD and VB in AIS girls and healthy female controls. Methods This study included 33 age-matched female controls and 76 AIS girls with a right-sided thoracic curvature. Wedge angle, height ratio and distance ratio of VB and IVD were measured on the best midline coronal and sagittal planes from reformatted MRI spine. Volumes of VB, IVD and nucleus pulposus (NP) were also evaluated on volumetric images. One-way ANOVA with Bonferroni correction and Pearson correlation tests were used. Results There was significant difference in wedge angle and height ratio of VB and IVD between AIS and controls. In severe-AIS, the position of NP was significantly shifted to the convexity when compared with non-severe AIS and controls. Whereas, the volume of IVD and NP in severe-AIS was found to be significantly smaller. In addition, Cobb angle was significantly correlated with wedge angle and height ratio, and inversely correlated with the volume of NP. Conclusions In addition to wedging of VB and IVD, there was significantly reduced volume of IVD and NP in AIS patients with severe curve, insinuating the mechanical effect of scoliosis leads to a compression on both IVD and NP before significant disc desiccation occurs. We postulate that the compression of IVD and NP can contribute to curve progression in severe-AIS, these patients are more prone to disc degeneration in adulthood if no operative treatment is offered. Further longitudinal study on these parameters is still warranted.
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Yahara Y, Tamura M, Seki S, Kondo Y, Makino H, Watanabe K, Kamei K, Futakawa H, Kawaguchi Y. A deep convolutional neural network to predict the curve progression of adolescent idiopathic scoliosis: a pilot study. BMC Musculoskelet Disord 2022; 23:610. [PMID: 35751051 PMCID: PMC9229131 DOI: 10.1186/s12891-022-05565-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that predominantly occurs in girls. While skeletal growth and maturation influence the development of AIS, accurate prediction of curve progression remains difficult because the prognosis for deformity differs among individuals. The purpose of this study is to develop a new diagnostic platform using a deep convolutional neural network (DCNN) that can predict the risk of scoliosis progression in patients with AIS. Methods Fifty-eight patients with AIS (49 females and 9 males; mean age: 12.5 ± 1.4 years) and a Cobb angle between 10 and 25 degrees (mean angle: 18.7 ± 4.5) were divided into two groups: those whose Cobb angle increased by more than 10 degrees within two years (progression group, 28 patients) and those whose Cobb angle changed by less than 5 degrees (non-progression group, 30 patients). The X-ray images of three regions of interest (ROIs) (lung [ROI1], abdomen [ROI2], and total spine [ROI3]), were used as the source data for learning and prediction. Five spine surgeons also predicted the progression of scoliosis by reading the X-rays in a blinded manner. Results The prediction performance of the DCNN for AIS curve progression showed an accuracy of 69% and an area under the receiver-operating characteristic curve of 0.70 using ROI3 images, whereas the diagnostic performance of the spine surgeons showed inferior at 47%. Transfer learning with a pretrained DCNN contributed to improved prediction accuracy. Conclusion Our developed method to predict the risk of scoliosis progression in AIS by using a DCNN could be a valuable tool in decision-making for therapeutic interventions for AIS.
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Affiliation(s)
- Yasuhito Yahara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan. .,Department of Molecular and Medical Pharmacology, Faculty of Medicine, University of Toyama, Toyama, Japan.
| | - Manami Tamura
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuo-ku, Niigata, 951-8518, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yohan Kondo
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuo-ku, Niigata, 951-8518, Japan.
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kenta Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Estrogen Receptor Type 1 and Type 2 Presence in Paravertebral Skeletal Muscles: Expression Level and Relation to Phenotype in Children with Idiopathic Scoliosis. Genes (Basel) 2022; 13:genes13050739. [PMID: 35627124 PMCID: PMC9141030 DOI: 10.3390/genes13050739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
The study aimed to detect the presence and assess the expression levels of the estrogen receptors type 1 (ESR1) and type 2 (ESR2) within paravertebral skeletal muscles of female patients with idiopathic scoliosis (IS) in relation to phenotype parameters. Intraoperatively, the muscle samples were obtained from 35 adolescent females. The RT-qPCR, western blot and immunohistochemistry techniques were applied. The ESR1 and ESR2 were detected within paravertebral skeletal muscle cells, either the superficial or the deep ones. The ESR1 expression level was significantly higher in the deep muscles compared to the superficial ones. A left-right asymmetry of the ESR1 and ESR2 expression level was demonstrated in the deep muscles. There was a significant relationship between the expression asymmetry and either the Cobb angle or the progression risk factor: both parameters decreased to the smallest values in the case of symmetric ESR1 or ESR2 expression, while they increased with increasing expression asymmetry. In conclusion, the ESR1 and ESR2 presence was confirmed in skeletal paravertebral muscles of patients with idiopathic scoliosis. The increased expression level and asymmetry of estrogen receptors in deep skeletal muscles was related to increasing scoliotic deformity magnitude or increasing risk of deformity deterioration. These findings may highlight the etiopathogenesis of IS in children.
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Tournavitis N, Çolak TK, Voutsas C. Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1617. [PMID: 34966856 PMCID: PMC8689379 DOI: 10.4102/sajp.v77i2.1617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/15/2021] [Indexed: 11/05/2022] Open
Abstract
Background It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing. Objectives The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS). Method We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0–2, age 10–14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment. Results The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p < 0.001). This would indicate a structural correction of 44%. Conclusions Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS. Clinical implications Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.
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Affiliation(s)
| | - Tuğba Kuru Çolak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Marmara University, Istanbul, Turkey
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20
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Idiopathic scoliosis: general characteristics and analysis of etiological theories (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem. The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.
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21
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Pasha S, de Reuver S, Homans JF, Castelein RM. Sagittal curvature of the spine as a predictor of the pediatric spinal deformity development. Spine Deform 2021; 9:923-932. [PMID: 33449344 DOI: 10.1007/s43390-020-00279-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The sagittal curvature of the spine is hypothesized to play an important role in induction of spinal deformities in adolescent idiopathic scoliosis. We previously showed an S shaped flexible rod, with the same curvature as the pediatric sagittal spinal curve, produces scoliotic-like deformities under physiologic loading. Yet, detailed characteristics of the pediatric sagittal spinal curves associated with higher risk of scoliosis are not well defined. METHODS A total of 32 patients in a population with a high prevalence of idiopathic-like scoliosis, 22q11.2 deletion syndrome (22q), were included and followed up for at least two-years. We developed a reduced order finite element model (FEM) of the sagittal profile of these 32 patients where the spine was modeled as an S shaped elastic rod. We related the geometrical parameters of the sagittal curves and the deformed FEM of the corresponding S shaped rods to the risk of scoliosis development at two-year follow-up in this cohort. RESULTS Variations in the sagittal curvature in the cohort of 22q patients resulted in five different deformity patterns shown by finite element analyses. Two sagittal plane deformity pattern groups had high rate of scoliosis development (86% and 100%) whereas the other 3 groups had less than 50% rate of scoliosis development (40%, 33%, and 0%). The pre-scoliotic position of the inflection point (where lordosis turns into kyphosis), the ratio of the spinal curvatures above and below the inflection point, and the length of the spinal curve above and below the inflection point were significantly different between the five deformity patterns groups, p < 0.05. CONCLUSION Combination of geometrical parameters of the sagittal profile prior to onset of scoliosis can relate to the development of spinal deformity in pediatric population.
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Affiliation(s)
- Saba Pasha
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle F Homans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Efficacy of bracing in early infantile scoliosis: a 5-year prospective cohort shows that idiopathic respond better than secondary-2021 SOSORT award winner. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3498-3508. [PMID: 34091763 DOI: 10.1007/s00586-021-06889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In conservative early onset scoliosis treatment, interest in bracing is growing because repeated general anaesthesia (required by casting) has been questioned for possible brain damages. We aimed to check the results in the medium term of bracing, comparing idiopathic (IIS) to secondary (SIS) infantile scoliosis. METHODS We performed a retrospective study in a consecutive prospective cohort. Inclusion criteria were: discovery of scoliosis and bracing below age 3; exclusion criteria: previous spine surgery, less than three consultations. We considered the following results: full (< 20° Cobb) and partial (< 30°) success; hold-up (progression < 5° but curve > 29°); partial (progression > 5°) and full (fusion) failure; statistics: ANOVA for repeated measures; linear mixed effect model with Cobb angle (dependent), time and diagnosis (independent) variables. RESULTS We included 34 infants (16 IIS and 18 SIS) of age 1·10 ± 0·10 (years·months), 44 ± 17° curves, 27 ± 10° rib vertebral angle difference, average observation 5·05 ± 3·03 years. We found progressive improvement of IIS and stability of SIS patients. Six IIS (37.5%) and one SIS (6%) reached brace weaning before puberty with 13 ± 5° (improvement 61 ± 15%, p < 0.001), after 4·11 ± 3·07 years of treatment. Three patients were fused, one IIS (6%) and two SIS (11%). Two IIS patients also reached end-of-growth with 18° (start 40° at 1·03 years) and 20° (start 32° at 2·12 years), respectively. CONCLUSION Bracing shows promising results in the medium term for high-degree IIS, with very few hold-ups (19%) and failures (12%). Conversely, failures prevail for SIS (full 11%), even if the partial failure (39%) is still a time-buying strategy.
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Won SH, Oh DW, Shen M. An 18-month follow-up study on the effect of a neuromuscular stabilization technique on Cobb's angle in adolescent idiopathic scoliosis: A single-blind, age-matched controlled trial. J Back Musculoskelet Rehabil 2021; 34:87-93. [PMID: 32986652 DOI: 10.3233/bmr-191559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The benefits of spinal realignment and stabilization in scoliosis need to be examined. OBJECTIVE We aimed to investigate the long-term effect of a neuromuscular stabilization technique (NST) on Cobb's angle in patients with adolescent idiopathic scoliosis. METHODS Twenty females recruited from two hospitals participated in this study. On the basis of convenience of location, participants were allocated to either the experimental group (EG) that underwent the NST, or the control group (CG) that received education for a home exercise program. The NST for the EG was performed for an average of 30 min per session, three times a week for six months, and consisted of spinal realignment and stabilization. Then, 12- and 18-month measurements for long-term follow-ups were conducted for the EG. The outcome measure was Cobb's angle. RESULTS Between-group comparison revealed a statistically significant difference at post-test (t=-3.26, p< 0.01) but not pre-test (t=-1.36, p= 0.19). Participants of the EG (-6.20 ± 2.49∘) showed greater differences between pre- and post-test scores compared to participants of the CG (-1.40 ± 0.52∘) (p< 0.05). Within-group comparisons showed a significant difference in both groups (p< 0.05). In the EG, Cobb's angle significantly changed across the follow-up sessions (p< 0.05), indicating more improvements by the 12-month (8.50 ± 4.03∘) and 18-month (6.60 ± 3.89∘) follow-ups. CONCLUSION This study shows that the NST may be a beneficial option to correct spinal alignments in patients with adolescent idiopathic scoliosis.
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Affiliation(s)
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Korea
| | - Min Shen
- Shanghai Rehabilitation and Vocational Training Center for the Disabled, Shanghai, China
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de Reuver S, IJsseldijk LL, Homans JF, Willems DS, Veraa S, van Stralen M, Kik MJL, Kruyt MC, Gröne A, Castelein RM. What a stranded whale with scoliosis can teach us about human idiopathic scoliosis. Sci Rep 2021; 11:7218. [PMID: 33785866 PMCID: PMC8009909 DOI: 10.1038/s41598-021-86709-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
Scoliosis is a deformation of the spine that may have several known causes, but humans are the only mammal known to develop scoliosis without any obvious underlying cause. This is called 'idiopathic' scoliosis and is the most common type. Recent observations showed that human scoliosis, regardless of its cause, has a relatively uniform three-dimensional anatomy. We hypothesize that scoliosis is a universal compensatory mechanism of the spine, independent of cause and/or species. We had the opportunity to study the rare occurrence of scoliosis in a whale (Balaenoptera acutorostrata) that stranded in July 2019 in the Netherlands. A multidisciplinary team of biologists, pathologists, veterinarians, taxidermists, radiologists and orthopaedic surgeons conducted necropsy and imaging analysis. Blunt traumatic injury to two vertebrae caused an acute lateral deviation of the spine, which had initiated the development of compensatory curves in regions of the spine without anatomical abnormalities. Three-dimensional analysis of these compensatory curves showed strong resemblance with different types of human scoliosis, amongst which idiopathic. This suggests that any decompensation of spinal equilibrium can lead to a rather uniform response. The unique biomechanics of the upright human spine, with significantly decreased rotational stability, may explain why only in humans this mechanism can be induced relatively easily, without an obvious cause, and is therefore still called 'idiopathic'.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lonneke L IJsseldijk
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Jelle F Homans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dorien S Willems
- Division of Diagnostic Imaging, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Stefanie Veraa
- Division of Diagnostic Imaging, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marijn van Stralen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja J L Kik
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Moyo C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Gröne
- Division of Pathology, Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Zaydman AM, Strokova EL, Pahomova NY, Gusev AF, Mikhaylovskiy MV, Shevchenko AI, Zaidman MN, Shilo AR, Subbotin VM. Etiopathogenesis of adolescent idiopathic scoliosis: Review of the literature and new epigenetic hypothesis on altered neural crest cells migration in early embryogenesis as the key event. Med Hypotheses 2021; 151:110585. [PMID: 33932710 DOI: 10.1016/j.mehy.2021.110585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) affects 2-3% of children. Numerous hypotheses on etiologic/causal factors of AIS were investigated, but all failed to identify therapeutic targets and hence failed to offer a cure. Therefore, currently there are only two options to minimize morbidity of the patients suffering AIS: bracing and spinal surgery. From the beginning of 1960th, spinal surgery, both fusion and rod placement, became the standard of management for progressive adolescent idiopathic spine deformity. However, spinal surgery is often associated with complications. These circumstances motivate AIS scientific community to continue the search for new etiologic and causal factors of AIS. While the role of the genetic factors in AIS pathogenesis was investigated intensively and universally recognized, these studies failed to nominate mutation of a particular gene or genes combination responsible for AIS development. More recently epigenetic factors were suggested to play causal role in AIS pathogenesis. Sharing this new approach, we investigated scoliotic vertebral growth plates removed during vertebral fusion (anterior surgery) for AIS correction. In recent publications we showed that cells from the convex side of human scoliotic deformities undergo normal chondrogenic/osteogenic differentiation, while cells from the concave side acquire a neuronal phenotype. Based on these facts we hypothesized that altered neural crest cell migration in early embryogenesis can be the etiological factor of AIS. In particular, we suggested that neural crest cells failed to migrate through the anterior half of somites and became deposited in sclerotome, which in turn produced chondrogenic/osteogenic-insufficient vertebral growth plates. To test this hypothesis we conducted experiments on chicken embryos with arrest neural crest cell migration by inhibiting expression of Paired-box 3 (Pax3) gene, a known enhancer and promoter of neural crest cells migration and differentiation. The results showed that chicken embryos treated with Pax3 siRNA (microinjection into the neural tube, 44 h post-fertilization) progressively developed scoliotic deformity during maturation. Therefore, this analysis suggests that although adolescent idiopathic scoliosis manifests in children around puberty, the real onset of the disease is of epigenetic nature and takes place in early embryogenesis and involves altered neural crest cells migration. If these results confirmed and further elaborated, the hypothesis may shed new light on the etiology and pathogenesis of AIS.
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Affiliation(s)
- Alla M Zaydman
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Elena L Strokova
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Nataliya Y Pahomova
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Arkady F Gusev
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Mikhail V Mikhaylovskiy
- Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan, Novosibirsk, Russia
| | - Alexander I Shevchenko
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences", Novosibirsk, Russia
| | | | - Andrey R Shilo
- Novosibirsk Zoo named after R.A. Shilo, Novosibirsk, Russia
| | - Vladimir M Subbotin
- Arrowhead Pharmaceuticals Inc., Madison WI, USA; University of Pittsburgh, Pittsburgh PA, USA; University of Wisconsin, Madison WI, USA.
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Grünwald ATD, Roy S, Alves-Pinto A, Lampe R. Assessment of adolescent idiopathic scoliosis from body scanner image by finite element simulations. PLoS One 2021; 16:e0243736. [PMID: 33566808 PMCID: PMC7875351 DOI: 10.1371/journal.pone.0243736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022] Open
Abstract
Adolescent idiopathic scoliosis, is a three-dimensional spinal deformity characterized by lateral curvature and axial rotation around the vertical body axis of the spine, the cause of which is yet unknown. The fast progression entails regular clinical monitoring, including X-rays. Here we present an approach to evaluate scoliosis from the three-dimensional image of a patient’s torso, captured by an ionizing radiation free body scanner, in combination with a model of the ribcage and spine. A skeletal structure of the ribcage and vertebral column was modelled with computer aided designed software and was used as an initial structure for macroscopic finite element method simulations. The basic vertebral column model was created for an adult female in an upright position. The model was then used to simulate the patient specific scoliotic spine configurations. The simulations showed that a lateral translation of a vertebral body results in an effective axial rotation and could reproduce the spinal curvatures. The combined method of three-dimensional body scan and finite element model simulations thus provide quantitative anatomical information about the position, rotation and inclination of the thoracic and lumbar vertebrae within a three-dimensional torso. Furthermore, the simulations showed unequal distributions of stress and strain profiles across the intervertebral discs, due to their distortions, which might help to further understand the pathogenesis of scoliosis.
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Affiliation(s)
- Alexander T. D. Grünwald
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Susmita Roy
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Ana Alves-Pinto
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Renée Lampe
- Orthopaedic Department, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Markus Würth Professorship, Technical University of Munich, Munich, Germany
- * E-mail:
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Zhang J, Wang Y, Cheng KL, Cheuk K, Lam TP, Hung ALH, Cheng JCY, Qiu Y, Müller R, Christen P, Lee WYW. Association of higher bone turnover with risk of curve progression in adolescent idiopathic scoliosis. Bone 2021; 143:115655. [PMID: 32979537 DOI: 10.1016/j.bone.2020.115655] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Emerging evidence suggest abnormal bone metabolism and defective bone qualities are associated to etipathogenesis of Adolescent Idiopathic Scoliosis (AIS). Systemic low bone mass is important prognosticator to predict risk of curve progression in AIS. The underlying mechanism is still unclear. We hypothesize that aberrant bone turnover correlates with bone qualities in AIS and associates to risk of curve progression. SUBJECTS AND METHODS Two cohorts were included in this study. The case-control study recruited 161 AIS girls and 161 ethnic/age-matched healthy girls. The longitudinal cohort recruited 128 AIS girls with two-year follow-up. Areal bone mineral density (BMD) at femoral necks were measured with dual-energy x-ray absorptiometry (DXA), and bone qualities of distal radius by high-resolution peripheral quantitative computed tomography (HR-pQCT). Time-lapse analysis of registered HR-pQCT images estimated local bone remodeling quantitatively. Serum levels of CTX and P1NP were measured with ELISA kits. RESULTS AIS presented significantly higher serum level of P1NP. In both AIS and control, the negative correlations were consistently observed between serum CTX/P1NP levels and most cortical bone quality parameters after adjustment to age. Significant correlation between serum bone turnover markers and trabecular bone parameters have been observed only in control. Progressive AIS has significant increase of serum P1NP level at first clinic visit. Time lapse register analysis showed high bone resorption and low net bone gain was associated with risk of progression in AIS. CONCLUSIONS Our study characterized AIS with higher serum bone turnover markers, which may contribute to defective bone qualities in AIS. For the first time, we showed that progressive AIS had higher systemic bone turnover markers level and local bone remodeling. This fresh evidence indicated association between disrupted bone turnover and risk of progression of AIS, which set the foundation of new prognostic method and of novel treatment target to curve progression. This study demonstrated the importance of bone metabolism in developing disease management of AIS to achieve goal of early prediction and non-surgical modulation.
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Affiliation(s)
- Jiajun Zhang
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Yujia Wang
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Ka-Lo Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Kayee Cheuk
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Alec L H Hung
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Jack C Y Cheng
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Yong Qiu
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Ralph Müller
- Institute for Biomechanics, ETH, Zurich, Zurich, Switzerland
| | - Patrik Christen
- Institute for Biomechanics, ETH, Zurich, Zurich, Switzerland; Institute for Information Systems, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Wayne Y W Lee
- Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
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Smit TH. Adolescent idiopathic scoliosis: The mechanobiology of differential growth. JOR Spine 2020; 3:e1115. [PMID: 33392452 PMCID: PMC7770204 DOI: 10.1002/jsp2.1115] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) has been linked to neurological, genetic, hormonal, microbial, and environmental cues. Physically, however, AIS is a structural deformation, hence an adequate theory of etiology must provide an explanation for the forces involved. Earlier, we proposed differential growth as a possible mechanism for the slow, three-dimensional deformations observed in AIS. In the current perspective paper, the underlying mechanobiology of cells and tissues is explored. The musculoskeletal system is presented as a tensegrity-like structure, in which the skeletal compressive elements are stabilized by tensile muscles, ligaments, and fasciae. The upright posture of the human spine requires minimal muscular energy, resulting in less compression, and stability than in quadrupeds. Following Hueter-Volkmann Law, less compression allows for faster growth of vertebrae and intervertebral discs. The substantially larger intervertebral disc height observed in AIS patients suggests high intradiscal pressure, a condition favorable for notochordal cells; this promotes the production of proteoglycans and thereby osmotic pressure. Intradiscal pressure overstrains annulus fibrosus and longitudinal ligaments, which are then no longer able to remodel and grow, and consequently induce differential growth. Intradiscal pressure thus is proposed as the driver of AIS and may therefore be a promising target for prevention and treatment.
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Affiliation(s)
- Theodoor H. Smit
- Department of Orthopaedic SurgeryAmsterdam Movement Sciences, Amsterdam University Medical CentresAmsterdamNetherlands
- Department of Medical BiologyAmsterdam University Medical CentresAmsterdamNetherlands
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de Reuver S, Brink RC, Homans JF, Vavruch L, Tropp H, Kruyt MC, van Stralen M, Castelein RM. Anterior lengthening in scoliosis occurs only in the disc and is similar in different types of scoliosis. Spine J 2020; 20:1653-1658. [PMID: 32184127 DOI: 10.1016/j.spinee.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Relative anterior spinal overgrowth was proposed as a generalized growth disturbance and a potential initiator of adolescent idiopathic scoliosis (AIS). However, anterior lengthening has also been observed in neuromuscular (NM) scoliosis and was shown to be restricted to the apical areas and located in the intervertebral discs, not in the bone. This suggests that relative anterior spinal overgrowth does not rightfully describe anterior lengthening in scoliosis, as it seems not a generalized active growth phenomenon, nor specific to AIS. PURPOSE To determine if compensatory curves in congenital scoliosis exhibit a mechanism of anterior lengthening without changes in the vertebral body, similar to curves in AIS and NM scoliosis. STUDY DESIGN/SETTING Cross-sectional. PATIENT SAMPLE CT-scans were included of patients in whom a short segment congenital malformation had led to a long thoracic compensatory curve without bony abnormality. Based on data of other scoliosis types, the calculated required sample size was n=12 to detect equivalence of vertebral bodies as compared with nonscoliotic controls. Out of 143 congenital scoliosis patients, 18 fit the criteria and compared with 30 nonscoliotic controls, 30 AIS and 30 NM scoliosis patients. OUTCOME MEASURES The anterior-posterior length discrepancy (AP%) of the total curve and for vertebral bodies and intervertebral discs separately. METHODS Of each vertebral body and intervertebral disc in the compensatory curve, the anterior and posterior length was measured on CT-scans in the exact mid-sagittal plane, corrected for deformity in all three planes. The AP% was calculated for the total compensatory curve (Cobb-to-Cobb) and for the vertebral bodies and the intervertebral discs separately. Positive AP% indicated that the anterior side was longer than the posterior side. RESULTS The total AP% of the compensatory curve in congenital scoliosis showed lordosis (+1.8%) that differed from the kyphosis in nonscoliotic controls (-3.0%; p<.001) and was comparable to the major curve in AIS (+1.2%) and NM scoliosis (+0.5%). This anterior lengthening was not located in the bone; the vertebral body AP% showed kyphosis (-3.2%), similar to nonscoliotic controls (-3.4%) as well as AIS (-2.5%) and NM scoliosis (-4.5%; p=1.000). However, the disc AP% showed lordosis (+24.3%), which sharply contrasts to the kyphotic discs of controls (-1.5%; p<.001), but was similar to AIS (+17.5%) and NM scoliosis (+20.5%). CONCLUSIONS The current study on compensatory curves in congenital scoliosis confirms that anterior lengthening is part of the three-dimensional deformity in different types of scoliosis and is exclusively located in the intervertebral discs. The bony vertebral bodies maintain their kyphotic shape, which indicates that there is no active anterior bony overgrowth. Anterior lengthening appears to be a passive result of any scoliotic deformity, rather than being related to the specific cause of AIS.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, the Netherlands
| | - Rob C Brink
- Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, the Netherlands
| | - Jelle F Homans
- Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, the Netherlands
| | - Ludvig Vavruch
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Hans Tropp
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, the Netherlands
| | - Marijn van Stralen
- Imaging Division, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, the Netherlands.
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Castelein RM, Pasha S, Cheng JC, Dubousset J. Idiopathic Scoliosis as a Rotatory Decompensation of the Spine. J Bone Miner Res 2020; 35:1850-1857. [PMID: 32697856 DOI: 10.1002/jbmr.4137] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
Many years of dedicated research into the etiology of idiopathic scoliosis have not led to one unified theory. We propose that scoliosis is a mechanical, rotatory decompensation of the human spine that starts in the transverse, or horizontal, plane. The human spine is prone to this type of decompensation because of its unique and individually different, fully upright sagittal shape with some preexistent transverse plane rotation. Spinal stability depends on the integrity of a delicate system of stabilizers, in which intervertebral disc stiffness is crucial. There are two phases in life when important changes occur in the precarious balance between spinal loading and the disc's stabilizing properties: (i) during puberty, when loads and moment arms increase rapidly, while the disc's "anchor," the ring apophysis, matures from purely cartilaginous to mineralized to ultimately fused to the vertebral body, and (ii) in older age, when the torsional stiffness of the spinal segments decreases, due to disc degeneration and subsequent laxity of the fibers of the annulus fibrosus. During these crucial periods, transverse plane vertebral rotation can increase during a relatively brief window in time, either as adolescent idiopathic or degenerative de novo scoliosis. Much more is known of the biomechanical changes that occur during disc aging and degeneration than of the changing properties of the disc during maturation. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saba Pasha
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Cy Cheng
- Department of Orthopaedics and Traumatology, S. H. Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Center of The Chinese University of Hong Kong-Nanjing University, The Chinese University of Hong Kong, Shatin, Hong Kong
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Anterior Vertebral Body Growth-Modulation Tethering in Idiopathic Scoliosis: Surgical Technique. J Am Acad Orthop Surg 2020; 28:693-699. [PMID: 32618681 DOI: 10.5435/jaaos-d-19-00849] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The management of idiopathic scoliosis in the skeletally immature patient can be challenging. Posterior spinal fusion and instrumentation is indicated for severe scoliosis deformities. However, the skeletally immature patient undergoing posterior fusion and instrumentation is at risk for developing crankshaft deformities. Moreover, bracing treatment remains an option for patients who are skeletally immature, and although it was found to be effective, it does not completely preclude deformity progression. Recently, fusionless treatment options, such as anterior vertebral body growth modulation, have been developed to treat these patients while avoiding the complications of posterior rigid fusion. Good results have been shown in recent literature with proper indications and planning in the skeletally immature patient.
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Liu D, Yang Y, Yu X, Yang J, Xuan X, Yang J, Huang Z. Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis: A Prospective Controlled Cohort Study. Spine (Phila Pa 1976) 2020; 45:1039-1046. [PMID: 32675606 PMCID: PMC7373466 DOI: 10.1097/brs.0000000000003451] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/09/2019] [Accepted: 01/20/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective controlled cohort study. OBJECTIVE The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window. SUMMARY OF BACKGROUND DATA Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role. METHODS We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared. RESULTS The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups (P < 0.05). CONCLUSION For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Delong Liu
- Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yunlin Yang
- Physical Education Institute, Chengdu University of Technology, Chengdu, China
| | - Xuexiang Yu
- Department of sports and Arts, Guangzhou Sport University, Guangzhou, Guangdong, China
| | - Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoling Xuan
- Xinmiao Scoliosis Prevention Center of Guangdong Province, Guangzhou, Guangdong, China
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zifang Huang
- Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Rajasekaran S, Tangavel C, Soundararajan DCR, Nayagam SM, Matchado MS, Muthurajan R, Anand KSSV, Rajendran S, Shetty AP, Kanna RM, Kuppamuthu D. Proteomic Signatures of Healthy Intervertebral Discs From Organ Donors: A Comparison With Previous Studies on Discs From Scoliosis, Animals, and Trauma. Neurospine 2020; 17:426-442. [PMID: 32615701 PMCID: PMC7338947 DOI: 10.14245/ns.2040056.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To catalog and characterize the proteome of normal human intervertebral disc (IVD). METHODS Nine magnetic resonance imaging (MRI) normal IVDs were harvested from 9 different brain dead yet alive voluntary organ donors and were subjected to electrospray ionization-liquid chromatography tandem mass spectrometry (ESI-LC-MS/MS) acquisition. RESULTS A total of 1,116 proteins were identified. Functional enrichment analysis tool DAVID ver. 6.8 categorized: extracellular proteins (38%), intracellular (31%), protein-containing complex (13%), organelle (9%), membrane proteins (6%), supramolecular complex (2%), and 1% in the cell junction. Molecular function revealed: binding activity (42%), catalytic activity (31%), regulatory activity (14%), and structural activity (7%). Molecular transducer, transporter, and transcription regulator activity together contributed to 6%. A comparison of the proteins obtained from this study to others in the literature showed a wide variation in content with only 3% of bovine, 5% of murine, 54% of human scoliotic discs, and 10.2% of discs adjacent to lumbar burst fractures common to our study of organ donors. Between proteins reported in scoliosis and lumbar fracture patients, only 13.51% were common, further signifying the contrast amongst the various MRI normal IVD samples. CONCLUSION The proteome of "healthy" human IVDs has been defined, and our results show that proteomic data on IVDs obtained from scoliosis, fracture patients, and cadavers lack normal physiological conditions and should not be used as biological controls despite normal MRI findings. This questions the validity of previous studies that have used such discs as controls for analyzing the pathomechanisms of disc degeneration.
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Affiliation(s)
| | | | | | | | | | - Raveendran Muthurajan
- Department of Plant Biotechnology, Tamil Nadu Agricultural University, Coimbatore, India
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Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst 2020; 36:1111-1119. [PMID: 32314025 PMCID: PMC7250959 DOI: 10.1007/s00381-020-04608-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis (AIS) is a complex 3D structural disorder of the spine that has a significant impact on a person's physical and emotionalstatus. Thus, efforts have been made to identify the cause of the curvature and improve management outcomes. AIM This comprehensive review looks at the relevant literature surrounding the possible aetio-pathogenesis of AIS, its clinical features, investigations, surgicalmanagement options, and reported surgical outcomes in anterior spinal fusion, posterior spinal fusion or combined approach in the treatment of AIS.
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Affiliation(s)
- Daniel Addai
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England
| | - Jacqueline Zarkos
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England
| | - Andrew James Bowey
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England.
- Newcastle University, Newcastle upon Tyne, UK.
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Rizkallah M, Sebaaly A, Kharrat K, Kreichati G. Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up. Global Spine J 2020; 10:406-411. [PMID: 32435559 PMCID: PMC7222690 DOI: 10.1177/2192568219858305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To evaluate the long-term effect of convex growth arrest (CGA) on coronal deformity correction in congenital scoliosis. METHODS Twenty-two patients with congenital scoliosis operated by 1-staged double approach hemiephysiodesis by bone grafting of the convex side without instrumentation are included. Eighteen curves had an isolated hemivertebra while 4 curves had congenital bar. Subgroup analysis was performed according to age at surgery (3 years cutoff), type of malformation (hemivertebra vs congenital bar), and severity of curve (35° cutoff). RESULTS Patients' mean age at surgery was 3 years (range 0.5-8 years), with a mean frontal Cobb angle of 40.59°. Mean follow-up is 10.7 years (range 5.5-25 years). Overall results showed mean frontal Cobb angle reduction of 35.47% (40.59° to 27.41°). Detailed analysis showed that 15 curves had a mean correction of 51.8%, 5 stabilized and 2 had a mean aggravation of 25.11%. Subgroup analysis revealed that patients operated ≤3 years of age had mean cobb angle correction of 43.1% versus 21.49% in patients operated >3 years (P = .140). Mean correction of 44.5% was gained in curves with isolated hemivertebra compared with 1.3% in curves with congenital bar (P = .004). A 58.17% mean correction was reached in curves ≤35° versus 23.68% in curves >35° (P = .032). CONCLUSIONS A limited convex hemiepiphysiodesis still has a place in congenital scoliosis care when it is performed in patients ≤3 years old, with curves ≤35°, and with isolated hemivertebra. It spares patients the risks of vertebral resection and instrumentation, while fusing the same number of levels.
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Affiliation(s)
- Maroun Rizkallah
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon,Maroun Rizkallah, Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Alfred Naccache Street, Achrafieh, Beirut 00961, Lebanon.
| | - Amer Sebaaly
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Khalil Kharrat
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Maqsood A, Hashmi SZ, Hartwell M, Sarwark JF. Idiopathic scoliosis: A pilot MR study of early vertebral morphological changes and spinal asymmetry. J Orthop 2020; 19:174-177. [PMID: 32025128 DOI: 10.1016/j.jor.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 11/18/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) a common spinal condition affecting adolescents. Though the etiology is still unknown, it is widely thought to have a multifactorial etiology and early diagnosis remains a significant challenge. The purpose of this study is to identify early vertebral morphological changes and patterns of spinal asymmetry in these at-risk individuals who later progress to adolescent idiopathic scoliosis. This was a retrospective study of patients treated for AIS between 1997 and 2017. We utilized two study groups, a group with immature onset of spinal asymmetry and a control group. Inclusion criteria for the immature onset group was defined by a Cobb angle between 10 and 40° diagnosed prior to the age of 12 with MRI scans and XRs available for review. Qualitative assessments observed for sagittal vertebral wedging, analysis of vertebral corner anatomy, spinal harmony, and sagittal balance. These findings were then qualitatively compared between groups. Twenty patients were included in this study, ten each in the immature onset and control groups. In the immature onset group, two patients had sagittal wedging, five had abnormal vertebral corners, nine did not have spinal harmony, and nine had negative sagittal balance, compared to none of the control patients having sagittal wedging, none having abnormal vertebral corners, all having spinal harmony, and nine having positive spinal balance. This pilot MRI study identifies qualitative vertebral morphological changes in patients who progress to AIS. Our findings suggest abnormal vertebral corner anatomy, sagittal wedging, and negative sagittal balance as potential early findings in patients who develop AIS.
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Affiliation(s)
- Ayesha Maqsood
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 69, Chicago, IL, 60611, USA
| | - Sohaib Z Hashmi
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 69, Chicago, IL, 60611, USA
| | - Matthew Hartwell
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 69, Chicago, IL, 60611, USA
| | - John F Sarwark
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 69, Chicago, IL, 60611, USA
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Chen H, Zhang J, Wang Y, Cheuk KY, Hung ALH, Lam TP, Qiu Y, Feng JQ, Lee WYW, Cheng JCY. Abnormal lacuno-canalicular network and negative correlation between serum osteocalcin and Cobb angle indicate abnormal osteocyte function in adolescent idiopathic scoliosis. FASEB J 2019; 33:13882-13892. [PMID: 31626573 PMCID: PMC6894095 DOI: 10.1096/fj.201901227r] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/10/2019] [Indexed: 12/28/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a prevalent spinal deformity occurring during peripubertal growth period that affects 1-4% of adolescents globally without clear etiopathogenetic mechanism. Low bone mineral density is an independent and significant prognostic factor for curve progression. Currently, the cause underlying low bone mass in AIS remains elusive. Osteocytes play an important role in bone metabolism and mineral homeostasis, but its role in AIS has not been studied. In the present study, iliac bone tissues were harvested from 21 patients with AIS (mean age of 14.3 ± 2.20 yr old) with a mean Cobb angle of 55.6 ± 10.61° and 13 non-AIS controls (mean age of 16.5 ± 4.79 yr old) intraoperatively. Acid-etched scanning electron microscopy (SEM) images of AIS demonstrated abnormal osteocytes that were more rounded and cobblestone-like in shape and were aligned in irregular clusters with shorter and disorganized canaliculi. Further quantitative analysis with FITC-Imaris technique showed a significant reduction in the canalicular number and length as well as an increase in lacunar volume and area in AIS. SEM with energy-dispersive X-ray spectroscopy analysis demonstrated a lower calcium-to-phosphorus ratio at the perilacunar/canalicular region. Moreover, microindentaion results revealed lower values of Vickers hardness and elastic modulus in AIS when compared with controls. In addition, in the parallel study of 99 AIS (27 with severe Cobb angle of 65.8 ± 14.1° and 72 with mild Cobb angle of 26.6 ± 9.1°) with different curve severity, the serum osteocalcin level was found to be significantly and negatively associated with the Cobb angle. In summary, the findings in this series of studies demonstrated the potential link of abnormal osteocyte lacuno-canalicular network structure and function to the observed abnormal bone mineralization in AIS, which may shed light on etiopathogenesis of AIS.-Chen, H., Zhang, J., Wang, Y., Cheuk, K.-Y., Hung, A. L. H., Lam, T.-P., Qiu, Y., Feng, J. Q., Lee, W. Y. W., Cheng, J. C. Y. Abnormal lacuno-canalicular network and negative correlation between serum osteocalcin and Cobb angle indicate abnormal osteocyte function in adolescent idiopathic scoliosis.
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Affiliation(s)
- Huanxiong Chen
- Department of Spine and Osteopathic Surgery, The
First Affiliated Hospital of Hainan Medical University, Hai-kou, China
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Jiajun Zhang
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Yujia Wang
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Ka-Yee Cheuk
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Alec L. H. Hung
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Yong Qiu
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
- Spine Surgery, Nanjing Drum Tower Hospital,
Nanjing University, Nanjing, China
| | - Jian Q. Feng
- Department of Biomedical Sciences, Texas
A&M College of Dentistry, Dallas, Texas, USA
| | - Wayne Y. W. Lee
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
| | - Jack C. Y. Cheng
- Department of Orthopaedics and Traumatology, S. H.
Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, NT,
Hong Kong, China
- Joint Scoliosis Research Center of The Chinese
University of Hong Kong–Nanjing University, The Chinese University of Hong
Kong, Hong Kong, China
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Spine Growth Modulation in Early Adolescent Idiopathic Scoliosis: Prospective US FDA IDE Pilot Study of Titanium Clip-Screw Implant at Two to Five Years. Spine Deform 2019; 7:899-909. [PMID: 31732000 PMCID: PMC8527925 DOI: 10.1016/j.jspd.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Prospective longitudinal study of growth modulation system for early adolescent idiopathic scoliosis (AIS), consecutive case series from first human use to skeletal maturity, fusion, or five years postoperation. OBJECTIVES Determine adverse events and curvature changes to end of study; examine factors most likely to explain variability in curve changes. SUMMARY OF BACKGROUND Pilot clinical safety study was performed under US Food and Drug Administration (FDA) Investigational Device Exemption (IDE). Safety and radiographic results were previously reported to 24 months postoperation. METHODS Subjects with early AIS underwent thoracoscopic placement of titanium clip-screw devices designed to modify growth asymmetrically. Eligibility was based on high risk of progression to 50°: single major thoracic curve 25°-40°, Risser 0, open triradiate cartilages, and premenarchal if female. Six subjects, the maximum allowed, enrolled. Adverse events (AEs), clinical outcomes, and curvatures were systematically collected. Disc heights, vertebral heights, and implant-bone contact areas were assessed. RESULTS Consecutive subjects enrolled, aged 12.1 years (±1.7), three were female. AEs from two to five years postoperation included deformity changes leading to a second surgery in three patients: two for posterior spinal fusion, and one for thoracoscopic removal of half the implants for overcorrection. In the latter case, overcorrection appeared halted for duration of study. One patient, whose curve exceeded 50° at age 18 years, did not choose fusion. Major thoracic curves were 34° (±3°) preoperatively and 42° (±20°) at end of study. CONCLUSIONS In a study of spine growth modulation in patients with early AIS with high risk of progression, at skeletal maturity or five years postoperation, major thoracic curves of half progressed to >50°, whereas curves of the other half remained <40°, below fusion indications. Removal of selected implants may halt overcorrection. The next, pivotal, study phase was approved by FDA. LEVEL OF EVIDENCE Level IV, prospective case series under stringent regulatory controls.
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Pasha S, Smith L, Sankar WN. Bone Remodeling and Disc Morphology in the Distal Unfused Spine After Spinal Fusion in Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:746-753. [PMID: 31495475 DOI: 10.1016/j.jspd.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Morphologic changes in the vertebral body in adolescent idiopathic scoliosis (AIS) have been associated with curve development and progression. Yet, after an AIS spinal surgery, the impact of the global and local spinal realignment on the vertebral body and intervertebral disc morphologic changes, particularly in the distal unfused spine, have not been determined. QUESTIONS/PURPOSES To determine the changes in the unfused lumbar vertebrae and disc morphology two years after spinal fusion in AIS patients undergoing selective thoracic fusion (STF). PATIENTS AND METHODS A total of 58 patients with Lenke type 1 AIS who underwent STF with a minimum two-year follow-up and 20 nonscoliotic adolescents were included. Biplanar stereoradiography of the spine at preoperative, early postoperative, and two-year follow-up were used to generate 3D models of the spine. Lumbar spine vertebral and intervertebral heights (anterior, posterior, left, and right) and the degree of wedging in the frontal and sagittal plane were calculated in the local coordinate system of the vertebral bodies. The morphology of vertebrae and discs were compared between the pre- and postoperative visits of AIS patients and nonscoliotic controls. RESULTS Lumbar lordosis was not statistically different between the pre- and post-operative AIS and controls, p > .05. The contribution of the lumbar vertebral bodies and discs' sagittal wedging to the total L1-L5 lordosis were 20% and 80%, respectively, for nonscoliotic controls and 61% and 39%, respectively, for AIS patients at two-year follow-up. The decrease in the anterior and left heights of the disc between the preoperative and two-year follow-up was significant, p < .05. CONCLUSION Patients undergoing STF for Lenke 1 AIS are able to achieve normal lumbar lordosis after surgery but seem to regain their sagittal alignment by morphologic changes in the disc more so than the vertebral body. A larger contribution of the vertebral sagittal wedging to the total lumbar lordosis at two years post STF was observed when these variables were compared to the nonscoliotic adolescents. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Saba Pasha
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Lachlan Smith
- Departments of Neurosurgery and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wudbhav N Sankar
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Walaszek R, Sterkowicz S, Chwała W, Sterkowicz-Przybycień K, Burdacka K, Burdacki M. Assessment of body posture with the Moire's photogrammetric method in boys practising judo versus their non-sports-practising peers. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Labelle F, Auger O, Carozzo C, Massenzio M, Miladi L, Odent T, Viguier E, Cachon T. Ex vivo biomechanical study on a porcine model of three types of stabilisation in scoliosis treatment. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Labelle
- Vetagro-Sup, Campus Vétérinaire de Lyon Unité de Chirurgie, Marcy-l’Etoile, France
| | - O. Auger
- Vetagro-Sup, Campus Vétérinaire de Lyon Unité de Chirurgie, Marcy-l’Etoile, France
| | - C. Carozzo
- Vetagro-Sup, Campus Vétérinaire de Lyon Unité de Chirurgie, Marcy-l’Etoile, France
| | - M. Massenzio
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - L. Miladi
- Service orthopédie pédiatrique, CHU Necker Enfants Malades, APHP, Faculté de Médecine, Paris Cedex 15, France
| | - T. Odent
- Chirurgie orthopédique pédiatrique, hôpital Clocheville, Tours, France
| | - E. Viguier
- Vetagro-Sup, Campus Vétérinaire de Lyon Unité de Chirurgie, Marcy-l’Etoile, France
| | - T. Cachon
- Vetagro-Sup, Campus Vétérinaire de Lyon Unité de Chirurgie, Marcy-l’Etoile, France
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Aulisa AG, Guzzanti V, Falciglia F, Giordano M, Galli M, Aulisa L. Brace treatment of Idiopathic Scoliosis is effective for a curve over 40 degrees, but is the evaluation of Cobb angle the only parameter for the indication of treatment? Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.04782-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee JG, Yun YC, Jo WJ, Seog TY, Yoon YS. Correlation of Radiographic and Patient Assessment of Spine Following Correction of Nonstructural Component in Juvenile Idiopathic Scoliosis. Ann Rehabil Med 2019; 42:863-871. [PMID: 30613080 PMCID: PMC6325314 DOI: 10.5535/arm.2018.42.6.863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the association between progression of curvature of scoliosis, and correction for functional component in patients with juvenile idiopathic scoliosis (JIS). Methods We retrospectively reviewed medical data of patients prescribed custom molded foot orthosis (FO) to correct inequality of RCSPA (resting calcaneal stance position angle), and chose 52 patients (26 females, 26 males) with Cobb angle ≥10° in radiology and uneven pelvic level at iliac crest by different RCSPA (≥3°) as a factor of functional scoliosis. They had different hump angle ≥5° in forward bending test, for idiopathic scoliosis component. Their mean age and mean period of wearing FO were 79.5±10.6 months and 18.6±0.70 months. Results Cobb angle was reduced from 22.03°±4.39° initially to 18.86°±7.53° after wearing FO. Pelvis height difference and RCSPA difference, were reduced from 1.07±0.25 cm initially to 0.60±0.36, and from 4.25°±0.71° initially to 1.71°±0.75° (p<0.01). Cobb angle improved most in 9 months. However, there was no significant improvement for those with more than 25° of Cobb angle initially. Mean Cobb angle improved in all age groups, but patients less than 6 years had clinically significant improvement of more than 5°. Conclusion JIS can have functional components, which should be identified and managed. Foot orthosis is useful in correcting functional factors, in the case of pelvic inequality caused by different RCSPA, for patients with juvenile idiopathic scoliosis.
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Affiliation(s)
- Jin Gyeong Lee
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Young Cheol Yun
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Won Jae Jo
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Tae Yong Seog
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
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Zaydman AM, Strokova EL, O Stepanova A, Laktionov PP, Shevchenko AI, Subbotin VM. A New Look at Causal Factors of Idiopathic Scoliosis: Altered Expression of Genes Controlling Chondroitin Sulfate Sulfation and Corresponding Changes in Protein Synthesis in Vertebral Body Growth Plates. Int J Med Sci 2019; 16:221-230. [PMID: 30745802 PMCID: PMC6367535 DOI: 10.7150/ijms.29312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background: In a previous report, we demonstrated the presence of cells with a neural/glial phenotype on the concave side of the vertebral body growth plate in Idiopathic Scoliosis (IS) and proposed this phenotype alteration as the main etiological factor of IS. In the present study, we utilized the same specimens of vertebral body growth plates removed during surgery for Grade III-IV IS to analyse gene expression. We suggested that phenotype changes observed on the concave side of the vertebral body growth plate can be associated with altered expression of particular genes, which in turn compromise mechanical properties of the concave side. Methods: We used a Real-Time SYBR Green PCR assay to investigate gene expression in vertebral body growth plates removed during surgery for Grade III-IV IS; cartilage tissues from human fetal spine were used as a surrogate control. Special attention was given to genes responsible for growth regulation, chondrocyte differentiation, matrix synthesis, sulfation and transmembrane transport of sulfates. We performed morphological, histochemical, biochemical, and ultrastructural analysis of vertebral body growth plates. Results: Expression of genes that control chondroitin sulfate sulfation and corresponding protein synthesis was significantly lower in scoliotic specimens compared to controls. Biochemical analysis showed 1) a decrease in diffused proteoglycans in the total pool of proteoglycans; 2) a reduced level of their sulfation; 3) a reduction in the amount of chondroitin sulfate coinciding with raising the amount of keratan sulfate; and 4) reduced levels of sulfation on the concave side of the scoliotic deformity. Conclusion: The results suggested that altered expression of genes that control chondroitin sulfate sulfation and corresponding changes in protein synthesis on the concave side of vertebral body growth plates could be causal agents of the scoliotic deformity.
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Affiliation(s)
- Alla M Zaydman
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, Russia
| | - Elena L Strokova
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, Russia
| | - Alena O Stepanova
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia.,Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Science, Novosibirsk, Russia
| | - Pavel P Laktionov
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia.,Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Science, Novosibirsk, Russia
| | | | - Vladimir M Subbotin
- University of Pittsburgh, Pittsburgh PA, USA.,Arrowhead Pharmaceuticals, Madison WI, USA
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Pasha S, Sankar WN, Castelein RM. The Link Between the 3D Spino-pelvic Alignment and Vertebral Body morphology in Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:53-59. [PMID: 30587321 DOI: 10.1016/j.jspd.2018.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/03/2018] [Accepted: 05/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vertebral anterior overgrowth has been suggested as part of the etio-pathogenesis of adolescent idiopathic scoliosis (AIS). However, the link between 3D spinopelvic alignment and the vertebral anteroposterior height asymmetry in different scoliotic curves types and whether it deviates from the non-scoliotic controls, has not been studied. PURPOSE We aimed to retrospectively describe the link between the anteroposterior vertebral height differences (ΔAPVH) measured in the true sagittal plane of each vertebra and the spinopelvic parameters in three anatomical planes. METHODS 30 AIS cases with primary thoracic curves, 28 with thoracolumbar/lumbar curves, and 20 non-scoliotic controls were included. All subjects had 3D reconstruction of the spine, generated from low-dose upright stereoradiography images. Pelvic incidence (PI), thoracic and lumbar coronal and sagittal curve measurements, and vertebral axial rotation were measured. The association between the spinopelvic parameters and ΔAPVH were compared between the two AIS and control groups. RESULTS ΔAPVH at the apex of the curve was significantly different between the two AIS groups, as well as between both AIS groups and the controls and was related to the vertebral apical rotation (p < 0.05). Kyphosis and lordosis measurements were significantly related to the sum of the ΔAPVH in thoracic and lumbar regions respectively in AIS group but not in non-scoliotic controls (p < 0.05). CONCLUSIONS The ΔAPVH depended on the scoliotic curve type and was significantly different from the controls only at the apical levels. Morphological changes in the scoliotic vertebrae, measured as anterior-posterior differences in the vertebral height, are related to the sagittal spinal profile suggesting the morphology of the vertebra contributes to the sagittal curvatures of the spine in AIS; nonetheless, such relationship between the vertebral morphology and the sagittal profile was not evident in non-scoliotic controls.
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Affiliation(s)
- Saba Pasha
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
| | - Woudbhav N Sankar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
| | - Rene M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Mao SH, Sun X, Shi BL, Qiu Y, Qian BP, Cheng JCY. Association between braced curve behavior by pubertal growth peak and bracing effectiveness in female idiopathic scoliosis: a longitudinal cohort study. BMC Musculoskelet Disord 2018; 19:88. [PMID: 29580223 PMCID: PMC5870088 DOI: 10.1186/s12891-018-1987-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-pubertal idiopathic scoliosis (IS) is associated with high risk of bracing ineffectiveness. Integrated multidimensional maturity assessments are useful but complex to predict the high-risk occurrence of curve progression. This study is designed to provide a simple screening method for brace effectiveness by determining whether or not the braced curve behavior at growth spurt, being defined as variations in Cobb angle velocity (AV) at peak height velocity (PHV), can be a new factor predictive of brace outcome prescribed before PHV. METHODS This is a retrospective study of a series of 35 IS girls with simplified skeletal maturity score no more than 3 at initiation of bracing treatment and followed up through the growth spurt until brace weaning or surgery. Serial Cobb angle and maturity indicators involving height velocity, Risser sign, triradiate cartilage, simplified skeletal maturity score and distal radius and ulna classification were assessed and patients were stratified into either a positive or negative category based on a positive or negative value of AV at PHV. Comparisons were made between the positive and negative AV groups, as well as the failed and successful bracing groups, using independent sample T test and crosstab analysis. Logistic regression analysis was used to identify the predictive factors of failed brace treatment. RESULTS Brace treatment prescribed before PHV was found to have an overall failure rate of 57.1% and a surgical rate of 45.7%. Negative AV at PHV accounting for 54.3% of the recruited patients were associated with lower brace failure rate (36.8% vs. 81.2%, p = 0.016) and surgical rate (21.1% vs. 75.0%, p = 0.002). Patients in the failed bracing group showed higher ratio of thoracic curve (80.0% vs. 26.7%,p = 0.002) and higher AV at growth peak (2.3 ± 9.1 vs. -6.5 ± 11.4°/yrs., p = 0.016). The logistic regression analysis revealed that positive AV at PHV (OR = 9.268, 95% CI = 1.279-67.137, p = 0.028) and thoracic curve type (OR = 13.391, 95% CI = 2.006-89.412, p = 0.007) were strong predictive factors of ineffective brace treatment initiated before PHV. CONCLUSIONS Sustained curve correction following bracing despite early onset and rapid pubertal growth was strongly predictive of effective brace control of scoliosis.
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Affiliation(s)
- Sai-Hu Mao
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Xu Sun
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Ben-Long Shi
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Yong Qiu
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China. .,Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China.
| | - Jack C Y Cheng
- Joint Scoliosis Research Center of the Chinese University of Hong Kong & Nanjing University, Nanjing, China
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Moramarco M, Moramarco K, Fadzan M. Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR). Open Orthop J 2018; 11:1490-1499. [PMID: 29399225 PMCID: PMC5759093 DOI: 10.2174/1874325001711011490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 01/25/2023] Open
Abstract
Introduction It has long been said that exercise-based rehabilitation for scoliosis is ineffective, however, these reports studied general exercises. This case report is a prospective one-year follow-up of a nearly skeletally mature adolescent female (Risser 4) with idiopathic scoliosis treated with Pattern-Specific-Scoliosis Rehabilitation (PSSR). Methods The 15-year old patient recommended for surgery (initial Cobb angle of 45°) completed a 16-hour scoliosis-specific back school (according to Schroth Best Practice®), over the course of five weeks. She continued with her program at home, and followed up with the lead author after 6 months and 1 year. Results The patient achieved a 13° reduction in her primary thoracic Cobb angle. Postural improvement and reduction in trunk rotation (ATR) was also achieved (-4° in the thoracic spine, and -5° in the lumbar spine). Conclusion Pattern-specific scoliosis rehabilitation (PSSR) works to reduce the asymmetrical load caused by scoliosis. PSSR is effective in stabilizing Cobb angle, and can, in some cases, reduce Cobb angle in adolescents. Patients recommended for surgery may be candidates for conservative treatment. This case suggests that the practice of discontinuing conservative treatment at Risser stage 4 should be re-evaluated.
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Affiliation(s)
- Marc Moramarco
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801
| | | | - Maja Fadzan
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801
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Barrios C, Lloris JM, Alonso J, Maruenda B, Burgos J, Llombart-Blanco R, Gil L, Bisbal V. Novel porcine experimental model of severe progressive thoracic scoliosis with compensatory curves induced by interpedicular bent rigid temporary tethering. J Orthop Res 2018; 36:174-182. [PMID: 28548698 DOI: 10.1002/jor.23617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED Using flexible tethering techniques, porcine models of experimental scoliosis have shown scoliotic curves with vertebral wedging but very limited axial rotation. The aim of this experimental work was to induce a severe progressive scoliosis in a growing porcine model for research purposes. A unilateral spinal bent rigid tether was anchored to two ipsilateral pedicle screws in eight pigs. The spinal tether was removed after 8 weeks. Ten weeks later, the animals were sacrificed. Conventional radiographs and 3D CT-scans were taken to evaluate changes in the alignment of the thoracic spine. After the first 8 weeks of rigid tethering, all animals developed scoliotic curves (mean Cobb angle: 24.3°). Once the interpedicular tether was removed, the scoliotic curves progressed in all animals during 10 weeks reaching a mean Cobb angle of 49.9°. The sagittal alignment of the thoracic spine showed loss of physiologic kyphosis (Mean: -18.3°). Axial rotation ranged from 10° to 49° (Mean 25.7°). Release of the spinal tether results in progression of the deformity with the development of proximal and distal compensatory curves. In conclusion, temporary interpedicular tethering at the thoracic spine induces severe scoliotic curves in pigs, with significant wedging and rotation of the vertebral bodies, and true compensatory curves. CLINICAL RELEVANCE The tether release model will be used to evaluate corrective non-fusion technologies in future investigations. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:174-182, 2018.
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Affiliation(s)
- Carlos Barrios
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - José Miguel Lloris
- Department of Surgery, Valencia University Medical School, Valencia, Spain
| | - Juan Alonso
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - Borja Maruenda
- Department of Orthopedic Surgery, Hospital de la Ribera, Alzira, Valencia, Spain
| | - Jesús Burgos
- Division of Pediatric Orthopedics, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Luis Gil
- lnstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
| | - Viviana Bisbal
- Animal Facility Services, Prince Felipe Research Center, Valencia, Spain
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Zaydman AM, Strokova EL, Kiseleva EV, Suldina LA, Strunov AA, Shevchenko AI, Laktionov PP, Subbotin VM. A New Look at Etiological Factors of Idiopathic Scoliosis: Neural Crest Cells. Int J Med Sci 2018; 15:436-446. [PMID: 29559832 PMCID: PMC5859766 DOI: 10.7150/ijms.22894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022] Open
Abstract
Idiopathic scoliosis is one of the most common disabling pathologies of children and adolescents. Etiology and pathogenesis of idiopathic scoliosis remain unknown. To study the etiology of this disease we identified the cells' phenotypes in the vertebral body growth plates in patients with idiopathic scoliosis. Materials and methods: The cells were isolated from vertebral body growth plates of the convex and concave sides of the deformity harvested intraoperatively in 50 patients with scoliosis. Cells were cultured and identified by methods of common morphology, neuromorphology, electron microscopy, immunohistochemistry and PCR analysis. Results: Cultured cells of convex side of deformation were identified as chondroblasts. Cells isolated from the growth plates of the concave side of the deformation showed numerous features of neuro- and glioblasts. These cells formed synapses, contain neurofilaments, and expressed neural and glial proteins. Conclusion: For the first time we demonstrated the presence of cells with neural/glial phenotype in the concave side of the vertebral body growth plate in scoliotic deformity. We hypothesized that neural and glial cells observed in the growth plates of the vertebral bodies represent derivatives of neural crest cells deposited in somites due to alterations in their migratory pathway during embryogenesis. We also propose that ectopic localization of cells derived from neural crest in the growth plate of the vertebral bodies is the main etiological factor of the scoliotic disease.
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Affiliation(s)
- Alla M Zaydman
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, Russia
| | - Elena L Strokova
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirsk, Russia
| | - Elena V Kiseleva
- Institute of Cytology and Genetics, Russian Academy of Science, Novosibirsk, Russia
| | - Lubov A Suldina
- Institute of Cytology and Genetics, Russian Academy of Science, Novosibirsk, Russia
| | - Anton A Strunov
- Institute of Cytology and Genetics, Russian Academy of Science, Novosibirsk, Russia
| | | | - Pavel P Laktionov
- Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Science, and Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Vladimir M Subbotin
- Arrowhead Pharmaceuticals, Madison WI, and University of Pittsburgh, Pittsburgh PA, USA
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50
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Fadzan M, Bettany-Saltikov J. Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present. Open Orthop J 2017; 11:1466-1489. [PMID: 29399224 PMCID: PMC5759107 DOI: 10.2174/1874325001711011466] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022] Open
Abstract
Adolescent idiopathic scoliosis is one of the most common spinal deformities, yet its cause is unknown. Various theories look to biomechanical, neuromuscular, genetic, and environmental origins, yet our understanding of scoliosis etiology is still limited. Determining the cause of a disease is crucial to developing the most effective treatment. Associations made with scoliosis do not necessarily point to causality, and it is difficult to determine whether said associations are primary (playing a role in development) or secondary (develop as a result of scoliosis). Scoliosis is a complex condition with highly variable expression, even among family members, and likely has many causes. These causes could be similar among homogenous groups of AIS patients, or they could be individual. Here, we review the most prevalent theories of scoliosis etiology and recent trends in research.
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Affiliation(s)
- Maja Fadzan
- Scoliosis 3DC, 3 Baldwin Green Common, Suite 204, Woburn, MA 01801, USA
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