Abstract
BackgroundRecent morphological analyses of vertebrae in patients with scoliosis have revealed three-dimensional (3D) deformities in the vertebral bodies. However, it remains controversial whether these deformities are secondary changes caused by asymmetrical vertebral loading or primary changes caused by aberrant asymmetrical vertebral growth. Furthermore, the difference in vertebral morphology between scoliosis with different pathogeneses remains unclear. This study was aimed to investigate the difference in the coronal asymmetry of vertebral bodies between neuromuscular scoliosis (NS) in Duchenne muscular dystrophy (DMD) and idiopathic scoliosis (IS) using in vivo 3D analysis.MethodsTwelve male skeletally immature patients with NS in DMD and 13 female skeletally immature patients with IS who underwent corrective fusion at our institution were included retrospectively. 3D bone models of the apical and adjacent upper and lower vertebrae in the major curve in the NS patients and in the main and compensatory curves in the IS patients were constructed using an image processing workstation. The heights of the concave and convex sides of the vertebral bodies were measured at the anterior, middle, and posterior and the concave-to-convex vertebral height ratios (VHR) were calculated.ResultsThe mean VHRs (anterior/middle/posterior) for the main curve for IS (0.897 ± 0.072/0.832 ± 0.086/0.883 ± 0.059) were significantly smaller than those for NS (0.970 ± 0.048/0.934 ± 0.081/0.958 ± 0.043) in all three parts (p < 0.001). Those of the compensatory curve in IS (0.968 ± 0.045/0.942 ± 0.067/0.967 ± 0.046) did not differ significantly from the NS values in any part.ConclusionsWhen compared to the wedging of the vertebral bodies around apical vertebrae in the major curve in NS, which was caused by asymmetric loading, the wedge deformities in both the main and compensatory curves in IS were more severe than would be expected. Our results indicated that morphometric characteristics of vertebral bodies differed according to the pathogenesis of scoliosis and that the pathology of the wedging of vertebral bodies in IS could not be a result only of asymmetric loading to the vertebral bodies.
Highlights
Recent morphological analyses of vertebrae in patients with scoliosis have revealed three-dimensional (3D) deformities in the vertebral bodies
Recent morphological analyses of vertebrae in patients with idiopathic scoliosis (IS) have revealed threedimensional (3D) deformities in the vertebral bodies such as wedging and torsion [1,2,3,4]. It remains controversial whether these deformities are secondary changes caused by asymmetrical vertebral loading or primary changes caused by aberrant asymmetrical vertebral growth [5]
Because the scoliotic change in patients with Duchenne muscular dystrophy (DMD) is not caused by primary vertebral wedging, establishing the differences in the morphometric characteristics of vertebral bodies between IS and neuromuscular scoliosis (NS) in DMD could help to clarify the pathology of vertebral deformities in patients with IS
Summary
Recent morphological analyses of vertebrae in patients with scoliosis have revealed three-dimensional (3D) deformities in the vertebral bodies It remains controversial whether these deformities are secondary changes caused by asymmetrical vertebral loading or primary changes caused by aberrant asymmetrical vertebral growth. Recent morphological analyses of vertebrae in patients with idiopathic scoliosis (IS) have revealed threedimensional (3D) deformities in the vertebral bodies such as wedging and torsion [1,2,3,4]. It remains controversial whether these deformities are secondary changes caused by asymmetrical vertebral loading or primary changes caused by aberrant asymmetrical vertebral growth [5]. Because the scoliotic change in patients with DMD is not caused by primary vertebral wedging, establishing the differences in the morphometric characteristics of vertebral bodies between IS and NS in DMD could help to clarify the pathology of vertebral deformities in patients with IS
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