Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance.

Christian Wong

doi:10.1186/s13013-015-0030-2

Abstract

Adolescent idiopathic scoliosis is regarded as a multifactorial disease and none of the many suggested causal etiologies have yet prevailed. I will suggest that adolescent idiopathic scoliosis has one common denominator, namely that initial curve development is mediated through one common normal physiological pathway of thoracic rotational instability. This is a consequence of gender specific natural growth of the passive structural components of thoracic spinal tissues for the adolescent female. This causes an unbalanced mechanical situation, which progresses if the paravertebral muscles cannot maintain spinal alignment. The alteration in the coronal plane with the lateral curve deformity is an uncoupling effect due to a culmination of a secondary, temporary sagittal plane thoracic flattening and of a primary, temporary transverse plane rotational instability for the adolescent female. Treatment of adolescent idiopathic scoliosis should address this physiological pathway and the overall treatment strategy is early intervention with strengthening of thoracic rotational stability for small curve adolescent idiopathic scoliosis.

Highlights

Adolescent idiopathic scoliosis has been described as early as 400 BC by Hippocrates [1]
Numerous studies have been conducted to clarify the etiologies behind adolescent idiopathic scoliosis, suggesting a broad variety of causes: central nervous system-related as a result of cortical brain development or disharmony in development between the somatic and autonomic nervous system, growth-related due to anterior spinal overgrowth or asymmetric rib growth, genetic as recognized from twin studies, hormonal related to melatonin, calmodulin or leptin system dysfunction, biomechanical as a result of a medullary or ligamental mechanical tether, related to asymmetry in pre-existing rotational patterns or developmental changes in the trunk, and many others causal theories [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Wong Scoliosis (2015) 10:2 instability in regards to treatment. Rather than considering it to be a coherent etiology accounting for all gender, age and curve variations, it should be seen as relevant observations leading to a suggested physiological pathway for scoliosis with a right primary thoracic curve, since treatment of these are required due to risk for progression [20]

Summary

Introduction

Adolescent idiopathic scoliosis has been described as early as 400 BC by Hippocrates [1]. The enigma of the common clinical characteristics of adolescent idiopathic scoliosis with a right primary thoracic curve at risk of progression (AIS), developing in the adolescent girl during spinal growth, cry out for a unifying theory, clarifying these aspects, or as formulated by Weinstein; “the key question of how and why initial small curve develops have not been answered” [2,3,19,20].

Results

Conclusion