Development Of Idiopathic Scoliosis Research Articles

The role of paranasal sinuses in the mysterious etiopathogenesis of idiopathic scoliosis

Aim: The paranasal sinuses play a role in maintaining postural balance and synthesizing neurotransmitters such as nitric oxide (NO). Although the etiopathogenesis of idiopathic scoliosis (IS) is not fully known, it is known that hormonal and neurosensory mechanisms play a role. In this study, the possible effects of paranasal sinuses on the etiology of IS were investigated. Methods: In this cross-sectional planned study, 38 individuals with IS (28 women and 10 men) and 39 healthy individuals (28 women and 11 men) were included. The right and left maxillary, sphenoid and frontal-ethmoid sinus volumes of the groups were calculated from magnetic resonance images. In addition, the entire head volume of each participant was calculated and the volume ratios occupied by all paranasal sinuses were calculated. Results: In the IS group, the right maxillary sinus mean volume decreased by 16% and the left maxillary sinus volume value decreased by 14% compared to the control group (p<0.01). No significant difference was detected between the groups in the sphenoid and frontal-ethmoid sinus parameters (p>0.05). It was observed that the values of left maxillary sinus volume, frontal-ethmoid sinus volume, right maxillary sinus ratio, left maxillary sinus ratio and frontal-ethmoid sinus ratio were lower in male individuals in the IS group than in healthy individuals (p < 0.01). Conclusion: In the presented study, it appears that the paranasal sinuses may have a role in the development of IS.

Upregulated estrogen receptors impairs myogenesis and elevates adipogenesis related factor levels in the paravertebral muscles of patients with idiopathic scoliosis

The prevalence of idiopathic scoliosis (IS) is 2–3% worldwide and is more common in girls. Estrogen receptors (ERs) is supposed to be related to sex differences and development of IS. Meanwhile, paravertebral muscle (PVM) abnormalities play important roles in the pathogenesis of IS. But the changes of ERs between the PVMs from IS patients and controls, and the mechanism by which ERs may affect IS patients remain unclear. Thus, the expression levels of ERs, myogenesis regulator (MYOG) and adipogenesis related factors (CEBPA, PPARγ, FABP4), as well as morphological changes in the PVMs and primary skeletal muscle mesenchymal progenitor cells (hSM-MPCs) of IS patients and controls were investigated. Increased expression levels of ERs and CEBPA, PPARγ, FABP4, together with severe myofiber necrosis and fat infiltration, were found in the PVMs of IS patients. Meanwhile, upregulated ERs, FABP4 and CEBPA, downregulated MYOG and impaired myogenesis were also revealed in the hSM-MPCs of IS patients compared with those of controls. Upregulation of ERs inhibited myogenesis but increased expression of CEBPA and FABP4 in C2C12 myoblasts. Nevertheless, treatment of ER antagonist increased expression of MYOG, enhanced myogenesis and decreased expression of CEBPA and FABP4 in skeletal muscle cells of IS patients. Therefore, our study suggested that PVMs specific upregulation of ERs could impair myogenesis and increase the expression of adipogenesis related factors, further leading to PVMs abnormalities in IS patients.

Morphology, Development and Deformation of the Spine in Mild and Moderate Scoliosis: Are Changes in the Spine Primary or Secondary?

Introduction and aim of the study: We aim to determine whether the changes in the spine in scoliogenesis of idiopathic scoliosis (IS), are primary/inherent or secondary. There is limited information on this issue in the literature. We studied the sagittal profile of the spine in IS using surface topography. Material and methods: After approval of the ethics committee of the hospital, we studied 45 children, 4 boys and 41 girls, with an average age of 12.5 years (range 7.5–16.4 years), referred to the scoliosis clinic by our school screening program. These children were divided in two groups: A and B. Group A included 17 children with IS, 15 girls and 2 boys. All of them had a trunk asymmetry, measured with a scoliometer, greater than or equal to 5 degrees. Group B, (control group) included 26 children, 15 girls and 11 boys, with no trunk asymmetry and scoliometer measurement less than 2 degrees. The height and weight of children were measured. The Prujis scoliometer was used in standing Adam test in the thoracic (T), thoraco-lumbar (TL) and lumbar (L) regions. All IS children had an ATR greater than or equal to 5 degrees. The Cobb angle was assessed in the postero-anterior radiographs in Group A. A posterior truncal surface topogram, using the “Formetric 4” apparatus, was also performed and the distance from the vertebra prominence (VP) to the apex of the kyphosis (KA), and similarly to the apex of the lumbar lordosis (LA) was calculated. The ratio of the distances (VP-KA) for (PV-LA) was calculated. The averages of the parameters were studied, and the correlation of the ratio of distances (VP-KA) to (VP-KA) with the scoliometer and Cobb angle measurements were assessed, respectively (Pearson corr. Coeff. r), in both groups and between them. Results: Regarding group A (IS), the average height was 1.55 m (range 1.37, 1.71), weight 47.76 kg (range 33, 65). The IS children had right (Rt) T or TL curves. The mean T Cobb angle was 24 degrees and 26 in L. In the same group, the kyphotic apex (KA (VPDM)) distance was −125.82 mm (range −26, −184) and the lordotic apex (LA (VPDM)) distance was −321.65 mm (range −237, −417). The correlations of the ratio of distances (KA (VPDM))/(LA (VPDM)) with the Major Curve Cobb angle measurement and scoliometer findings were non-statistically significant (Pearson r = 0.077, −0.211, p: 0.768, 0.416, respectively. Similarly, in the control group, KA (VPDM))/(LA (VPDM) was not significantly correlated with scoliometer findings (Pearson r = −0.016, −p: 0.939). Discussion and conclusions: The lateral profile of the spine was commonly considered to be a primary aetiological factor of IS due to the fact that the kyphotic thoracic apex in IS is located in a higher thoracic vertebra (more vertebrae are posteriorly inclined), thus creating conditions of greater rotational instability and therefore greater vulnerability for IS development. Our findings do not confirm this hypothesis, since the correlation of the (VP-KA) to (VP-KA) ratio with the truncal asymmetry, assessed with the scoliometer and Cobb angle measurements, is non-statistically significant, in both groups A and B. In addition, the aforementioned ratio did not differ significantly between the two groups in our sample (0.39 ± 0.11 vs. 0.44 ± 0.08, p: 0.134). It is clear that hypokyphosis is not a primary causal factor for the commencing, mild or moderate scoliotic curve, as published elsewhere. We consider that the small thoracic hypokyphosis in developing scoliosis adds to the view that the reduced kyphosis, facilitating the axial rotation, could be considered as a permissive factor rather than a causal one, in the pathogenesis of IS. This view is consistent with previously published views and it is obviously the result of gravity, growth and muscle tone.

Idiopathic scoliosis: general characteristics and analysis of etiological theories (literature review)

Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem. The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.

Novel Mutations in UTS2R are Associated with Adolescent Idiopathic Scoliosis in the Chinese Population.

A case-control study. To investigate the association of urotensin II (UTS2) signals with the susceptibility of adolescent idiopathic scoliosis (AIS) in the Chinese Han population. Dysregulated UTS2 signals induced by impaired cerebrospinal fluid flow have been implicated in the development of idiopathic scoliosis through studies on zebrafish. Furthermore, mutations in urotensin II receptor (UTS2R) were reported to cause severe scoliosis in zebrafish. In spite of the evidence presented in animal models, there is still a lack of knowledge concerning the role of UTS2 signaling related genes in AIS. In the discovery stage, exons of UTS2, UTS2R, and UTS2D were sequenced for 200 AIS patients and 200 healthy controls. Newly identified mutations were further genotyped in another independent cohort of 1000 AIS patients and 1000 controls by allelic-specific multiple ligase detection reactions. Gene expression analysis was performed in 36 AIS patients and 36 age-matched congenital scoliosis patients. The Chi-square test was used to compare the genotyping data between the groups. Gene expression analysis was compared with the Student t test. Association between two novel mutations (rs11654140, c.51T > C; rs568196624, c.1146C > G) and the development of AIS was identified. Allele C of rs11654140 and allele G of rs568196624 were significantly associated with the risk of AIS (1.5% vs. 0.5%, odds ratio = 3.02, P = 0.01 for rs11654140; 1.41% vs. 0.58%, odds ratio = 2.29, P = 0.04 for rs568196624). The mRNA expression of UTS2R in the AIS group was significantly higher as compared with that in the control group (0.059 ± 0.015 vs. 0.035 ± 0.013, P < 0.01). Rare mutations in UTS2R were significantly associated with AIS. Expression of UTS2R was significantly increased in AIS patients. The role of UTS2 signaling in the development of AIS is worthy of further investigation.Level of Evidence: N/A.

Relationship between autophagy, apoptosis and endoplasmic reticulum stress induced by melatonin in osteoblasts by septin7 expression.

Melatonin secreted by the pineal body is associated with the occurrence and development of idiopathic scoliosis. Melatonin has a concentration-dependent dual effect on osteoblast proliferation, in which higher concentrations can inhibit osteoblast proliferation and induce apoptosis; however, the underlying mechanism remains unclear. In the present study, flow cytometry was used to demonstrate that osteoblast cells treated with melatonin exhibited significantly increased early and late stage apoptotic rates as the concentration increased. Chromatin condensation in the nucleus and apoptotic body formation could be observed using fluorescent microscopy in osteoblast cells treated with 2 mM melatonin. Western blotting results showed that there was an upregulation in the expression of apoptosis marker proteins [poly (ADP-ribose) polymerase 1 (PARP-1)], endoplasmic reticulum stress [ERS; C/EBP homologous protein (CHOP) and glucose-regulated protein, 78 kDa (GRP78)] and autophagy [microtubule-associated protein 1 light chain 3β (LC3)-I/LC3II]. PARP-1 expression was not altered when treated with ERS inhibitor 4PBA and autophagy inhibitor 3MA, whereas 4PBA or 3MA in combination with 2 mM melatonin (or the three together) significantly increased PARP-1 expression. Furthermore, the use of septin7 small interfering RNA confirmed that increased expression of GRP78 and CHOP was related to septin7, and melatonin- mediated ERS was necessary for septin7 activation. These findings suggest that ERS and autophagy might occur in the early stage of treatment with a high concentration of melatonin, and each might play a protective role in promoting survival; in a later stage, ERS and autophagy might interact and contribute to the induction of apoptosis. Overall, the results indicated that septin7 may be a target protein of melatonin-induced ERS.

GENETIC ASPECTS OF IDIOPATHIC ESCOLIOSIS - A LITERATURE REVIEW

ABSTRACT The idiopathic scoliosis (IS) is the most common form of spinal deformity. The pathogenesis of IS is still poorly understood. Several studies show evidence that the genetic component is determinant to the development of IS. In this setting, a crescent focus has been placed on the identification of genes, associated genetic polymorphisms, and multiple susceptibility loci. This review highlights the genes and genetic polymorphisms currently studied, identified as influential in the genesis of IS, such as MMP-3, IL-6, type I collagen, and vitamin D and estrogen receptors. We concluded that IS remains a complex disease with a polygenic background and that genetic polymorphisms are intrinsically related to this condition. Level of evidence III; Narrative Review.

IDENTIFICATION OF SNPs IGF-1 GENE IN VERTICAL MANDIBULAR ASYMMETRY PATIENTS WITH IDIOPATHIC SCOLIOSIS SYMPTOM

Objective:Previous studies reported IGF-1 (Insulin-like Growth factor type-1) gene expression in mandibular condylar cartilage and idiopathic scoliosis development. This paper aims to correlate the Single Nucleotide Polymorphism (SNPs) of IGF-1 gene rs5742632 in vertical mandibular asymmetry patients with idiopathic scoliosis symptom.Methods:TheIGF-1 gene rs5742632 polymorphism of 49 patients (19.38±3.24-year-old) who were treated at orthodontics department Dental Hospital Universitas Sumatera Utara and orthopedics department of Haji Adam Malik Hospital from April-August 2017, were genotyped using polymerase chain reaction-restriction fragment length polymorphism analysis in case-control of idiopathic scoliosis symptom. An enzyme-linked immunochemiluminescent assay measured IGF-1 levels. Analyzing of mandibular asymmetry index based on Kjellberg's technique using the panoramic radiograph.Results:The scoliosis symptom based on clinical judgment of orthopedics by asymmetry trunk posture and adam’sforward bend test movement analysis. This study showed no significant difference (p&gt;0.05) in the genotype distribution (rs5742632) haplotype in vertical mandibular asymmetry based on scoliosis symptom. However, there was a significant difference between early and late adolescent among those subjects in IGF-1 level measurement (p=0.033). dam’s forward bend test and a scoliometer measurementConclusion:The result was still not conclusive due to variance in mandibular growth and curve lateral spine in adolescent patients. Further study will requiresubject increment and more specific samples to study the risk factor of vertical mandibular asymmetry .

GENE EXPRESSION IN GROWTH PLATE CHONDROCYTES OF PATIENTS WITH IDIOPATHIC SCOLIOSIS

Objective. To analyze the expression of candidate genes presumably responsible for the development of idiopathic scoliosis. Material and Methods. The study subjects were vertebral body growth plates of children aged 11-15 years suffering from Grade III-IV idiopathic scoliosis. Real-Time SYBR Green PCR assay was used to investigate the expression of genes responsible for growth regulation, chondrogenic differentiation, matrix formation and synthesis, and sulfation and transmembrane transport of sulfates. Results. Comparative analysis of gene expression did not give a clear answer. On the background of representative morphological and biochemical data including violation of the structural organization of cells and matrix on the concave side of deformity, presence of poorly differentiated chondroblasts, and lack of differentiation in columnar and hypertrophic structures, a sharp decline in synthetic potency of cells contradicted the data on high expression of IHH, TGFBR1, and EGFR genes, matrix proteoglycans genes ACAN, LUM, and VCAN, collagen types I and II, and of sulfation and sulfate transmembrane transport genes DTDST, CHST1, and CHST3. Expression of growth hormone receptor gene, differentiation genes SOX9 and PAX9, and link protein gene was reduced. Factor analysis of the studied genes has shown significant difference between gene expression in chondroblasts of patients with idiopathic scoliosis and that in controls. Conclusion. Complex interaction of genes under the control of the central regulatory mechanisms coordinates the periodization of gene turning on, thereby integrating the process of the spine growth. Violation of any of the factors in the complex system of morphogenesis regulation causes asymmetric growth resulting in scoliosis development.

Association Between IL-6 and MMP3 Common Genetic Polymorphisms and Idiopathic Scoliosis in Bulgarian Patients: A Case-control Study.

A case-control study was performed on 105 patients with idiopathic scoliosis (IS) and 210 unrelated gender-matched controls from Bulgarian population. Investigation of the association between common genetic polymorphisms of IL-6 and MMP3 genes and the etiology and progression of IS among Bulgarian patients. The IL-6 and MMP3 genes have been considered as candidate genes of IS in Caucasian population. Molecular detection of the promoter polymorphisms of IL-6 and MMP3 was performed by polymerase chain reaction followed by restriction fragment length polymorphism. The statistical analysis was performed by χ test with a value of P < 0.05 as statistically significant. The combinatorial effect of the candidate genes was also examined. This case-control study revealed statistically significant association between the IL-6 (rs1800795) functional polymorphism and susceptibility to IS (χ = 16.055; P < 0.0001). In addition, a significant association between IL-6 (rs1800795) and curve severity was detected (χ = 16.87; P < 0.0001). No genotype or allele of MMP3 (rs3025058) was found to be correlated to the onset or progression of IS (P > 0.05). One IL-6-MMP3 genotype combination was associated with the susceptibility to IS. IL-6 gene could be considered as a susceptibility and modifying factor of IS. The identification of molecular markers with diagnostic and prognostic value could be useful for early detection of children at risk for the development of IS and for prognosis of the risk for a rapid deformity progression. That would facilitate the therapy decisions and early stage treatment of the patient with the least invasive procedures. 4.

Effect of symmetric mobilization exercises applied sagittale plane on spine flexibility and angle of trunk rotation in scoliosis

Thoracic and lumber flatback has been assumed to be the triggerring factor for idiopathic scoliosis. It is belived that rotation and lateral deviation are secondary patterns of deformity in the development of idiopathic scoliosis, and it should be possible to improve scoliosis by forces in sagittal plane. It is suggested that Physio-logic® exercises stabilize the spine posture and correct scoliosis in 3-D. The aim of this study was to assess the effect of symmetric mobilization exercise which was defined in Physio-logic®exercises on spine flexibility and angle of trunk rotation. Thirty four patients (30 female, 4 male) with adolescent idiopathic scoliosis (AIS) were included in this study. King classification was used to classify of scoliosis types. “Symmetric mobilization” exercise was done 20 repetitions, 15 sessions in supin position under physiotherapist supervision. Spine flexibility was evaluated with forward and lateral bending test and angle of trunk rotation was measured with scoliometer. Evaluations were performed before and after every session. The mean age of patients was 13.5years (range; 10-17). The mean Cobb angle was 31.64° (range; 12°- 60°) and angle of trunk rotation was 9.86° (range; 3°-16°). Statistically significant improvements were observed for all assessed measurements after the treatment (p<0.05). Our results showed that spine flexibility can be improved and angle of trunk rotation can be decreased by sagittal forces. Increasing of spine flexibility and decreasing angle of trunk rotation may prevent progression of scoliosis. We suggest that symmetric mobilisation exercises should take place in the rehabilitation programme of AIS.

Torakaliumbalinės fascijos pakitimų vertinimas ultragarso tyrimo pagalba esant paauglių idiopatinei skoliozei – bandomasis tyrimas

Radiologiškai įrodyta, kad fascijos vaidina svarbų vaidmenį lėtinių juosmens ir kaklo miofascialinių skausmų patogenezėje, konstatuoti jų morfologiniai pakitimai. Taikant reabilitacijos priemones užfiksuotas fascijų normalizavimasis ir simptomų sumažėjimas. Paauglių idiopatinės skoliozės priežastis yra neaiški, tikėtina ji polietiologinės kilmės. Torakoliumbalinės fascijos vaidmuo idiopatinės skoliozės atveju nežinomas ir radiologiškai nebuvo tirtas. Idiopatinės skoliozės atveju tikėtinas panašus patofiziologinis fascijų pažeidimo mechanizmas kaip ir esant miofascialiniams skausmams. Šio bandomojo tyrimo tikslas buvo sužinoti, ar yra skirtumas tarp torakoliumbalinės fascijos radiologinių charakteristikų (storis, sluoksniuotumas) sveikiems ir idiopatinę skoliozę turintiems paaugliams. Vaikų ligoninėje, VšĮ Vilniaus universiteto ligoninės Santariškių klinikų filiale, nuo 2015 lapkričio mėnesio iki 2016 sausio mėnesio atliktas bandomasis palyginamasis stebėjimas. Sergančių idiopatine skolioze ir kontrolinę sveikų vaikų grupę sudarė po 9 vaikus. Torakoliumbalinės fascijos ultragarso tyrimui atlikti ir įvertinti taikyta Langevin aprašyta metodika. Torakoliumbalinė fascija storesnė idiopatine skolioze sergantiems vaikams lyginant su kontrolinės grupės vaikais. Sergančių vaikų grupėje torakoliumbalinės fascijos storio vidurkis buvo 0,96 cm kairėje ir 0,91 cm dešinėje stuburo pusėje. Sveikų vaikų grupėje torakoliumbalinės fascijos storis buvo 0,77 cm kairėje ir 0,73 cm dešinėje stuburo pusėje. Sergančių vaikų grupėje fascija sustorėjusi supramuskulinės dalies sąskaita: kairėje pusėje vidurkis – 0,44 cm, kontrolinėje grupėje kairėje pusėje vidurkis – 0,26 cm (p=0,001); panašus skirtumas gautas ir dešinėje pusėje tiriamoje grupėje: vidurkis – 0,46 cm, kontrolinėje grupėje: vidurkis – 0,24 cm (p&amp;lt;0,001). Fascijos sluoksniuotumas aiškiai didesnis supramuskulinėje dalyje idiopatine skolioze sergančių grupėje: dešinėje pusėje – 88,9% ir 22,2% (p=0,015); kairėje pusėje – 88,9% ir 11,1% (p=0,003). Nenustatyta reikšmingo torakoliumbalinės fascijos storio skirtumo tarp dešinės ir kairės anatominių pusių nei tiriamojoje, nei kontrolinėje grupėje. Remiantis ultragarso tyrimu nustatyta, kad idiopatine skolioze sergančių paauglių torakoliumbalinė fascija yra morfologiškai pakitusi (sustorėjusi, daugiasluoksnė) lyginant su muskuloskeletinės patologijos neturinčiais paaugliais. Esant paauglių idiopatinei skoliozei aktualus ir galimas pilnos apimties tyrimas vertinant torakoliumbalinės fascijos ir paravertebralinių raumenų pakitimus ultragarso tyrimu prieš ir po kompleksinės reabilitacijos.

Proline, glutamic acid, and leucine rich protein 1 (PELP1) expression in deep paravertebral muscles in idiopathic scoliosis girls

Objectives Estrogens and their receptors are postulated to be important factors in development of idiopathic scoliosis. Transcription functions of estrogen receptors are influenced by coregulators such as proline, glutamic acid, and leucine rich protein 1 (PELP1). Deep paravertebral muscles are potential elements participating in idiopathic scoliosis development. The aim of the present study was to evaluate PELP1 mRNA expression levels and the protein presence in deep paravertebral muscles on both sides of the spinal curve and correlation between the expression level and scoliosis parameters.

Body Composition as a Predictor of Scoliosis

Research Article| December 01 2014 Body Composition as a Predictor of Scoliosis AAP Grand Rounds (2014) 32 (6): 64. https://doi.org/10.1542/gr.32-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Body Composition as a Predictor of Scoliosis. AAP Grand Rounds December 2014; 32 (6): 64. https://doi.org/10.1542/gr.32-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: scoliosis, body composition Source: Clark EM, Taylor HJ, Harding I, et al. Association between components of body composition and scoliosis: a prospective cohort study reporting differences identifiable before the onset of scoliosis. J Bone Miner Res. 2014; 29(8): 1729– 1736; doi: https://doi.org/10.1002/jbmr.2207Google Scholar Investigators from the University of Bristol, United Kingdom sought to determine the relationship of body mass with the development of idiopathic scoliosis in children. Using the cohort of patients from the Avon Longitudinal Study of Parents and Children (ALSPAC), the authors carried out the first population-based prospective study evaluating the association between fat and lean mass at age 10 years with presence of scoliosis at age 15 years. The presence or absence of scoliosis at age 15 years was measured using dual energy X-ray absorptiometry (DXA) images, and scoliosis was defined as a curve of ≥6°. Total body fat and lean mass at 10 and 15 years of age were also assessed using DXA. Leptin and adiponectin levels were determined at age 10 years in nonfasting blood samples. Logistic regression was used to assess the relationship between several measures of body composition at age 10 (body mass index [BMI], body weight, fat mass, and lean mass) and presence of scoliosis at age 15. The association between leptin and adiponectin levels and scoliosis were also assessed. Of 5,299 children with measurements, 312 (5.9%) had scoliosis at age 15 years. After adjustment for age and gender, higher BMI and higher body weight at age 10 years were both associated with a significantly reduced risk for scoliosis at age 15 years (OR = 0.80 and 0.87, respectively). There was also a significantly reduced risk of scoliosis at age 15 years per standard deviation increase in fat mass at age 10 years (OR = 0.86). Lean mass was negatively associated with presence of scoliosis at age 15. These findings reflect associations between scoliosis and both fat mass and lean mass. In terms of adipocyte function, a statistically significant inverse association was seen between leptin at age 10 years and scoliosis, but there was no significant association between adiponectin at age 10 years and scoliosis. The authors conclude that altered body composition is present before the onset of scoliosis. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Prior case-control studies have suggested that lower body weight is associated with scoliosis.1 The current study is the first to prospectively determine the association between individual components of body weight and scoliosis. The authors demonstrated a negative association between BMI/body weight and scoliosis. Additionally, they found both reduced fat mass and reduced lean mass in children with scoliosis. Furthermore, the authors found differences in the function of adipose tissue as assessed by adipocyte-derived hormone levels at age 10 years, before the onset of clinically detectable adolescent idiopathic scoliosis. Interestingly, these findings are in contrast to the well-known... You do not currently have access to this content.

3. Cutaneous silent period in idiopatic scoliosis: A pilot study

Objective The pathogenesis of idiopathic scoliosis (IS) remains poorly understood. One of the hypothesis of the development of IS could be an abnormal sensorimotor integration. Cutaneous silent period (CSP) is a plurisegmental spinal inhibitory reflex, which occurs after painful stimulation of small diameter A-delta fibers. To date, CSPs have not been extensively studied in patients with idiopathic scoliosis. Materials and methods We recorded CSPs induced by noxious digit II stimulation in both thenar muscles while the subject maintains a moderately strong voluntary muscle contraction in 6 patients with idiopatic scoliosis before surgery (1 male; age 14–28 years) and in 9 healthy volunteers (4 males; age 20–34 years). The beginning, duration and end of the CSP have been measured in individual traces. Results CSP onset, duration and end latencies in IS did not significantly differ between concavity and convexity of the scoliotic curve. Moreover, there was not any significant difference in CSP onset, duration and end latencies in IS as compared to controls. Conclusion We conclude that plurisegmental spinal inhibitory reflex is well preserved in idiopatic scolioisis. These findings did not support the hypothesis of disturbances in sensorimotor integration at the spinal level. Supported by Research Projects of Charles University PRVOUK P34, Grant Project of Czech Ministry of Health NT12282, NT13693.

Subjective visual vertical in patients with idiopatic scoliosis

Idiopathic scoliosis (IS) is characterized by a three-dimensional deviation of the vertebral column and its etiopathogenesis is unknown. Various factors are associated with idiopathic scoliosis, among these a prominent role has been attributed to integration of vestibular information with graviception for perception of space. Subjective visual vertical (SVV) is a sensitive sign of verticality perception. The aim of this study was to determine if SVV in adolescents with IS is different from healthy controls. Examination of SVV was performed using the bucket method. Binocular measurements of SVV were made in 23 adolescents with IS (age 14.5 ± 2.5, mean ± SD) and 23 healthy subjects (age 14.0 ± 2.9). The groups differed significantly on SVV deviation (p < 0.01): healthy controls (-0.04° ± 0.64°), IS group (0.86° ± 1.39°). There was also significant difference in SVV uncertainty (p< 0.001): healthy controls (1.50° ± 0.94°), IS group (2.46 ± 0.82°). We conclude that the perception of visual vertical is altered in IS which may play role in development of IS.

Idiopathic scoliosis in the sagittal plane

Idiopathic scoliosis in sagittal plane is characterised by hypokyphosis and the restriction of anteflexion. This we have to take into consideration when we start an early treatment. The results are the best in children beyond 8 years of age with an angle of Cobb below 20 degrees and in thoracolumbar scoliosis. For the beginning idiopathic scoliosis the definition as an error of form is useless. The thesis that restriction of anteflexion has the priority in the development of idiopathic scoliosis will be supported by the examination of pupils.

ON ETIOPATHOGENESIS OF IDIOPATHIC SCOLIOSIS

Objectives. To study a role of the central nervous system (CNS) in development of idiopathic scoliosis (IS) and to reveal potential neurophysiologic mechanisms participating in this process. Material and Methods. Electroencephalography (EEG) has been applied to examine patients with IS. For the first time the received data were processed by a mathematical method which allowed to establish the temporal organization of basic brain rhythm formation (α, β, θ). Results. Variants of deviations in functioning of basal structures of the brain and its trunk distinctive for sluggish and rapid progressing forms of IS are revealed. Theoretical description of pathogenetic links of idiopathic three-plane spine deformity formation is suggested. It is proved that a basic condition for its development is a disturbance in longitudinal growth conjugation of the spine bone structures and the spinal cord, which demands certain compensating reactions. Conclusion. Long-term uncontrolled asymmetric change in paravertebral muscle tone is a key link in a clinical formation of IS.

ETIOLOGY AND PATHOGENESIS OF IDIOPATHIC SCOLIOSIS

Objective. To study etiologic factors and pathogenetic mechanisms of scoliosis development. Material and Methods. We investigated vertebral body growth plates (GP) from convex and concave sides of the curve, intervertebral discs (IVD), and vertebral bone tissue – surgical material obtained from 100 patients at the age from 10 to 14 years with III–IV grade idiopathic scoliosis (IS). Structural components of the spine of 12–14 years old children obtained from the forensic medicine department were used as controls. The methods of morphohistochemistry, biochemistry, and ultrastructural analysis were used to study glycosaminoglycans (GAGs), oxidation-reduction enzymes, alkali and acid phosphatases, RNA, DNA, qualitative and quantitative composition of GAGs. The expression of proteoglycan genes of cartilage tissue and their protein products was investigated with molecular genetic assays. Results. Pathogenetic mechanism of spine deformity formation in idiopathic scoliosis was formulated. It was shown that idiopathic scoliosis development is predetermined by a disorder in regulation and synthesis of proteoglycans in vertebral GP. The decrease of chondroitin sulphate and increase of keratan sulphate components in proteoglycans indicate the change of proteoglycan spectrum in IS. The revealed keratan sulphate fraction is a result of increased expression of lumikan gene in condition of sharp decrease of aggrecan gene expression and its protein product quantity in chondroblasts of patients with III–IV grade IS. Conclusion. Alteration in aggrecan gene expression at the level of transcription and translation testifies for its involvement in scoliosis development.

MECHANISM OF IDIOPATHIC SCOLIOSIS INHERITANCE

The etiologic factor of idiopathic scoliosis (IS) is a subject of discussions for scientists of different disciplines. The great number of theories testifies to an absence of a uniform sight on etiology and pathogenesis of this pathology. Objectives: to investigate the mechanism of genetic determination of IS. Materials and methods: 101 probands with II–IV grade IS and 703 family members of I–III degree of relationship were examined by clinical-genetic, radiological and optical-topographical methods. The pedigrees were processed by a method of segregation analysis. G3 exon of agrecan gene was studied from isolated family DNA by method of PCR reaction. Results: Segregation analysis of pedigrees, in which proband had II–IV grade IS has shown, that IS is inherited according to autosomal-dominant type with incomplete genotype penetrance depending on sex and age. It is revealed that idiopathic scoliosis is controlled by a major gene. Study of connection of agrecan gene to determination of IS development on a small sample of pedigrees has not revealed a reliable association of IC with polymorphism of G3 exon. Investigation of another exons of agrecan gene on expanded pedigrees is continued.