Etiology Of Scoliosis Research Articles

In vivo effects of axial loading on double-curve scoliotic spines.

The in vivo three-dimensional orientation of the vertebral columns in five adolescent idiopathic scoliotic subjects with double curves were examined in standing, supine, and supine positions with Cotrel traction postures using a biplanar radiographic technique. This analysis was compared with that obtained from a previous study on five healthy adolescent subjects to assess the postural changes and mechanical factors relating to the development of double-curve scoliotic deformity. Statistical analysis of vertebral orientation, rotation, disc distraction, and wedging between the normal and scoliotic subjects indicated that central intervertebral disc height and anteroposterior wedging were most consistently altered in double-curve scoliotic deformity. Since these two parameters relate directly to the geometry of the disc, the etiology of double-curve scoliosis may be related to a primary defect affecting the geometry of the intervertebral disc that results in a vertebral column which then undergoes rotational deformity.

BLEEDING TIME AND SCOLIOSIS

Collagen abnormalities in idiopathic scoliosis are on record. Since there is a correlation between the platelet aggregating power of the collagen and the bleeding time in patients with scoliosis, the bleeding time was studied in 195 cases with scoliosis and in 318 controls. The bleeding time was longer in the females, especially in those with idiopathic scoliosis (n = 149). Patients with paralytic scoliosis (n = 5) also had a significantly longer bleeding time than non-scoliotic controls. The patients with congenital scoliosis (n = 13) did not differ significantly from the controls or from patients with idiopathic scoliosis. The bleeding time in idiopathic scoliosis did not vary with age or magnitude of the scoliosis. Our data support the view that collagen abnormalities play a role not only in the aetiology of idiopathic scoliosis, but also in other forms of scoliosis.

SCOLIOSIS: A REVIEW

School screening of adolescents reveals a high prevalence of mild rotational deformity. The objective of screening is to prevent serious deformity by regular review of these children, early recognition of progression and provision of spinal bracing for curves greater than 25°. Two per cent of students screened in the age range 11-13 years have curves greater than 10° but only two per thousand screened require active treatment. A programme of exercise combined with bracing until skeletal maturity is reached, obviates the need for major surgery. Indications for follow-up and treatment are reviewed, and some current concepts of the aetiology of idiopathic scoliosis are examined with particular emphasis on the relationship between scoliosis and growth.

Etiology of scoliosis in children

The morphology of paravertebral muscles biopsied from 5 patients with scoliosis, as well as muscles autopsied from 35 corpses of newborns and children who died from accidental causes and had no signs of scoliosis, was studied. The asymmetry of the structure of paravertebral muscles in newborns and children, caused by congenital dysplasia of muscle tissue, was found. This asymmetry can be considered as an etiological factor in the onset of scoliosis.

Association of Glycosaminoglycan Depletion and Degradative Enzyme Activity in Scoliosis

Although several theories have been advanced about etiology of idiopathic scoliosis, the pathogenesis still remains unknown. One study detected a decrease in the glycosaminoglycan content of the nucleus pulposus in idiopathic scoliosis, and it was theorized that this represented increased degradation. The present study was designed to investigate degradative enzyme activity in scoliotic intervertebral disks. Twenty-three disks from 5 patients with idiopathic scoliosis and 18 disks from 3 patients with scoliosis resulting from myelomeningocele were obtained at surgery (Dwyer procedure). Five disks were obtained during 2 postmortem examinations. Analyses of hydroxyproline, hexosamine and acid phosphatase were performed separately on the annulus and nucleus of each disk. Hexosamine was decreased in idiopathic scoliotic nuclei versus controls (p less than 0.001) by approximately 25%. Hydroxyproline was proportionately increased (p less than 0.05). Similar changes of a greater magnitude were seen when comparing myelomeningoceles to controls. In both types of scoliosis, acid phosphatase was elevated in nuclear and annular tissue. Acid phosphatase activity and hexosamine varied inversely in the nucleus. Finding similar biochemical patterns in idiopathic and neurovascular scoliosis raises the possibility that these changes may be secondary.

Etiologic Factors in Adolescent Idiopathic Scoliosis

The etiology of idiopathic scoliosis is still unsolved, despite extensive research. This paper analyzes the different factors of relevance. Recent investigations have convincingly demonstrated the hereditary traits of idiopathic scoliosis. In the adolescent group a specific growth pattern has also been demonstrated, while muscular factors and biochemical changes of connective tissues are somewhat more uncertain. A significant number of patients demonstrate asymmetries in the vestibular apparatus and electroencephalographic abnormalities. Because of the essential role of the vestibular and central nervous systems in the postural equilibrium, functional asymmetries or minor pathologic changes in these structures might also be factors of importance. It is our view that adolescent idiopathic scoliosis should be regarded as a multifactorial disease. Combining the findings in recent investigations, a possible model for the pathogenesis of the disease is outlined.

Histocompatibility Determinants in Idiopathic Scoliosis

The HLA antigen distribution in 64 random scoliosis patients has been determined. Of the surgical group (greater than 50 degrees), the specificity W19 was increased. In the nonsurgical group (less than 45 degrees) the W19 specificity was also increased; however, the only specificity significantly increased was A29 (X2=11.64, P=less than .02). These observations are preliminary and more extensive work is needed to establish the relevance of the major histocompatibility system in the etiology and progression of idiopathic scoliosis.

Spinal muscle in scoliosis: Part 1. Histology and histochemistry

Histological and histochemical techniques were employed in a study of the spinal muscles from 35 adolescent scoliotic patients. Many abnormalities were found and, in general, the changes were indicative of denervation and neuropathy. None of the abnormalities were found at any one site more frequently than at any other, nor were they more often seen on one side or the other. None of the patients examined were normal at all sites of biopsy. These findings provide evidence of a neuropathic process being involved in the aetiology or progression of scoliosis. So-called ‘idiopathic’ scoliosis may, perhaps, be the result of an otherwise sub-clinical lower motor neurone disorder.

Pathogenesis of Scoliosis

Scoliosis often occurs in otherwise normal individuals or it may be associated with many widely differing diseases. The curve patterns are fairly uniform and the vertebrae always rotate in the frontal and horizontal planes producing convex side rotation with little displacement of the spinuous processes. Many small curves do not increase. Progressive scoliosis increases linearly and the rate of increase accelerates at puberty. No endocrine abnormalities have been observed in these patients. Usually the deformity is not caused by abnormal vertebral growth nor by abnormal collagen in verterbral ligaments. The glycosaminoglycans of nucleus pulposus are decreased in patients with idiopathic scoliosis. We speculate that loss of proteoglycans will affect the viscoelastic properties of the intervertebral discs which may result in permanent deformation. The etiology of scoliosis appears to be multifactorial with a genetic tendency to the deformity which is triggered in different individuals by different factors, some medical, some mechanical and some genetic.

Kinematics of the normal spine as related to scoliosis

Knowledge of the normal is a basis, if not a prerequisite, for an understanding of the abnormal. This paper describes and discusses certain aspects of the kinematics of the normal spine related to scoliosis. Fundamental concepts and definitions related to spine kinematics are reviewed. The salient anatomic considerations are described. The kinematics of the thoracic spine is presented along with experimental methods employed in the observations. The findings are interpreted in the context of theoretical implications related to etiology and treatment of scoliosis.

ROENTGENOLOGY IN SCOLIOSIS: CONTRIBUTION TO EVALUATION AND MANAGEMENT

ROENTGENOLOGY IN SCOLIOSIS: CONTRIBUTION TO EVALUATION AND MANAGEMENTLIONEL W. YOUNG, M.D., ALAN E. OESTREICH, M.D. and LOUIS A. GOLDSTEIN, M.D.Audio Available | Share

The Effect of Yap Taz on Flexibility Exercise in Patient With Idiopathic Scoliosis

ABSTRACTDuring the outbreak of Covid-19, the policy of working from home for employees and studying from home for students create a new problem. Employees and students mostly have to sit for long periods of time. This can affect body posture leading to lower back pain. Scoliosis is a postural disorder consistingof lateral curvature and rotation of the vertebrae. The etiology of idiopathic scoliosis remains unknown, and still present as theoretical hypothesis’s experts. One of non-surgical treatment that has been used for mild to moderate scoliosis is flexibility exercises. Flexibility exercises have been reported to reducethe degree of curvature in idiopathic scoliosis through the muscle hypertrophy mechanism. Muscle hypetrophy is regulated by Yes-associated protein (Yap) and transcriptional co-activator with PDZbinding motif protein (Taz) through three pathways, such as Hippo pathway signal, mechanosensorresponse, and mTOR signaling. The aim of this review is to examine more deeply the effect of Yap Taz protein on flexibility exercises in idiopathic scoliosis patien ts.Keywords: flexibility, hypertrophy, scoliosis, Taz, Yap.

Attempted Treatment of Scoliosis by Unilateral Vertebral Epiphyseal Arrest

A series of four cases is reported in which an unsuccessful attempt was made to produce surgically a unilateral growth arrest of the vertebral bodies in an isolated area on the convex side of a lateral curvature of the spine. This surgery was performed on from three to four vertebrae at the level of the maximum thoracic curvature where there was evidence of early lateral wedging. The procedure consisted in excision of a block of bone from the side of convexity, further destruction of the adjacent epiphyseal cartilage by means of a curette, and the insertion of an inlay type of autogenous-bone graft taken from a rib on the convex side of the curve. In three of these patients, the deformity was associated with idiopathic scoliosis. In the fourth, the localized thoracic curvature had occurred in conjuction with an arrested neuroblastoma. Follow-up study of between two and one-half and three years in each patient indicated that the progression of the curve was not altered. Studies of the epiphyseal plates obtained at the time of surgery indicated that there exists a lack of organization and uniformity in the cartilage-cell columns in patients with scoliosis. These changes may be significant in explaining the etiology of idiopathic scoliosis.

Paralytic scoliosis.

The etiological factors concerned in paralytic scoliosis are complex. Four main types of paralytic scoliosis can be recognised. 1. The general C-curve due to the body's anatomical attempt to shift its centre of gravity towards the weaker side. Vertebral rotation is not usually marked. This type usually occurs when patients with relatively slight paralysis have been allowed up too early ; it does not usually progress to severe deformity but may occasionally do so, gradually changing into Type 2. This type usually responds well to a period of rest and muscle redevelopment in recumbency. It also responds favourably to correction and fusion because correction is easy and there is little tendency to deterioration. Many of the "successes" of correction and fusion are in this class—almost equal success would often have been gained without "correction." The spine is slightly, but not very, unstable and a relatively localised fusion will give the little extra support that is needed. 2. The "general collapse" type of curve due to extensive spinal weakness. This is the type in which simple head suspension produces marked correction. Rotation is moderate. Provided the patient's general condition is satisfactory extensive spinal fusion is usually the best treatment and produces gratifying improvement. 3. The primary lumbar curve due to a combination of pelvic obliquity, extraspinal imbalance and imbalance of the deep rotator muscles. Rotation is usually marked. Treatment must include the correction of all these factors. In mild cases correction of the pelvic obliquity is enough, but in marked cases the spine must also be corrected. The disability from a lumbar paralytic scoliosis is much greater than that from a lumbar idiopathic scoliosis of the same degree; so correction is necessary in this type. Correction in a Risser-type jacket is often inadequate and recourse to operative correction is usually required. 4. The primary thoracic curve—often associated with weakness of the scapular muscles. The indications for and methods of treatment are practically the same as in primary idiopathic thoracic curves. These curves tend to be progressive and uncompensated. Although the most popular treatment is correction and fusion, wedge osteotomy of the spine gives better correction in intractable cases. The main need is for further investigation into the etiology of paralytic scoliosis so that adequate preventive measures may be undertaken at an early stage. It is essential that every child who contracts poliomyelitis should have his back muscles examined before he gets up. If there is any suggestion of scoliosis further investigations including radiography and electromyography are essential.

La Pratique des déviations vertébrales:

This is a second edition which contains considerable revision of the original text. The first 284 pages of this volume are concerned with a discussion of the anatomy and physiology of the spine and the etiology, pathology, and treatment of scoliosis. Chapter 18 deals with the problem of round back and kyphosis of adolescence, and there is a short chapter on lordosis. Theories of etiology as expressed in this volume are similar to those which have been found in the literature of the past 50 or 60 years. The treatment recommended is essentially the same as that which was standard among orthopedic surgeons in this country prior to about 1920. The authors emphasize the importance of prophylaxis through carefully supervised and planned gymnastic exercises to prevent scoliosis or to correct it at its very inception. The exercises and physical therapy which they recommend and illustrate with adequate line drawings are

SCOLIOSIS WITH PARAPLEGIA

1. Five cases of scoliosis with paraplegia are reported, and thirty-six comparable cases from the literature are reviewed. These forty-one cases have been studied with the object of determining the etiology of scoliosis, the reason why cord compression sometimes develops, and the results of conservative and operative treatment of such compression of the cord. 2. The cause of paraplegia is nearly always compression of the spinal cord by the dura, which, in severe scoliosis, is under longitudinal tension because of its firm attachment to the foramen magnum above and the sacrum below. Such tension, resisting displacement of the spinal cord from the straight line, may be shown to cause incomplete spinal block even when there is no paralysis. 3. When paralysis occurs it usually develops during the years of most rapid growth, the tight dura being unable to accommodate itself to the rate of growth of the spinal column; cord compression is probably increased by narrowing of the dural sac by rotational displacement. 4. The most striking results have been secured by laminectomy with section of the dura and sometimes division of dentate ligaments and tight nerve roots. After such division there is evidence of release of compression: the cord herniates through the dural slit; and spinal pulsation returns. 5. It is important to control bleeding in order to avoid post-operative compression by blood clot; and to prevent leakage of cerebro-spinal fluid through the arachnoid. 6. It is unwise to perform spinal fusion at the same time as decompression because it increases the danger of haematoma formation. Moreover the improvement gained by decompression is maintained even if no fusion of the spine is performed. 7. Conservative treatment of scoliosis with paraplegia should not be continued for long periods unless there is evidence of early and progressive improvement because prolonged compression causes irreversible changes in the cord. 8. In three cases, paraplegia was not due to dural compression: one turned out later to be a case of syringomyelia; one, reported by Heyman, was due to the pressure of a bone spur; and one, reported in this series, was due to a congenital tight band of developmental origin which might have caused the scoliosis as well as the paralysis, and in which, after resection of the band, recovery from the paralysis was complete.

Scoliosis—Etiology, Pathogenesis and Prevention of Experimental Rotary Lateral Curvature of the Spine*

There is an absence of accurate anatomic and physiologic knowledge of the mechanism of production of structural scoliosis. Beginning with Hippocrates, who gave the generic name to any twisted spine, many volumes have been written on the condition that is now known definitely as rotary lateral curvature of the spine. Most of the evidence presented, however, has consisted of end-results of pathologic processes, the causes and starting point of which have been obscured or obliterated in the majority of patients with scoliosis. Excellent experimental work and observations on human and animal subjects that have advanced knowledge of the causes of scoliosis have been done by Lovett, 1 Brackett, 2 Scudder, 3 Schulthess, 4 Wullstein, 5 Arnd, 6 Thompson and Mendel, 7 Muller, 8 Abbott, 9 Bardeen, 10 Bucholz and Osgood, 11 Kleinberg, 12 Wilson, 13 Steindler, 14 Bohm, 15 Feiss, 16 Nathan, 17 Buchmann 18 and Calve. 19 The

Recent Observations in the Etiology, Prophylaxis, and Therapy of Scoliosis

(1905). Recent Observations in the Etiology, Prophylaxis, and Therapy of Scoliosis. American Physical Education Review: Vol. 10, No. 3, pp. 222-232.