Abstract
To better understand the etiology of idiopathic scoliosis, prospective research into the pre-scoliotic state is required, but this research is practically impossible to carry out in the general population. The use of ‘models’, such as idiopathic-like scoliosis established in genetically modified animals, may elucidate certain elements, but their translatability to the human situation is questionable. The 22q11.2 deletion syndrome (22q11.2DS), with a 20-fold increased risk of developing scoliosis, may be a valuable and more relevant alternative and serve as a human ‘model’ for idiopathic scoliosis. This multicenter study investigates the morphology, dynamic behavior, and presence of intraspinal anomalies in patients with 22q11.2DS and scoliosis compared to idiopathic scoliosis. Scoliosis patients with 22q11.2DS and spinal radiography (n = 185) or MRI (n = 38) were included (mean age 11.6 ± 4.2; median Cobb angle 16°) and compared to idiopathic scoliosis patients from recent literature. Radiographic analysis revealed that 98.4% of 22q11.2DS patients with scoliosis had a curve morphology following predefined criteria for idiopathic curves: eight or fewer vertebrae, an S-shape and no inclusion of the lowest lumbar vertebrae. Furthermore, curve progression was present in 54.2%, with a mean progression rate of 2.5°/year, similar to reports on idiopathic scoliosis with 49% and 2.2–9.6°/year. The prevalence of intraspinal anomalies on MRI was 10.5% in 22q11.2DS, which is also comparable to 11.4% reported for idiopathic scoliosis. This indicates that 22q11.2DS may be a good model for prospective studies to better understand the etiology of idiopathic scoliosis.
Highlights
Scoliosis is a deformity of the spine and trunk that can have a clear cause, such as neuromuscular disease or congenital spinal malformation; the majority of cases are referred to as ‘idiopathic’ and occur in otherwise healthy adolescents [1]
Prospective cohort research, which follows the development of scoliosis starting in the pre-scoliotic spine, is practically impossible in the general population due to practical and ethical obstacles: the prevalence of idiopathic scoliosis would require thousands of children to be included for sufficient statistical power, and there would have to be periodic followups with full spine radiographs, raising ionizing radiation concerns
This study focused on the morphology, dynamic behavior, and presence of intraspinal anomalies, all of which are quantifiable features relevant to idiopathic scoliosis development
Summary
Scoliosis is a deformity of the spine and trunk that can have a clear cause, such as neuromuscular disease or congenital spinal malformation; the majority of cases are referred to as ‘idiopathic’ and occur in otherwise healthy adolescents [1]. Idiopathic scoliosis is quite common, with a prevalence of 2–4% in the general population, but its exact etiology remains clouded, despite important recent discoveries about genetics and the role of human upright spinal biomechanics [1,2,3,4,5,6]. The problem with current human etiology research is that, by necessity, only patients with an already established idiopathic scoliosis are studied; it is impossible to distinguish cause from effect [1,3]. Prospective cohort research, which follows the development of scoliosis starting in the pre-scoliotic spine, is practically impossible in the general population due to practical and ethical obstacles: the prevalence of idiopathic scoliosis would require thousands of children to be included for sufficient statistical power, and there would have to be periodic followups with full spine radiographs, raising ionizing radiation concerns. The best option is to use a ‘model’ with better availability or a higher idiopathic scoliosis prevalence—
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