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Grivas TB, Vasiliadis E, Mazioti C, Papagianni D, Mamzeri A, Chandrinos M, Vynichakis G, Athanasopoulos K, Christodoulides P, Jevtic N, Pjanic S, Ljubojevic D, Savvidou O, Kaspiris A, Grunstein J. Are the Spinal Changes in the Course of Scoliogeny Primary but Secondary? J Clin Med 2024; 13:2163. [PMID: 38673436 PMCID: PMC11051170 DOI: 10.3390/jcm13082163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity.
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Affiliation(s)
- Theodoros B. Grivas
- Trauma and Orthopaedic Department, Former Head, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (E.V.); (A.K.)
| | | | | | | | - Michail Chandrinos
- Orthopedic Department, Gen. Hospital of Argolida-N.M. Argous, 212 00 Argos, Greece; (M.C.); (G.V.)
| | - George Vynichakis
- Orthopedic Department, Gen. Hospital of Argolida-N.M. Argous, 212 00 Argos, Greece; (M.C.); (G.V.)
| | | | | | - Nikola Jevtic
- Scolio Centar, 403916 Novi Sad, Serbia; (N.J.); (D.L.)
| | - Samra Pjanic
- Department of Paediatric Rehabilitation, Institute for Physical, Rehabilitation Medicine and Orthopaedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina;
| | | | - Olga Savvidou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University General Hospital, Rimini 1, 124 62 Athens, Greece;
| | - Angelos Kaspiris
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (E.V.); (A.K.)
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, 265 04 Patras, Greece
| | - Jarrett Grunstein
- Chiropractic Center Livingston, 340 E Northfield Rd # 2E, Livingston, NJ 07039, USA;
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Archer JE, Dong H, Berryman F, Pynsent P, Gardner A. The anatomical growth of the thoracic cage in adolescents with specific reference to axial growth comparing the right and left hemithorax. Clin Anat 2023; 36:2-10. [PMID: 36271772 DOI: 10.1002/ca.23971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
This study has demonstrated the changing volume of both the anterior and posterior thorax in normal adolescents (without spinal or thoracic deformity), differentiating for both sex and age, to further understand how the thorax grows, along with the differences in growth between the anterior and posterior thorax. The thorax was measured on axial CT slices at every vertebral level from T3 to T12 in a series of scans previous taken for routine clinical care. Measurements taken were the anteroposterior thoracic distance and the area of the anterior and posterior rib prominences on either side of the thorax. Data was analyzed per vertebral level, differentiating for age and sex. There were 486 CT scans analyzed (257 males and 229 females) between the ages of 8 and 18 years. The analysis identified that for the anterior thorax, there are three phases of growth with an initial slow increase in volume, followed by a stabilization of little growth, followed by another phase of a more rapid increase in volume. For the posterior thorax, there was a gradual increase in area with increasing age. This study demonstrates that the shape of the thorax is age and sex dependent, with males having both a greater width and depth of thorax compared to females. Of particular note is the difference in patterns of growth between the anterior and posterior thorax. This information will add to the understanding of normal growth, which will aid in the management of conditions where that growth is disturbed.
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Affiliation(s)
- James E Archer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, UK
| | - Huan Dong
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, UK
| | - Fiona Berryman
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, UK
| | - Paul Pynsent
- The Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, UK.,The Institute of Health and Life Sciences, Aston University, UK
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Letter to the Editor Concerning: "Patterns of Rib Growth in the Human Child" by Richard M. Schwend, John A. Schmidt, Julie L. Reigrut, Laurel C. Blakemore, and Behrooz A. Akbarnia. Spine Deform 3 (2015):297-302, http://dx.doi.org/10.1016/j.jspd.2015.01.007. Spine Deform 2015; 3:608-610. [PMID: 27927564 DOI: 10.1016/j.jspd.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022]
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Schwend RM, Schmidt JA, Reigrut JL, Blakemore LC, Akbarnia BA. Letter to the Editor: Response to Grivas et al. Spine Deform 2015; 3:610-611. [PMID: 27927565 DOI: 10.1016/j.jspd.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Richard M Schwend
- Division of Orthopaedics, University of Missouri Kansas City, University of Kansas, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | | | | | - Laurel C Blakemore
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, University of Florida Orthopaedics and Sports Medicine Institute, FL 32611-2727, USA
| | - Behrooz A Akbarnia
- University of California, 6190 Cornerstone CT, Ste 212, San Diego, CA 92121, USA
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Santosh KC, Candemir S, Jaeger S, Karargyris A, Antani S, Thoma GR, Folio L. Automatically Detecting Rotation in Chest Radiographs Using Principal Rib-Orientation Measure for Quality Control. INT J PATTERN RECOGN 2015. [DOI: 10.1142/s0218001415570013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a novel method for detecting rotated lungs in chest radiographs for quality control and augmenting automated abnormality detection. The method computes a principal rib-orientation measure using a generalized line histogram technique for quality control, and therefore augmenting automated abnormality detection. To compute the line histogram, we use line seed filters as kernels to convolve with edge images, and extract a set of lines from the posterior rib-cage. After convolving kernels in all possible orientations in the range [0°, 180°), we measure the angle with maximum magnitude in the line histogram. This measure provides an approximation of the principal chest rib-orientation for each lung. A chest radiograph is upright if the difference between the orientation angles of both lungs with respect to the horizontal axis is negligible. We validate our method on sets of normal and abnormal images and argue that rib orientation can be used for rotation detection in chest radiographs as an aid in quality control during image acquisition. It can also be used for training and testing data sets for computer aided diagnosis research, for example. In our experiments, we achieve a maximum accuracy of approximately 90%.
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Affiliation(s)
- K. C. Santosh
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Sema Candemir
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Stefan Jaeger
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Alexandros Karargyris
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Sameer Antani
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - George R. Thoma
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Les Folio
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20892, USA
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Casha AR, Camilleri L, Manché A, Gatt R, Attard D, Gauci M, Camilleri-Podesta MT, Grima JN. External rib structure can be predicted using mathematical models: An anatomical study with application to understanding fractures and intercostal muscle function. Clin Anat 2015; 28:512-9. [PMID: 25716367 DOI: 10.1002/ca.22513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 12/26/2014] [Accepted: 01/06/2015] [Indexed: 11/07/2022]
Abstract
As ribs adapt to stress like all bones, and the chest behaves as a pressure vessel, the effect of stress on the ribs can be determined by measuring rib height and thickness. Rib height and thickness (depth) were measured using CT scans of seven rib cages from anonymized cadavers. A Finite Element Analysis (FEA) model of a rib cage was constructed using a validated approach and used to calculate intramuscular forces as the vectors of both circumferential and axial chest wall forces at right angles to the ribs. Nonlinear quadratic models were used to relate rib height and rib thickness to rib level, and intercostal muscle force to vector stress. Intercostal muscle force was also related to vector stress using Pearson correlation. For comparison, rib height and thickness were measured on CT scans of children. Rib height increased with rib level, increasing by 13% between the 3rd and 7th rib levels, where the 7th/8th rib was the widest part or "equator" of the rib cage, P < 0.001 (t-test). Rib thickness showed a statistically significant 23% increase between the 3rd and 7th ribs, P = 0.004 (t-test). Intercostal muscle force was significantly related to vector stress, Pearson correlation r = 0.944, P = 0.005. The three nonlinear quadratic models developed all had statistically significant parameter estimates with P < 0.03. External rib morphology, in particular rib height and thickness, can be predicted using statistical mathematical models. Rib height is significantly related to the calculated intercostal muscle force, showing that environmental factors affect external rib morphology.
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Affiliation(s)
- Aaron R Casha
- Department of Anatomy, University of Malta, Msida, Malta; Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
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Foley G, Aubin CE, Parent S, Labelle H, d'Astous J, Johnston C, Sanders J. Physical Significance of the Rib Vertebra Angle Difference and Its 3-Dimensional Counterpart in Early-Onset Scoliosis. Spine Deform 2013; 1:259-265. [PMID: 27927356 DOI: 10.1016/j.jspd.2013.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 04/09/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Analysis of the rib vertebra angle difference (RVAD) on coronal plane radiographs and the 3-dimensional (3D) RVAD and Local RVAD in the vertebral reference frame from 3D reconstructions of the spine and rib cage of early-onset scoliosis patients (cross-sectional study). OBJECTIVES To determine the relationship of RVAD with the geometry of the chest wall. SUMMARY OF BACKGROUND DATA Although scoliosis is a complex 3D deformity, RVAD is measured on coronal plane radiographs. No clear physical significance has been established for this measurement from a 3D perspective. METHODS We measured RVAD on posteroanterior radiographs of 42 infantile scoliotic patients (Cobb > 20°) from T4 to T10 using Mehta's method. We computed RVAD 3D using the same landmarks from the 3D reconstruction generated from the calibrated biplanar radiographs. Local RVAD was measured in the local vertebral frontal plane, based on the axial rotation of each vertebra. We divided cases into Phase I and II, based on the rib head overlap with the apical vertebral body on coronal plane radiographs. RESULTS Apical Local RVAD correlated with Metha's RVAD (Phase I: r = 0.690; Phase II: r = 0.666), and RVAD 3D (Phase I: r = 0.908; Phase II: r = 0.862). Maximal values of RVAD and RVAD 3D were above the apex. Rib vertebra angle difference and Local RVAD were significantly different at the level of maximal RVAD (p < .001) but not at the apex (p = .800). The difference between Local RVAD and maximal RVAD correlated with vertebral axial rotation (Phase I: r = 0.691; Phase II: r = 0.659). CONCLUSIONS Rib vertebra angle difference not only indicates asymmetry of the ribs in relation to the spine, it is a compound of physical factors including vertebral axial rotation. The root of its prognostic value remains unclear. Rib vertebra angle difference 3D can serve as an alternative to determine true asymmetry in the costovertebral geometry.
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Affiliation(s)
- Genevieve Foley
- Polytechnique Montreal, PO Box 6979, Downtown station, Montreal, Quebec, H3C 3A7, Canada
| | - Carl-Eric Aubin
- Polytechnique Montreal, PO Box 6979, Downtown station, Montreal, Quebec, H3C 3A7, Canada; CHU Sainte-Justine, 3175 Cote-Sainte-Catherine Rd, Montreal, Quebec, H3T 1C5, Canada.
| | - Stefan Parent
- CHU Sainte-Justine, 3175 Cote-Sainte-Catherine Rd, Montreal, Quebec, H3T 1C5, Canada
| | - Hubert Labelle
- CHU Sainte-Justine, 3175 Cote-Sainte-Catherine Rd, Montreal, Quebec, H3T 1C5, Canada
| | - Jacques d'Astous
- Shriners Hospitals for Children, 1275 Fairfax Rd, Salt Lake City, UT 84103, USA
| | - Charles Johnston
- Texas Scottish Rite Hospital, 2222 Welborn St, Dallas, 75219 TX, USA
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Grivas TB, Burwell GR, Dangerfield PH. Body mass index in relation to truncal asymmetry of healthy adolescents, a physiopathogenetic concept in common with idiopathic scoliosis: summary of an electronic focus group debate of the IBSE. SCOLIOSIS 2013; 8:10. [PMID: 23799971 PMCID: PMC3702412 DOI: 10.1186/1748-7161-8-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/06/2013] [Indexed: 02/01/2023]
Abstract
There is no generally accepted scientific theory for the cause of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE).introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this debate was written by Dr TB Grivas. It is based on published research from Athens, Greece evaluating schoolchildren age 11-17 years for the relation of body mass index (BMI) to each of truncal asymmetry (TA) and menarcheal status. Girls with relatively lower BMI were found to have a significant excess of severe TAs and significantly later menarche confirming the well-known relation of BMI to menarche. Together with other evidence linking nutritional status to skeletal growth, the observations suggest energy balance via the hypothalamus is related to trunk asymmetry. As with a recent speculative hypothesis for the pathogenesis of AIS in girls, Grivas et al. suggest that the severe TAs involve a genetically-determined selectively increased sensitivity (up-regulation) of the hypothalamus to circulating leptin with asymmetry as an adverse response to stress (hormesis). The TA is expressed bilaterally via the sympathetic nervous system to produce left-right asymmetry in ribs and/or vertebrae leading to severe TAs when beyond the capacity of postural mechanisms of the somatic nervous system to control the shape distortion in the trunk. This EFG discusses the findings and interpretations of the paper by Grivas and colleagues as research at the borderland between the genesis of TA (physiogenesis) and AIS (pathogenesis). It is suggested that TAs, here regarded in common with AIS, result from the combination of secondary sexual development affecting body composition, adolescent skeletal growth velocity, and an asymmetry process. The possible involvement of epigenetic factors is not considered.
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Affiliation(s)
- Theodoros B Grivas
- Department of Trauma and Orthopedics, “Tzanio” General Hospital, Tzani and Afendouli 1st, Piraeus 18536, Greece
| | - Geoffrey R Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
| | - Peter H Dangerfield
- University of Liverpool, Ashton Street, L69 3GE, Liverpool, UK
- Staffordshire University, Leek Road, Stoke-on-Trent ST4 2DF, UK
- Royal Liverpool Children’s Hospital, Eaton Road, Liverpool L12 2AP, UK
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Burwell RG, Dangerfield PH, Grivas TB. Scoliogeny of adolescent idiopathic scoliosis: inviting contributions for a discussion based on evidence and theoretical interpretations aiming ultimately to prevention or aetiological treatment. SCOLIOSIS 2013; 8:8. [PMID: 23663879 PMCID: PMC3656779 DOI: 10.1186/1748-7161-8-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 04/26/2013] [Indexed: 11/23/2022]
Affiliation(s)
- R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
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Tsiligiannis T, Grivas T. Pulmonary function in children with idiopathic scoliosis. SCOLIOSIS 2012; 7:7. [PMID: 22445133 PMCID: PMC3410782 DOI: 10.1186/1748-7161-7-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/23/2012] [Indexed: 11/10/2022]
Abstract
Idiopathic scoliosis, a common disorder of lateral displacement and rotation of vertebral bodies during periods of rapid somatic growth, has many effects on respiratory function. Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles. Scoliosis decreases the chest wall as well as the lung compliance and results in increased work of breathing at rest, during exercise and sleep. Pulmonary hypertension and respiratory failure may develop in severe disease. In this review the epidemiological and anatomical aspects of idiopathic scoliosis are noted, the pathophysiology and effects of idiopathic scoliosis on respiratory function are described, the pulmonary function testing including lung volumes, respiratory flow rates and airway resistance, chest wall movements, regional ventilation and perfusion, blood gases, response to exercise and sleep studies are presented. Preoperative pulmonary function testing required, as well as the effects of various surgical approaches on respiratory function are also discussed.
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Affiliation(s)
- Theofanis Tsiligiannis
- Pediatric Pulmonology, Mitera Pediatric Hospita, Kifisias & Erythrou Stavrou Street 6, Amarousion, 15123 Athens, Greece
- Office address: Theofanis Tsiligiannis MD, Aegialias 30 Amarousion, 15125 Athens, Greece
| | - Theodoros Grivas
- Department of Trauma and Orthopaedics, "Tzanio" General Hospital of Piraeus, Tzani & Afendouli str, 18536 Piraeus, Greece
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Canavese F, Turcot K, Holveck J, Farhoumand AD, Kaelin A. Changes of concave and convex rib-vertebral angle, angle difference and angle ratio in patients with right thoracic adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:129-34. [PMID: 20811755 DOI: 10.1007/s00586-010-1563-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/08/2010] [Accepted: 08/22/2010] [Indexed: 11/24/2022]
Abstract
The aim of this study is to describe the radiological changes in rib-vertebral angles (RVAs), rib-vertebral angle differences (RVADs), and rib-vertebral angle ratios (RVARas) in patients with untreated right thoracic adolescent idiopathic scoliosis and to compare with the normal subjects. The concave and convex RVA from T1 to T12, the RVADs and the RVARas were measured on AP digital radiographs of 44 female patients with right convex idiopathic scoliosis and 14 normal females. Patients were divided into three groups: normal subjects (group 1), scoliotic patients with Cobb's angle equal or <30° (group 2) and scoliotic patients with Cobb's angle over 30° (group 3). Overall values (mean ± SD) of the RVAs on the concave side were 90.5° ± 17° in group 1, 90.3° ± 15.8° in group 2 and 88.8° ± 15.4° in group 3. On the convex side, values were 90.0° ± 17.3° in group 1, 86.3° ± 13.7° in group 2 and 80.7° ± 14.4° in group 3. Overall values (mean ± SD) of the RVADs at all levels were 0.5° ± 0.7° in group 1, 4.0° ± 4.8° in group 2 and 8.0° ± 4.0° in group 3. The RVARa values (mean ± SD) at all levels was 1.008° ± 0.012° in group 1, 1.041° ± 0.061° in group 2 and 1.102° ± 0.151° in group 3. RVAD and RVARa values in the scoliotic segment were greater in patients with untreated scoliosis over 30° than in patients with an untreated deformity of <30° or normal subjects. A significant effect between groups was observed for the RVA, RVAD and RVARa variables. Measurement of RVA, RVAD and RVARa should not only be performed at and around the apex of a thoracic spinal deformity, but also extended to the whole thoracic spine.
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Affiliation(s)
- Federico Canavese
- Paediatric Orthopaedic Unit, Department of Child and Adolescent, Faculty of Medicine, University of Geneva Hospitals, 6 Rue Willy Donzé, Geneva 14, Switzerland.
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Kotwicki T, Negrini S, Grivas TB, Rigo M, Maruyama T, Durmala J, Zaina F. Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper. SCOLIOSIS 2009; 4:26. [PMID: 19941650 PMCID: PMC2794256 DOI: 10.1186/1748-7161-4-26] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/26/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of orthopaedics, there is deficit of data which clinical and radiological parameters are considered in everyday practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life. AIM OF THE STUDY To investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis. METHODS Structured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Session on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement. RESULTS 90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and researchers. CONCLUSION The consensus was reached on evaluation of the morphology of the patient with idiopathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the variety of parameters indicated by the panellists, the Cobb angle, yet the gold standard, can be seen neither as the unique nor the only decisive parameter in the management of patients with idiopathic scoliosis.
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Affiliation(s)
- Tomasz Kotwicki
- Department of Pediatric Orthopaedics, University of Medical Sciences, Poznan, Poland
| | | | - Theodoros B Grivas
- Department of Orthopaedics and Traumatology, "Tzanio" General Hospital of Piraeus, Piraeus, Greece
| | | | - Toru Maruyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Jacek Durmala
- Department of Rehabilitation, Medical University of Silesia, Katowice, Poland
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
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Abstract
The aetiology of the three-dimensional spinal deformity of idiopathic scoliosis (IS) is unknown. Progressive adolescent idiopathic scoliosis (AIS) that mainly affects girls is generally attributed to relative anterior spinal overgrowth from a mechanical mechanism (torsion) during the adolescent growth spurt. Established biological risk factors to AIS are growth velocity and potential residual spinal growth assessed by maturity indicators. Spine slenderness and ectomorphy in girls are thought to be risk factors for AIS. Claimed biomechanical susceptibilities are (1) a fixed lordotic area and hypokyphosis and (2) concave periapical rib overgrowth. MRI has revealed neuroanatomical abnormalities in approximately 20% of younger children with IS. A neuromuscular cause for AIS is probable but not established. Possible susceptibilities to AIS in tissues relate to muscles, ligaments, discs, skeletal proportions and asymmetries, the latter also affecting soft tissues (e.g. dermatoglyphics). AIS is generally considered to be multi-factorial in origin. The many anomalies detected, particularly left-right asymmetries, have led to spatiotemporal aetiologic concepts involving chronomics and the genome altered by nurture without the necessity for a disease process. Genetic susceptibilities defined in twins are being evaluated in family studies; polymorphisms in the oestrogen receptor gene are associated with curve severity. A neurodevelopmental concept is outlined for the aetiology of progressive AIS. This concept involves lipid peroxidation and, if substantiated, has initial therapeutic potential by dietary anti-oxidants. Growth saltations have not been evaluated in IS.
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Chu WCW, Lam WMW, Ng BKW, Tze-ping L, Lee KM, Guo X, Cheng JCY, Burwell RG, Dangerfield PH, Jaspan T. Relative shortening and functional tethering of spinal cord in adolescent scoliosis - Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. SCOLIOSIS 2008; 3:8. [PMID: 18588673 PMCID: PMC2474583 DOI: 10.1186/1748-7161-3-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 06/27/2008] [Indexed: 12/17/2022]
Abstract
There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The Statement for this debate was written by Dr WCW Chu and colleagues who examine the spinal cord to vertebral growth interaction during adolescence in scoliosis. Using the multi-planar reconstruction technique of magnetic resonance imaging they investigated the relative length of spinal cord to vertebral column including ratios in 28 girls with AIS (mainly thoracic or double major curves) and 14 age-matched normal girls. Also evaluated were cerebellar tonsillar position, somatosensory evoked potentials (SSEPs), and clinical neurological examination. In severe AIS compared with normal controls, the vertebral column is significantly longer without detectable spinal cord lengthening. They speculate that anterior spinal column overgrowth relative to a normal length spinal cord exerts a stretching tethering force between the two ends, cranially and caudally leading to the initiation and progression of thoracic AIS. They support and develop the Roth-Porter concept of uncoupled neuro-osseous growth in the pathogenesis of AIS which now they prefer to term 'asynchronous neuro-osseous growth'. Morphological evidence about the curve apex suggests that the spinal cord is also affected, and a 'double pathology' is suggested. AIS is viewed as a disorder with a wide spectrum and a common neuroanatomical abnormality namely, a spinal cord of normal length but short relative to an abnormally lengthened anterior vertebral column. Neuroanatomical changes and/or abnormal neural function may be expressed only in severe cases. This asynchronous neuro-osseous growth concept is regarded as one component of a larger concept. The other component relates to the brain and cranium of AIS subjects because abnormalities have been found in brain (infratentorial and supratentorial) and skull (vault and base). The possible relevance of systemic melatonin-signaling pathway dysfunction, platelet calmodulin levels and putative vertebral vascular biology to the asynchronous neuro-osseous growth concept is discussed. A biomechanical model to test the spinal component of the concept is in hand. There is no published research on the biomechanical properties of the spinal cord for scoliosis specimens. Such research on normal spinal cords includes movements (kinematics), stress-strain responses to uniaxial loading, and anterior forces created by the stretched cord in forward flexion that may alter sagittal spinal shape during adolescent growth. The asynchronous neuro-osseous growth concept for the spine evokes controversy. Dr Chu and colleagues respond to five other concepts of pathogenesis for AIS and suggest that relative anterior spinal overgrowth and biomechanical growth modulation may also contribute to AIS pathogenesis.
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Affiliation(s)
- Winnie CW Chu
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Wynnie MW Lam
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Bobby KW Ng
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Lam Tze-ping
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Kwong-man Lee
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - Xia Guo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Jack CY Cheng
- Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, PR China
| | - R Geoffrey Burwell
- The Centre for Spinal Studies & Surgery, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | | | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
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Grivas TB, Burwell GR, Vasiliadis ES, Webb JK. A segmental radiological study of the spine and rib--cage in children with progressive infantile idiopathic scoliosis. SCOLIOSIS 2006; 1:17. [PMID: 17049098 PMCID: PMC1635062 DOI: 10.1186/1748-7161-1-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 10/18/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of rib cage in the development of progressive infantile idiopathic scoliosis (IIS) has not been studied previously. No report was found for rib growth in children with IIS. These findings caused us to undertake a segmental radiological study of the spine and rib-cage in children with progressive IIS. The aim of the present study is to present a new method for assessing the thoracic shape in scoliotics and in control subjects and to compare the findings between the two groups. MATERIALS AND METHODS In the posteroanterior (PA) spinal radiographs of 24 patients with progressive IIS, with a mean age of 4.1 years old, the Thoracic Ratios (TRs) (segmental convex and concave TRs), the Cobb angle, the segmental vertebral rotation and vertebral tilt were measured. In 233 subjects, with a mean age of 5.1 years old, who were used as a control group, the segmental left and right TRs and the total width of the chest (left plus right TRs) were measured in PA chest radiographs. Statistical analysis included Mann-Whitney, Spearman correlation coefficient, multiple linear regression analysis and ANOVA. RESULTS The comparison shows that the scoliotic thorax is significantly narrower than that of the controls at all spinal levels. The upper chest in IIS is funnel-shaped and the vertebral rotation at T4 early in management correlates significantly with the apical vertebral rotation at follow up. CONCLUSION The IIS thorax is narrower than that of the controls, the upper chest is funnel-shaped and there is a predictive value of vertebral rotation at the upper limit of the thoracic curve of IIS, which reflects, impaired rib control of spinal rotation possibly due to neuromuscular factors, which contribute also to the funnel-shaped chest.
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Affiliation(s)
- Theodoros B Grivas
- Orthopaedic Department, "Thriasion" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | - Geoffrey R Burwell
- School of Biomedical Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Elias S Vasiliadis
- Orthopaedic Department, "Thriasion" General Hospital, G. Gennimata Av. 19600, Magoula, Attica, Greece
| | - John K Webb
- Centre for Spinal Studies, University Hospital, Nottingham, NG7 2UH, UK
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Sevastik B, Xiong B, Sevastik J, Lindgren U, Willers U. Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:84-8. [PMID: 9209873 PMCID: PMC3454587 DOI: 10.1007/bf01358737] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The concave and convex rib-vertebral angle (RVA) at levels T2-T12 was measured on AP radiographs of 19 patients with right convex idiopathic thoracic scoliosis and 10 patients with major thoracic right convex neuromuscular scoliosis. The difference between the angles on the concave and the convex sides, the RVAD, was calculated. The RVAs were also measured on radiographs from three animal groups in which spinal curves had been induced experimentally in a variety of ways. Group 1 comprised 16 rabbits that had been subjected to selective electrostimulation of the latissimus dorsi, the erector spinae and the intercostal muscles. Group 2 comprised four dead rabbits whose spines had been subjected to manual bending. Group 3 comprised eight rabbits that had undergone mechanical elongation of one rib. In both the idiopathic and the neuromuscular group, the convex RVA was smaller than the concave RVA between levels T2 and T8, with a maximal difference between T4 to T5. From T9 to T12 the concave RVA was smaller than the convex. The RVA in relation to the scoliotic segment, i.e. the apex level of the curve and the two neighbouring vertebrae above and below this level, showed similar results. With increasing Cobb angle the RVADs increased linearly with the greatest difference at the second vertebra above the apex. In the three experimental groups the pattern of the RVADs between T6 to T12 was basically similar to the findings of the clinical study. From the results of these clinical and experimental studies, it is concluded that the typical pattern of the RVAs on the concave and convex sides seems to be independent of the underlying cause of the spinal curvature. It is likely that the RVADs result from a passive mechanical adaptation of the ribs to the lateral curvature of the spine.
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Affiliation(s)
- B Sevastik
- Department of Orthopaedic Surgery, Huddinge University Hospital, Sweden
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