Adolescent Idiopathic Scoliosis Girls Research Articles

Lack of association between suppressor of cytokine signaling-3 gene polymorphism and susceptibility and curve severity of adolescent idiopathic scoliosis.

To explore whether the suppressor of cytokine signaling-3 (SOCS3) gene polymorphisms are associated with the susceptibility and abnormal growth pattern of adolescent idiopathic scoliosis (AIS). Three hundred and ninety eight AIS girls aged 10-18 years old were enrolled, and 367 age-matched healthy girls were recruited as controls. Only patients who had Cobb angles larger than 20º were included in this study. Anthropometric parameters including body weight, height, and body mass index (BMI) were measured for AIS girls. Rs4969198 was selected as tagSNP to cover all of the related polymorphisms on SOCS3. Genotyping was performed using PCR-based Invader assay with the probe sets designed and synthesized by third wave. The genotyping results were read with an ABI PRISM7900HT sequence detection system (Applied Biosystems, Foster City, CA). A subgroup of 322 skeletally mature AIS patients who did not received bracing or any other conservative treatment previously were analyzed to define the contribution of rs4969168 on curve severity, body height, body weight, and BMI. Rs4969198 was successfully genotyped. No significant difference of genotype frequencies from the Hardy-Weinberg equilibrium (HWE) test was noted for the AIS patients or the normal controls. Neither the genotype nor the allele frequencies of rs49691968 were significantly different between the AIS patients and the normal controls. Rs4969168 was not found to be associated with age, curve severity of scoliosis, and body height. AIS patients with AA genotype had significantly higher body weight and BMI than the patients with AG and GG genotype (P = 0.014). The SOCS3 gene polymorphisms are not associated with the occurrence of AIS, but the gene polymorphism (rs4969168) is associated with abnormal growth pattern of AIS, indicating that SOCS3 gene might be a disease-modifying gene of AIS.

Are Volumetric Bone Mineral Density and Bone Micro-Architecture Associated with Leptin and Soluble Leptin Receptor Levels in Adolescent Idiopathic Scoliosis? – A Case-Control Study

BackgroundAdolescent idiopathic scoliosis (AIS) is associated with low bone mineral density (BMD). The underlying etiology and how it may relate to the development of osteopenia remains unknown. Leptin has been postulated as one of the etiologic factors of AIS because of its profound effects on bone metabolism and pubertal growth. Its modulator, soluble leptin receptor (sOB-R), may affect leptin bioavailability and signaling. This study aimed to investigate whether serum leptin and sOB-R levels may be associated with bone quality, and whether these relationships may differ between young adolescent girls with and without AIS.MethodsThis was a case-control study involving 94 newly diagnosed AIS girls (Cobb angle 12–48°) aged 12 to 14 years old and 87 age and gender-matched normal controls. Subjects with BMI>23.0 Kg/m2 were excluded. Anthropometric measurements including body weight, height, arm span and sitting height were taken. Serum total leptin and sOB-R were assayed with ELISA. Non-dominant distal radius was scanned with High Resolution pQCT for assessing bone quality in terms of bone morphometry, volumetric BMD (vBMD) and trabecular bone micro-architecture.ResultsCompared with normal controls, AIS girls had numerically higher sOB-R (p = 0.006), lower average vBMD (p = 0.048), lower cortical vBMD (p = 0.029), higher cortical bone perimeter (p = 0.014) and higher trabecular area (p = 0.027), but none remained statistically significant after the Hochberg-Benjamini procedure. Correlation analysis on serum leptin level indicated that distinctive correlations with trabecular bone parameters occurred only in AIS.ConclusionThis study showed that bone quality in AIS girls was deranged as compared with controls. In addition, the distinct differences in correlation pattern between leptin and trabecular bone parameters indicated possible abnormalities in bone metabolism and dysfunction of the leptin signaling pathway in AIS.

Bone structural and mechanical indices in Adolescent Idiopathic Scoliosis evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT)

Adolescent Idiopathic Scoliosis (AIS) is associated with systemic low bone mass. It could persist into adulthood and was shown to be an important prognostic factor for curve progression in AIS. Previous studies were confined to areal bone mineral density (aBMD) measured by Dual-energy X-ray Absorptiometry (DXA) which was a two-dimensional measurement for a three-dimensional structure. This conventional measurement was inadequate to evaluate volumetric bone density and bone quality which are important determinants for bone strength and bone health status as defined in the 2000 NIH consensus statement. High-resolution peripheral quantitative computed tomography (HR-pQCT) was therefore used in this study for three-dimensional evaluation of volumetric bone mineral density and bone micro-architecture as well as estimation of bone strength. In this study, 214 newly diagnosed AIS girls and 187 age and gender-matched normal control aged between 11 and 13years old were recruited for HR-pQCT evaluations on bone geometry, trabecular bone micro-architecture and volumetric BMD (vBMD) at the non-dominant distal radius. We demonstrated that AIS was associated with lower Cortical Bone Area, Cortical Bone vBMD, Trabecular Number and greater Trabecular Separation. With multivariate linear regression analysis and after adjustment for age, dietary calcium intake and physical activity level, the association of AIS with lower Cortical Bone vBMD, lower Trabecular Number and greater Trabecular Separation remained statistically significant. The findings of this study indicated that AIS was associated with an abnormal bone quality profile suggestive of alteration in endocortical modeling, derangement in trabecular bone structure and disturbance in bone mineralization. The cause for these changes and how they are related to the etiopathogenesis of AIS warrant further studies.

Effect of long-term orthotic treatment on gait biomechanics in adolescent idiopathic scoliosis

Background contextA previous study showed subtle biomechanical changes in the gait of unbraced adolescent idiopathic scoliosis (AIS) patients such as a reduction of pelvic, hip, knee, and ankle displacements. However, lumbopelvic muscles' timing activity was bilaterally increased during gait and correlated to excessive oxygen consumption as compared with healthy subjects. Usually, a brace, when indicated, is worn strictly for 22 hours every day in skeletally immature idiopathic scoliotic girls. To our knowledge, no study has assessed the long-term brace effect (6 months) on functional activities such as level walking. PurposeTo assess the stiffening effects of 6 months' brace wearing on instrumented gait analysis in girls with thoracolumbar/lumbar adolescent idiopathic scoliosis. Study design/settingClinical prospective study. Patient sampleThirteen girls diagnosed as progressive adolescent idiopathic scoliosis with left thoracolumbar/lumbar curves (curves ranging 25°–40°). Outcome measuresAll patients underwent a radiographic and instrumented gait analysis, including assessment of kinematics, mechanics, electromyography (EMG), and energetics of walking. MethodsThe scoliotic girls were prospectively studied at S1 (before bracing) and 6 months later at S2 (out-brace: treatment effect). The gait parameters were compared with those of 13 matched healthy girls. A t paired test was conducted to evaluate the effect of the 6-month orthotic treatment in AIS girls. Student t test was performed to compare the scoliotic group at S2 and the healthy subjects to identify if the observed changes in gait parameters meant improvement or worsening of gait. ResultsAfter 6 months of orthotic treatment in AIS, thoracolumbar/lumbar curves and apical rotation remained reduced by 25% and 61%, respectively. During gait, frontal pelvis and hip motions were significantly increased. Muscular mechanical work increased becoming closer but still different as compared with healthy subjects. Bilateral lumbopelvic muscles were almost 40% more active in AIS at S1 compared with healthy subjects and did not change at S2 except for the erector spinae muscles EMG activity, which decreased significantly. Energy cost exceeded by 30% in AIS at S1 compared with healthy subjects and did not change at 6 months' follow-up. ConclusionsAfter 6 months of orthotic treatment, in an out-brace situation, the main structural thoracolumbar/lumbar curve remained partly corrected. Frontal pelvis and hip motion increased, contributing to an improvement of muscular mechanical work during walking. EMG activity duration of lumbopelvic muscles did not change except for the erector spinae muscles, which was decreased but without any beneficial change in the energy cost of walking. In summary, brace treatment, after 6 months, did not significantly influence the gait variables in AIS girls deleteriously, but did not reduce the excessive energy cost, which was 30% above the values of normal adolescents.

Osteopenia Predicts Curve Progression of Adolescent Idiopathic Scoliosis in Girls Treated With Brace Treatment

Previous studies have shown a significant association between osteopenia and adolescent idiopathic scoliosis (AIS). And initial bone mineral density (BMD) was proposed to serve as a new prognostic factor of curve progression in AIS. However, it remains unknown whether there is a link between the initial bone mineral status and the outcome of brace treatment. This study aimed to investigate whether the initial bone mineral status could influence the final outcome of brace treatment in AIS. Girls with AIS treated with brace treatment were recruited. These patients either completed brace treatment, or were indicated for correction surgery with a curve magnitude of >45 degrees. Patients with a progressed scoliosis (group A) and those with a nonprogressed scoliosis (group B) were identified. The associations between the bracing outcome and the indices before bracing, including growth status, anthropometric measurements, BMD status, curve magnitude, and curve pattern were evaluated using univariate analysis and regression analysis. Sixty-eight patients were included. There were 17 girls (25%) in group A and 51 girls (75%) in group B, respectively. The girls in group A had a significantly larger initial Cobb angle (32.3±6.6 vs. 29.1±5.3 degrees), a significantly lower BMD of lumbar spine from L2 to L4 value (0.80±0.11 vs. 0.88±0.12 g/cm), and a marginally significantly lower Risser grade (1.4±1.5 vs. 2.2±1.4), than in group B. In comparison with group B, more girls in group A were found to be premenarche (P=0.008), osteopenic (P=0.003), with a lower Risser grade (P=0.079), a greater curve magnitude (P=0.159), and a main thoracic pattern (P=0.122) before the initiation of bracing treatment. As revealed by the multiple logistic regression analysis, osteopenia (P=0.002) was identified as an independent risk factor in curve progression in AIS girls, during the total duration of bracing treatment. Osteopenia is identified to serve as a new independent risk factor in the curve progression during the duration of bracing treatment. The evaluation of initial BMD status before bracing may help to predict the outcome of brace treatment. Level II.

Very short-term effect of brace wearing on gait in adolescent idiopathic scoliosis girls

Adolescent idiopathic scoliotic (AIS) deformity induces excessive oxygen consumption correlated to a bilateral increase of lumbo-pelvic muscles timing activity (EMG) during gait. Wearing a brace, the usual treatment for AIS, by supporting the spine and the pelvis, would generate lumbo-pelvic muscular relaxation and consequently reduce excessive oxygen consumption. The purpose of this study was to evaluate the short-term effect of bracing on gait biomechanics in scoliotic spine when compared with normal braced spine. Thirteen healthy volunteers were compared to 13 AIS girls. In both samples, gait analysis was assessed using a three-dimensional motion analysis, including synchronous kinematic, electromyographic, mechanical and energy measurements, first without brace, then wearing a brace. For scoliotic patients, comparison of in-brace and out-brace situations revealed a significant decrease of frontal pelvis (p < 0.001), hip (p < 0.001) and shoulder (p = 0.004) motion in brace associated with a significant reduction of pelvis rotation (p = 0.003). However, the brace did not change significantly the lumbo-pelvic muscle activity duration (EMG) or the mechanical and energetic parameters. Transversal pelvis motion was reduced by 39% (p = 0.04), frontal hip and shoulder motions by 23% (p = 0.004) and 30% (p = 0.01) respectively, and energy cost of walking remained increased by 37% in braced AIS girls relatively to braced healthy subjects. Mechanical and electromyographic variables were not significantly different between the two braced populations during gait except for the gluteus medius muscle that showed bilaterally an increase of duration of electrical activity in healthy subjects and contrarily a decrease in AIS patients (healthy: -3.5 ± 9.6% of gait cycle vs. scoliotic: 3.7 ± 7.7% of gait cycle; p = 0.04). Bracing changed neither the oxygen consumption nor the timing of the lumbo-pelvic muscles activity in both groups during gait. However, in brace the timing activity of bilateral gluteus medius muscles tended to decrease in AIS patients and increase in healthy subjects. Moreover, braced AIS patients had more restricted frontal hips and shoulder motion as well as pelvis rotation than braced healthy subjects.

Scoliogeny of adolescent idiopathic scoliosis: inviting contributions for a discussion based on evidence and theoretical interpretations aiming ultimately to prevention or aetiological treatment

This Editorial initiates a Thematic Series on the aetiology, pathogenesis and pathomechanisms (scoliogeny) of adolescent idiopathic scoliosis (AIS). It introduces the Series and invites contributions from researchers in the field and from interested parties. The aim is to develop a wideranging online discussion based on evidence and theoretical interpretations, In doing this, it will extend the role of the electronic focus group of the International Federated Body on Scoliosis Etiology (IBSE) which discussed nine selected topics from 2003 to 2013 [1,2]. While the relationship between scoliosis and growth was recognized forty years ago [3], progress in understanding the causation of AIS was fettered by a relative paucity of basic biological and biomechanical scientific data. Since then and subsequent to emphasis in pathogenesis on sagittal spinal plane [4] and relative anterior spinal overgrowth [5], advances in biological knowledge have enabled scoliogenic understanding to progress particularly after the year 2000 [6-8]. Knowledge limtation still restricts scoliogenic understanding for example in relation to the biochemistry and endocrinology of AIS [9] and the abnormal extra-spinal skeletal length asymmetries of AIS girls which are of unknown pathogenetic significance [2,10,11]. Research on the genetic variant hypothesis of disease for AIS has led to significant achievements [12]. Within the research forum of the British Scoliosis Research Foundation [13] there is a separate, private forum for the International Scoliosis Genetics Interest Group (ISGIG), a specialist group formed at the 2011 International Phillip Zorab Symposium. A possible role for environmental and epigenetic factors in AIS scoliogeny is

Abnormal Skeletal Growth in Adolescent Idiopathic Scoliosis Is Associated with Abnormal Quantitative Expression of Melatonin Receptor, MT2

The defect of the melatonin signaling pathway has been proposed to be one of the key etiopathogenic factors in adolescent idiopathic scoliosis (AIS). A previous report showed that melatonin receptor, MT2, was undetectable in some AIS girls. The present study aimed to investigate whether the abnormal MT2 expression in AIS is quantitative or qualitative. Cultured osteoblasts were obtained from 41 AIS girls and nine normal controls. Semi-quantification of protein expression by Western blot and mRNA expression by TaqMan real-time PCR for both MT1 and MT2 were performed. Anthropometric parameters were also compared and correlated with the protein expression and mRNA expression of the receptors. The results showed significantly lower protein and mRNA expression of MT2 in AIS girls compared with that in normal controls (p = 0.02 and p = 0.019, respectively). No differences were found in the expression of MT1. When dichotomizing the AIS girls according to their MT2 expression, the group with low expression was found to have a significantly longer arm span (p = 0.036). The results of this study showed for the first time a quantitative change of MT2 in AIS that was also correlated with abnormal arm span as part of abnormal systemic skeletal growth.

Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial

The aim of this randomized controlled trial was to determine whether whole body vibration (WBV) therapy was effective for treating osteopenia in adolescent idiopathic scoliosis (AIS) patients. Results showed that WBV was effective for improving areal bone mineral density (aBMD) at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects. AIS is associated with osteopenia. Although WBV was shown to have skeletal anabolic effects in animal studies, its effect on AIS subjects remained unknown. The objective of this study was to determine whether WBV could improve bone mineral density (BMD) and bone quality for osteopenia in AIS subjects. This was a randomized, controlled trial recruiting 149 AIS girls between 15 and 25 years old and with bone mineral density (BMD) Z-scores <-1. They were randomly assigned to the Treatment or Control groups. The Treatment group (n = 61) stood on a low-magnitude high-frequency WBV platform 20 min/day, 5 days/week for 12 months. The Control group (n = 63) received observation alone. Bone measurement was done at baseline and at 12 months: (1) aBMD and BMC at femoral necks and lumbar spine using dual-energy X-ray absorptiometry (DXA) and (2) bone quality including bone morphometry, volumetric BMD (vBMD), and trabecular bone microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT) for nondominant distal radius and bilateral distal tibiae. The Treatment group had numerically greater increases in all DXA parameters with a statistically significant difference being detected for the absolute and percentage increases in femoral neck aBMD at the dominant leg (0.015 (SD = 0.031)g/cm(2), 2.15 (SD = 4.32)%) and the absolute increase in lumbar spine BMC (1.17 (SD = 2.05)g) in the Treatment group as compared with the Control group (0.00084 (SD = 0.026)g/cm(2), 0.13 (SD = 3.62)% and 0.47 (SD = 1.88)g, respectively). WBV had no significant effect for other bone quality parameters. WBV was effective for improving aBMD at the femoral neck of the dominant side and lumbar spine BMC in AIS subjects.

Anatomic Deviation Between the Central Hip Vertical Axis and Central Sacral Vertical Line in Adolescent Idiopathic Scoliosis

A radiographic and clinical study. To compare the anatomic deviation between the central hip vertical axis (CHVA) and central sacral vertical line (CSVL) in 2 distinct adolescent idiopathic scoliosis (AIS) groups (right thoracic vs. left thoracolumbar/lumbar) and normal adolescents. The CSVL was traditionally used as a reference line to assess spinal deformity. Recently, the Scoliosis Research Society 3-dimensional (3D) committee proposed the CHVA as a reference line for the 3D evaluation of scoliosis. However, a previous study showed that the CHVA was on an average 3.2 mm to the right compared with the CSVL in right thoracic AIS patients, generating a shift in evaluation of the coronal plane measurements. Fifty-five AIS girls with right thoracic curves (TC) and 56 AIS girls with left thoracolumbar/lumbar curves (TLC) were recruited. AIS girls who had a Cobb angle >40 degrees were excluded from this study in consideration of the potential pelvic rotation in patients with large curves. Another 57 normal girls were set to be the control group. All girls were between 10 and 18 years old. The deviation between the CHVA and CSVL was measured on each posteroanterior radiograph and compared between the 3 groups. The shift of CHVA relative to CSVL was found to be significantly greater in the TC and TLC groups (2.2±3.3 mm vs. 2.3±4.0 mm, respectively) when compared with the control group (0.1±2.6 mm), but had no statistical difference between the 2 AIS groups. No significant correlations were found between age, Cobb angle, and the CHVA shift in the 3 groups. The CHVA was more commonly found to be at the right side of the CSVL in the TC (50.9%) and TLC (51.8%) groups, whereas superposition of the 2 lines was more commonly found in the control group (52.6%). Anatomic deviation between the CHVA and CSVL was significantly different in the TC and TLC groups when compared with the control group, but was similar between the 2 AIS groups. The CHVA was on an average approximately 2 mm to the right when compared with the CSVL in AIS girls. Adaption of the measures related to the CSVL is necessary to adopt the CHVA as a reference axis for the 3D evaluation of idiopathic scoliosis.

Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS.

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.

Normal Leptin Expression, Lower Adipogenic Ability, Decreased Leptin Receptor and Hyposensitivity to Leptin in Adolescent Idiopathic Scoliosis

Leptin has been suggested to play a role in the etiology of Adolescent Idiopathic Scoliosis (AIS), however, the leptin levels in AIS girls are still a discrepancy, and no in vitro study of leptin in AIS is reported. We took a series of case-control studies, trying to understand whether Leptin gene polymorphisms are involved in the etiology of the AIS or the change in leptin level is a secondary event, to assess the level of leptin receptor, and to evaluate the differences of response to leptin between AIS cases and controls. We screened all exons of Leptin gene in 45 cases and 45 controls and selected six tag SNPs to cover all the observed variations. Association analysis in 446 AIS patients and 550 healthy controls showed no association between the polymorphisms of Leptin gene and susceptibility/severity to AIS. Moreover, adipogenesis assay of bone mesenchymal stem cells (MSCs) suggested that the adipogenic ability of MSCs from AIS girls was lower than controls. After adjusting the differentiation rate, expressions of leptin and leptin receptor were similar between two groups. Meanwhile, osteogenesis assay of MSC showed the leptin level was similar after adjusting the differentiation rate, but the leptin receptor level was decreased in induced AIS osteoblasts. Immunocytochemistry and western blot analysis showed less leptin receptors expressed in AIS group. Furthermore, factorial designed studies with adipogenesis and osteogenesis revealed that the MSCs from patients have no response to leptin treatment. Our results suggested that Leptin gene variations are not associated with AIS and low serum leptin probably is a secondary outcome which may be related to the low capability of adipogenesis in AIS. The decreased leptin receptor levels may lead to the hyposensitivity to leptin. These findings implied that abnormal peripheral leptin signaling plays an important role in the pathological mechanism of AIS.

Abnormal Leptin Bioavailability in Adolescent Idiopathic Scoliosis

This was a cross-sectional study. The present study aimed to explore the differences in leptin bioavailability between adolescent idiopathic scoliosis (AIS) and healthy age-matched girls in a Chinese Han population. AIS is a common spinal deformity mainly occurring in girls during the peripubertal period. The development of scoliosis is related to relative anterior spinal overgrowth. AIS girls also have associated lower body mass index (BMI) and lower bone mineral status. Leptin, together with soluble leptin receptor (sOB-R), was shown to play an important role in the regulation of bone and energy metabolism in children. It was hypothesized that leptin and sOB-R are abnormal and associated with deranged growth and anthropometric phenotypes in AIS girls. Serum leptin and sOB-R were measured together with documentation of anthropometric parameters and clinical data in 95 AIS girls and 46 healthy matched controls (age 11-16 years). Serum leptin and sOB-R concentrations were measured by enzyme-linked immunosorbent assay and correlated with the different measured parameters. AIS girls had significantly lower BMI and longer arm span than healthy controls. AIS girls were found to have significantly higher sOB-R levels and lower free leptin index (FLI) after adjusting for age and body weight in multivariate regression analysis. Significant correlation was found between sOB-R, FLI, and curve severity in AIS girls. This is the first study demonstrating the presence of abnormal leptin bioavailability in AIS girls that might play an important role in the etiopathogenesis of AIS. Further investigation is required to provide a better understanding of the underlying mechanisms, with the aim to explore the potential clinical application as a biomarker for predicting curve initiation or progression in AIS.

Body growth parameters in girls with adolescent idiopathic scoliosis: single thoracic idiopathic scoliosis versus single lumbar idiopathic scoliosis

Objective To investigate anthropometric and body composition parameters of girls with single thoracic idiopathic scoliosis and lumbar idiopathic scoliosis in China.Methods Three hundred and thirty-nine adolescent idiopathic scoliosis (AIS) girls and 3914 healthy girls,aged 10-17 years,were included.All AIS girls had a mean Cobb angle of 32°±10° (range,15°-63°).According to the locations of curves end vertebrae,AIS girls were divided into 2 subgroups:a single thoracic curve and a single lumbar curve.Body weight and standing height were measured,and body mass index (BMI) and leg length were calculated of each subject in three groups,and corrected height was computed in AIS group according to Bjure's formula.One-way ANOVA was used to determine the statistical differences in weight,height,corrected height and BMI between AIS and healthy girls.Results Standing height and sitting height showed no significant difference between thoracic scoliosis and lumbar scoliosis girls.Compared to healthy girls at the same age,thoracic and lumbar AIS girls had a significantly higher corrected standing and sitting height,arm span and leg length.Thoracic AIS girls had a significantly lower body weight than healthy girls at the age of 15 years.Yet,body weight showed no significant difference between lumbar AIS and healthy girls.Conclusion Compared to healthy girls at the same age,the thoracic and lumbar AIS girls had the similar abnormal growth characteristics.In addition,thoracic AIS girls are leaner than healthy girls. Key words: Scoliosis; Adolescent; Growth

Iliac crest orientation and geometry in able-bodied and non-treated adolescent idiopathic scoliosis girls with moderate and severe spinal deformity

To identify pelvic rotation and/or distortion in able-bodied and untreated AIS girls with moderate and severe scoliosis and verify association of pelvic morphological changes with Cobb angle increase. The 3D coordinates of nine anatomic bony landmarks were identified to estimate pelvic orientation using a Flock of Birds system. The distances between the first sacral vertebral body (S1) and each of the eight iliac spine landmarks in all three planes were calculated to identify pelvic distortion. Analysis of variance was used to assess pelvic orientation and determine pelvic distortion. Pearson coefficients of correlation were used to identify any relationships between Cobb angle and pelvic morphological parameters. Pelvic orientation was similar in able-bodied and scoliotic girls regardless of the severity of the spinal deformity. Significant differences were observed in pelvic morphology between AIS with severe untreated scoliosis and those with a moderate scoliosis for the right anterosuperior iliac spines (ASIS), the tip of the superior iliac crest (TSIC) and the widest tip of the iliac crest (WTIC) widths from S1. Statistically significant correlations were observed between the Cobb angles and the iliac crest distances measured from S1. Differences in iliac spine geometries occurred in the transverse plane correlating to Cobb angles which suggest altered bone growth in AIS girls. Such findings could indicate right thoracic spinal deformity as a result of pelvic torsion.

Anthropometry and Body Composition Profile of Girls With Nonsurgically Treated Adolescent Idiopathic Scoliosis

Cross-sectional study with level III of evidence. To describe different anthropometric and body composition parameters of adolescent girls with adolescent idiopathic scoliosis (AIS), comparing them with the standards of a healthy age-matched population. Body growth and development of adolescent girls with AIS seems to differ from the healthy subjects, especially at perpubertal stages. Young scoliotic adults have been found to be taller, lighter, and thinner than age-matched healthy population. Body composition profile taken from measurements of skin-fold thickness, bony diameters at different levels, and arm and legs perimeters has not been previously reported in AIS patients. A nonconsecutive series of 52 AIS girls (mean age: 13.9 years) with an average scoliotic curve of 27° Cobb (range: 20-58) underwent an anthropometric study. None of the AIS girls had been treated previously with spinal surgery. The control group consisted of 92 girls without spine deformity, matched in age (mean: 13.8 years). Weight, height, and skin-fold thickness in millimeters at six levels were measured. Body mass index (BMI), Ponderal index, percentage of body fat, percentage of muscular tissue, fat mass, lean body mass, muscular weight, bony weight, and residual weight were calculated using standard rules to estimate body composition. The somatotype components (endomorphy, mesomorphy, and ectomorphy) were calculated according to the Carter equations. RESULTS.: Compared with the control population, scoliotic girls had a significantly lower mean weight (51.4 ± 10.2 kg vs. 54.7 ± 8.1 kg; P < 0,05), a lower BMI (20.1 ± 3.4 vs. 21.4 ± 2.4; P < 0.001), and a higher Ponderal index (43.2 ± 2.4 vs. 42.2 ± 1.6; P < 0.01). Girls with AIS showed a progressive decrease of the BMI as the age increased. The percentage of body fat was also lower in scoliotic girls, without significant statistical differences (14.1 ± 3.8 vs. 15 ± 3.6). Out of the 52 AIS girls, 11 (21.2%) showed a BMI below 17.5, which has been considered the limit for anorexia. In the control group, only 3 of 92 girls (3.3%) had BMI below that level. The somatotype differed also between scoliotics and controls: higher in the ectomorphic component (3.29 ± 1.68 vs. 2.40 ± 1.11; P < 0.001), and lower in the mesomorphic component (2.86 ± 0.82 vs. 3.70 ± 1.11; P < 0.01) in AIS patients. The differences in some anthropometric parameters (weight, IMC, IP) and in the somatotype suggest that the idiopathic scoliosis not only disturbs normal spine growth but also seems to have implications on the whole corporal development. Whether these changes could be related to abnormal spinal growth or subsequent to nutritional changes in AIS still remains uncertain. Presumably, some endocrine factors affecting body composition and growth might be involved in the etiology of idiopathic scoliosis.

Abnormal Bone Quality in Adolescent Idiopathic Scoliosis

A case-control study comparing bone quality in Adolescent Idiopathic Scoliosis (AIS) with normal controls. To evaluate bone quality with quantitative ultrasound (QUS) in AIS and normal controls so as to detect any derangement in bone quality among AIS subjects. AIS is characterized by complex spinal deformities. Despite its high prevalence and clinical impact in adolescents, etiology of AIS remains unknown but one possible mechanism is related to derangement of bony mechanical stability, as quantified by bone mineral density (BMD) and bone quality. AIS is known for its association with osteopenia, but little is known about the bone quality in AIS. With technological advancement, QUS can provide objective measurement of bone quality. In this study, we sought to compare bone quality in AIS with normal controls using QUS in addition to the conventional BMD measurement. Six hundred thirty-five AIS girls and 269 age-matched normal girls were investigated. Broadband ultrasound attenuation (BUA), velocity of sound (VOS), and stiffness index (SI) were measured over the nondominant calcaneus using QUS. The results were correlated with anthropometric measurement, radiologic assessment, and BMD of both hips. The z-score of BMD at the femoral neck of AIS subjects (-0.47 ± 0.97) was significantly lower than that of normal controls (-0.12 ± 1.01, P < 0.001). Crude comparison showed that BUA, VOS, and SI of AIS group were 3.8% (P < 0.01), 0.5% (P = 0.042), and 6.9% (P < 0.01) lower than controls, respectively. After controlling confounding from maturity, body weight, body height, and BMD with multiple linear regression analysis for both mild (Cobb's angle ≤ 25°) and severe (Cobb's angle > 25°) curves, BUA and SI were found to be statistically significantly lower in AIS as compared with controls (P < 0.05). In addition to higher prevalence of osteopenia, AIS patients were also found to have deranged bone quality. These might contribute to the etiopathogenesis of spinal deformities in AIS.

Timing of menarche in Chinese girls with and without adolescent idiopathic scoliosis: current results and review of the literature

Age at menarche is closely related to scoliosis progression during adolescence. Current data concerning the timing of menarche between scoliotic and non-scoliotic girls in the literature are conflicting, with inconclusive results. The aim of this study was to investigate the distribution difference of age at menarche for adolescent idiopathic scoliosis (AIS) girls and normal control population and to subsequently elucidate the menarche age difference through literature reviewing. Moreover, menarche age of AIS girls with Cobb angle <40°, 40-60°, >60° were compared to estimate its association with curve severity. Menstrual status data were available for 6,376 healthy female adolescents and 2,196 AIS girls. We notice that less than 10% of healthy Chinese girls experienced onset of menses before 11.38 years, and approximately 90% of healthy Chinese girls were menstruating by 13.88 years, with a median age of 12.63 years. As for AIS girls, less than 10% started to menstruate before 11.27 years, and approximately 90% were menstruating by 14.38 years, with a median age of 12.83 years. Average menarche age in AIS (12.83 ± 1.22 years) was significantly later than that of normal control girls (12.63 ± 0.98 years) (p < 0.001). Age at menarche for AIS affected girls was significantly greater than that of normal control girls at 75%, 90% of whom had attained menarche (p = 0.001, p < 0.001). Proportion of girls starting to menstruate after 14 years was significantly higher in AIS population compared with normal controls (16.3 vs. 8.1%, p < 0.001). In addition, AIS girls with Cobb angle >60° experienced onset of menses at an average age of 13.25 years, which was significantly later than AIS girls with Cobb angle <40° (12.81 years, p < 0.05) and marginally significantly later than AIS girls with Cobb angle between 40 and 60° (12.86 years, p = 0.053). In conclusion, a tendency of delayed onset of menarche was observed in Chinese idiopathic scoliotic girls in this large sample study, especially for girls with Cobb angle >60°, which is supported by multiple previously established positive linkages on AIS etiology studies. Accordingly it is believed that late menarche may contribute importantly to abnormal pubertal growth and subsequently modulate curve behavior in AIS.

Horizontal body and trunk center of mass offset and standing balance in scoliotic girls

In adolescent idiopathic scoliotic girls, postural imbalance is attributed to a sensory rearrangement of the motor system on the representation of the body in space. The objectives of this study were to test if the anteroposterior (AP), mediolateral (ML) and resultant body-head and trunk center of mass (COM) horizontal offsets were similar in able-bodied and scoliotic girls and if these offsets were related to the center of pressure displacements. A total of 21 adolescent idiopathic scoliosis girls and 20 able-bodied girls participated in this study. Their body COM position and that of the head and trunk were estimated according to Damavandi et al. (Med Eng Phys 31:1187-1194, 2009). The COP range and speed in both AP and ML axes were calculated from force plate measurements in quiet standing. The AP offset of the able-bodied group was anterior to the body COM by 11.0±15.9mm, while that of the scoliotic group was posterior to it by -17.3±11.2mm. The able-bodied group maintained their head-trunk segment COM more to the right by 14.1±13.1mm, while that of the scoliotic group was nearly over their body centerline. The scoliotic girls presented higher values for COP range and COP speed than the able-bodied girls. The resultant COM offset was correlated with both the ML COP range and speed only for the scoliotic girls. The small ML COM offset in the scoliotic girls was attributed to a compensatory action of the spinal deformity in the frontal plane resulting in a backward resultant COM offset to regain postural balance concomitant to an increase in the ML neuromuscular demand.

Abnormal proliferation and differentiation of osteoblasts from girls with adolescent idiopathic scoliosis to melatonin

Melatonin deficiency has been postulated as an etiologic factors in adolescent idiopathic scoliosis (AIS). In previous studies, melatonin was shown to regulate skeletal growth and bone formation in both humans and rats. Although it remains controversial whether there are differences in serum melatonin level between AIS and control subjects, melatonin signaling pathway dysfunction in osteoblasts has been reported in patients with AIS. Recently, our group found that melatonin receptor 1B (MT2) gene polymorphism was associated with the occurrence of AIS. Hence, the present study investigated the effect of melatonin on AIS osteoblasts. In vitro assays were performed with osteoblasts isolated from 17 severe AIS girls and nine control subjects. The osteoblasts were exposed to different concentrations of melatonin for 3 days. The effects of melatonin on cell proliferation (as evidenced by MTT assay) and differentiation (demonstrated by alkaline phosphatase activity) were determined. In the control group, melatonin significantly stimulated osteoblasts to proliferate and differentiate. However, in the AIS group, the stimulatory effects of melatonin were not discernible. Importantly, this finding demonstrated that there is a significant difference between AIS and control osteoblasts in functional response toward melatonin. Melatonin-stimulated proliferation of control osteoblasts was inhibited by the MT2 antagonist, 4-phenyl-2-propionamidotetraline, as well as by luzindole, a nonselective melatonin receptor antagonist, suggesting that MT2 is associated with the proliferative action of melatonin. The lack of response in AIS osteoblasts might be because of dysfunction of the melatonin signaling pathway, which may contribute to the low bone mineral density and abnormal skeletal growth observed in patients with AIS.