Morphological changes in scoliosis during growth. Study in the human spine

Abstract

ObjectivesTo analyse the pathological substrate of human scoliotic spine during growth. Material and methodsWe studied two spines obtained at the autopsy of two patients suffering from untreated scoliosis: Sample A (a girl of 13 years and 2 months) and sample B (a boy of 14 years and one month). On the conventional radiological study the curves were measured using the method of Cobb, and the vertebral rotation with the Pedriolle method. A CT scan and analysis of the posterior asymmetry were also performed. The bone structure, growth plate, subchondral bone were evaluated in the histological study, as well as the presence and distribution of fibrous tissue. ResultsLevels from C7 to L5 were studied in sample A, and levels from T2 to L4 in sample B. There was no evidence of vertebral deformity in the frontal, sagittal or axial planes, except for T5 in sample A, where wedging into the concavity in the frontal plane was observed. The deformity originated in the intervertebral discs. Endochondral ossification of the epiphyseal cartilage showed increased activity on the side of the convexity of the curve. Neurocentral cartilage was present at thoracic and cervical levels, having disappeared at lumbar level. No asymmetry was observed in the neurocentral cartilage. ConclusionsThe deformity begins in the intervertebral discs, producing distortions in the epiphyseal cartilage. Those changes may influence the end of growth and therefore the deformity of the scoliotic vertebrae, basically resulting in wedging and rotation of the vertebrae.