1
|
Akçay B, İnanç G. The effect of Schroth Best Practice exercises and Cheneau brace treatment on perceptual and cognitive asymmetry in adolescent idiopathic scoliosis with thoracic major curve. Ir J Med Sci 2024; 193:1479-1486. [PMID: 38123885 DOI: 10.1007/s11845-023-03593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) patients have been found to exhibit cortical asymmetry. Although asymmetries in cortical structures have been found in patients with AIS, there has been no research on how conservative treatments affect cerebellar functional organization. AIMS This study aimed to examine the impact of conservative treatments on perceptual and cognitive asymmetry in the auditory system assessed by dichotic listening in AIS patients with thoracic major curves. METHOD This study involved 30 AIS patients and 21 healthy subjects. The intervention group used a Cheneau brace and performed 18 Schroth Best Practice (SBP) exercise sessions. Auditory lateralization was assessed using the Dichotic Listening Paradigm (DLP) in both groups before and after the intervention. RESULTS The 6-week intervention resulted in a significant increase in left ear responses in the force-left condition in the AIS (p < 0.05). Left ear responses were lower in AIS at baseline (p < 0.05). The results at week 6 were similar in all conditions (p > 0.05). CONCLUSION The results of this study demonstrated that SBP exercises and Cheneau brace treatment can improve perceptual and cognitive asymmetry in the auditory system in AIS patients with thoracic major curve. Scoliosis-associated changes in the spine and postural control may affect auditory perception by causing adaptations in sensory and motor networks. Future studies are needed to examine the connectivity in brain regions related to motor control and auditory processing after conservative treatment. TRIAL REGISTRATION Clinical trials number: NCT06141759.
Collapse
Affiliation(s)
- Burçin Akçay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandırma Onyedi Eylül University, Bandırma, Turkey.
| | - Gonca İnanç
- Department of Biophysics, Faculty of Medicine, Near East University, Nicosia, Turkish Republic of Northern Cyprus
| |
Collapse
|
2
|
Paramento M, Passarotto E, Maccarone MC, Agostini M, Contessa P, Rubega M, Formaggio E, Masiero S. Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review. PLoS One 2024; 19:e0303086. [PMID: 38776317 PMCID: PMC11111046 DOI: 10.1371/journal.pone.0303086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects approximately 4% of the world's population. Several hypotheses regarding the etiology of AIS have been investigated. In the last decades, impaired visual-spatial perception, alterations in spatial body orientation and sensory integration deficits have been documented. OBJECTIVE We aimed to summarize the neurophysiological, balance, and motion evidence related to AIS published in the last fifteen years, between January 2008 and April 2023. Both observational and interventional studies were considered. Only studies using quantitative assessment methods, such as electroencephalography (EEG), electromyography (EMG), magnetic resonance imaging (MRI), somatosensory evoked potentials, force platform, or motion capture, were included. METHODS 1250 eligible records identified from online database searching were filtered by duplicate removal, title and abstract screening, and qualitative analysis. 61 articles met the inclusion criteria (i.e., Cobb range 10°-35°, age range 10-18 years) and were summarized. RESULTS We found significant evidence of impaired standing balance in individuals with AIS who greatly rely on visual and proprioceptive information to stay upright. EMG studies frequently reported an increased activity on the convex side of the intrinsic spinae muscles. EEG data show increased delta and theta power, higher alpha peak frequencies, and significant suppression in the alpha and beta bands in subjects with AIS during standing tasks. MRI studies report changes in white matter structures, differences in the vestibular system, and abnormal cortical activations over motor-related areas in subjects with AIS. Bracing appears to be an effective treatment for AIS, leading to improvements in static balance and gait. Methodological issues prevent reliable conclusions about the effects of other treatment options. CONCLUSIONS This review underscores the importance of quantitative assessment methods to explore the etiology and pathophysiology of AIS. Further research is needed to measure the impact of physical therapy and orthotic treatments on the neurophysiological mechanisms of the disease.
Collapse
Affiliation(s)
- Matilde Paramento
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Edoardo Passarotto
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Maria Chiara Maccarone
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Michela Agostini
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Paola Contessa
- Orthopedic Rehabilitation Unit, Padova University Hospital, Padova, Italy
| | - Maria Rubega
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Emanuela Formaggio
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Stefano Masiero
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
- Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza, Motta di Livenza, Treviso, Italy
| |
Collapse
|
3
|
Soh RCC, Chen BZ, Hartono S, Lee MS, Lee W, Lim SL, Gan J, Maréchal B, Chan LL, Lo YL. The hindbrain and cortico-reticular pathway in adolescent idiopathic scoliosis. Clin Radiol 2024; 79:e759-e766. [PMID: 38388254 DOI: 10.1016/j.crad.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024]
Abstract
AIM To characterise the corticoreticular pathway (CRP) in a case-control cohort of adolescent idiopathic scoliosis (AIS) patients using high-resolution slice-accelerated readout-segmented echo-planar diffusion tensor imaging (DTI) to enhance the discrimination of small brainstem nuclei in comparison to automated whole-brain volumetry and tractography and their clinical correlates. MATERIALS AND METHODS Thirty-four participants (16 AIS patients, 18 healthy controls) underwent clinical and orthopaedic assessments and brain magnetic resonance imaging (MRI) on a 3 T MRI machine. Automated whole-brain volume-based morphometry, tract-based spatial statistics analysis, and manual CRP tractography by two independent raters were performed. Intra-rater and inter-rater agreement of DTI metrics from CRP tractography were assessed by intraclass correlation coefficient. Normalised structural brain volumes and DTI metrics were compared between groups using Student's t-tests. Linear correlation analysis between imaging parameters and clinical scores was also performed. RESULTS AIS patients demonstrated a significantly larger pons volume compared to controls (p=0.006). Significant inter-side CRP differences in mean (p=0.02) and axial diffusivity (p=0.01) were found in patients only. Asymmetry in CRP fractional anisotropy significantly correlated with the Cobb angle (p=0.03). CONCLUSION Relative pontine hypertrophy and asymmetry in CRP DTI metrics suggest central supranuclear inter-hemispheric imbalance in AIS, and support the role of the CRP in axial muscle tone. Longitudinal evaluation of CRP DTI metrics in the prediction of AIS progression may be clinically relevant.
Collapse
Affiliation(s)
- R C C Soh
- Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - B Z Chen
- Singapore General Hospital, Singapore
| | - S Hartono
- Duke-NUS Medical School, Singapore; National Neuroscience Institute, Singapore
| | - M S Lee
- Singapore General Hospital, Singapore
| | - W Lee
- Singapore General Hospital, Singapore
| | - S L Lim
- Singapore General Hospital, Singapore
| | - J Gan
- Siemens Healthineers, Singapore
| | - B Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - L L Chan
- Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - Y L Lo
- Duke-NUS Medical School, Singapore; National Neuroscience Institute, Singapore
| |
Collapse
|
4
|
Pizones J, Chang DG, Suk SI, Izquierdo E. Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis. Spine Deform 2024; 12:247-255. [PMID: 37975988 DOI: 10.1007/s43390-023-00787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior. METHODS In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis. RESULTS The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis. CONCLUSION The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.
Collapse
Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
| | - Se-Il Suk
- Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea
| | | |
Collapse
|
5
|
Paramento M, Rubega M, Di Marco R, Contessa P, Agostini M, Cantele F, Masiero S, Formaggio E. Experimental protocol to investigate cortical, muscular and body representation alterations in adolescents with idiopathic scoliosis. PLoS One 2023; 18:e0292864. [PMID: 37824513 PMCID: PMC10569634 DOI: 10.1371/journal.pone.0292864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. AIS is a three-dimensional morphological spinal deformity that affects approximately 1-3% of adolescents. Not all factors related to the etiology of AIS have yet been identified. OBJECTIVE The primary aim of this experimental protocol is to quantitatively investigate alterations in body representation in AIS, and to quantitatively and objectively track the changes in body sensorimotor representation due to treatment. METHODS Adolescent girls with a confirmed diagnosis of mild (Cobb angle: 10°-20°) or moderate (21°-35°) scoliosis as well as age and sex-matched controls will be recruited. Participants will be asked to perform a 6-min upright standing and two tasks-named target reaching and forearm bisection task. Eventually, subjects will fill in a self-report questionnaire and a computer-based test to assess body image. This evaluation will be repeated after 6 and 12 months of treatment (i.e., partial or full-time brace and physiotherapy corrective postural exercises). RESULTS We expect that theta brain rhythm in the central brain areas, alpha brain rhythm lateralization and body representation will change over time depending on treatment and scoliosis progression as a compensatory strategy to overcome a sensorimotor dysfunction. We also expect asymmetric activation of the trunk muscle during reaching tasks and decreased postural stability in AIS. CONCLUSIONS Quantitatively assess the body representation at different time points during AIS treatment may provide new insights on the pathophysiology and etiology of scoliosis.
Collapse
Affiliation(s)
- Matilde Paramento
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Maria Rubega
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Roberto Di Marco
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Paola Contessa
- Orthopedic Rehabilitation Unit, Padova University Hospital, Padova, Italy
| | - Michela Agostini
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Francesca Cantele
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Stefano Masiero
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
- Orthopedic Rehabilitation Unit, Padova University Hospital, Padova, Italy
- Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza, Motta di Livenza, Treviso, Italy
| | - Emanuela Formaggio
- Department of Neurosciences, Section of Rehabilitation, University of Padova, Padova, Italy
| |
Collapse
|
6
|
Yagci G, Metin G, Erel S, Erbahceci F. Dual Task Performance in Adolescents With Idiopathic Scoliosis. Percept Mot Skills 2023; 130:1889-1900. [PMID: 37282549 DOI: 10.1177/00315125231182276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Daily life activities commonly include many combinations of dual tasks. Although dual task ability has been studied in healthy young adults, dual task performance in adolescents with idiopathic scoliosis (IS) has not been explored. Our objective in this study was to investigate dual task performance in adolescents with IS. We paired 33 adolescents diagnosed with IS and 33 healthy control participants (age range: 11-17 years) and administered to both groups the Stroop Color and Word test as a measure of cognitive ability, and both the Expanded Timed Up and Go (ETUG) test and the Tandem Gait test as measures of motor tasks. During the motor tasks, we had participants spell five-letter words in reverse and count down by seven from a randomly presented number between 50 and 100 to assess their dual task (cognitive-motor) performance. All cognitive, motor, and dual cognitive-motor test scores differed significantly between the IS and healthy control groups. The time taken to complete all these tasks was longer for participants with IS compared with controls (p < .05). These results revealed diminished performances on dual cognitive-motor tasks among adolescents with IS when compared to peers without IS. Dual task performance is a new research paradigm in the scoliosis rehabilitation field, and it should be further investigated in future studies.
Collapse
Affiliation(s)
- Gozde Yagci
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Gulnihal Metin
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Suat Erel
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Pamukkale University, Denizli, Türkiye
| | - Fatih Erbahceci
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| |
Collapse
|
7
|
Is the Integration Problem in the Sensoriomotor System the Cause of Adolescent Idiopathic Scoliosis? J Pediatr Orthop 2023; 43:e111-e119. [PMID: 36418290 DOI: 10.1097/bpo.0000000000002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The reason behind the balance control disorder seen in adolescent idiopathic scoliosis (AIS) has been suggested as a central nervous system dysfunction, yet it has not been investigated in detail whether this problem originates from sensory, motor, or from both systems. This study aimed to reveal the differences in the pathways that provide proprioceptive sense, motor control, and coordination between these 2 systems in female individuals with AIS. METHODS Brain Diffusion Tensor Imaging was applied to 30 healthy individuals and 30 Lenke type 1 AIS patients. All of the individuals included in the study were predominantly right-handed and aged between 10 and 18. Diffusion tensor imaging of both groups were performed bilateral tractography on the corticospinal tract (CS tr), medial lemniscus (ML), superior longitudinal fasciculus (SLF), and inferior longitudinal fasciculus (ILF) tracts using DSI Studio software. RESULTS Significant differences in the parameters of CS tr, ML, SLF, ILF pathways were found between the AIS and the control groups. In the AIS group, significant differences were found in the fiber count and fiber ratio of the ML that carries the proprioceptive sense and CS tr, which is responsible for the somatomotor system. There were also significant differences between the left and right CS tr, ML, SLF, and ILF pathways of the AIS group ( P <0.05). CONCLUSIONS Differences in the CS tr, ML, SLF, and ILF pathways may trigger muscular asymmetry and cause postural instability and thus spinal deformity in AIS.
Collapse
|
8
|
Gómez Cristancho DC, Jovel Trujillo G, Manrique IF, Pérez Rodríguez JC, Díaz Orduz RC, Berbeo Calderón ME. Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:1-11. [PMID: 35256329 DOI: 10.1016/j.neucie.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023]
Abstract
The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: "scoliosis", "vision", "eye", "vestibule", "labyrinth" "posture", "balance", "eye movements", "cerebellum", "proprioception", and "physiological adaptation". In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.
Collapse
Affiliation(s)
- David Camilo Gómez Cristancho
- Médico General, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Gabriela Jovel Trujillo
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Iván Felipe Manrique
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Roberto Carlos Díaz Orduz
- Médico Neurocirujano, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | | |
Collapse
|
9
|
Formaggio E, Bertuccelli M, Rubega M, Di Marco R, Cantele F, Gottardello F, De Giuseppe M, Masiero S. Brain oscillatory activity in adolescent idiopathic scoliosis. Sci Rep 2022; 12:17266. [PMID: 36241666 PMCID: PMC9568615 DOI: 10.1038/s41598-022-19449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023] Open
Abstract
Pathophysiology of Adolescent Idiopathic Scoliosis (AIS) is not yet completely understood. This exploratory study aims to investigate two aspects neglected in clinical practice: a defective postural central nervous system control in AIS, and alterations of body schema due to scoliosis spinal deformities. We recorded EEG data and balance data in four different standing positions in 14 adolescents with AIS and in 14 controls. A re-adaptation of the Image Marking Procedure (IMP) assessed body schema alterations on the horizontal (Body Perception Indices (BPIs)) and vertical direction (interacromial and bisiliac axes inclinations). Our results revealed no differences in balance control between groups; higher EEG alpha relative power over sensorimotor areas ipsilateral to the side of the curve and a significant increase of theta relative power localized over the central areas in adolescents with AIS. The difference in BPI shoulder and BPI waist significantly differed between the two groups. The inclinations of the perceived interacromial axes in adolescents with AIS was opposite to the real inclination. Increased theta activity and alpha lateralization observed may be a compensatory strategy to overcome sensorimotor dysfunction mirrored by altered body schema. Scoliosis onset might be preceded by sensorimotor control impairments that last during curve progression.
Collapse
Affiliation(s)
- Emanuela Formaggio
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Margherita Bertuccelli
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center, University of Padova, Via Orus 2/B, 35129 Padova, Italy
| | - Maria Rubega
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Roberto Di Marco
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy ,grid.5611.30000 0004 1763 1124Present Address: Department of Computer Science, University of Verona, Strada le Grazie 15, 37134 Verona, Italy
| | - Francesca Cantele
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Federica Gottardello
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Michela De Giuseppe
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Stefano Masiero
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Giustiniani 3, 35128 Padova, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center, University of Padova, Via Orus 2/B, 35129 Padova, Italy
| |
Collapse
|
10
|
Simoneau M, Pialasse JP, Mercier P, Blouin JS. Adolescents with idiopathic scoliosis show decreased intermuscular coherence in lumbar paraspinal muscles: a new pathophysiological perspective. Clin Neurophysiol 2022; 138:38-51. [DOI: 10.1016/j.clinph.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
|
11
|
Boček V, Krbec M, Vaško P, Brabec K, Pavlíková M, Štětkářová I. Alteration of cortical but not spinal inhibitory circuits in idiopathic scoliosis. J Spinal Cord Med 2022; 45:186-193. [PMID: 32202478 PMCID: PMC8986185 DOI: 10.1080/10790268.2020.1739893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: The pathogenesis of adolescent idiopathic scoliosis (AIS), including the role of brain and spinal inhibitory circuits, is still poorly elucidated. The aim of this study was to identify which central inhibitory mechanisms are involved in the pathogenesis of AIS.Design: A prospective neurophysiological study, using a battery of neurophysiological tests, such as cutaneous (CuSP) and cortical (CoSP) silent periods, motor evoked potentials (MEP) and paired-pulse transcranial magnetic stimulation (ppTMS).Settings: Neurophysiological laboratory.Participants: Sixteen patients with AIS (14 females, median age 14.4) and healthy controls.Outcome measures: MEPs were obtained after transcranial magnetic stimulation (TMS) and recorded from the abductor pollicis muscle (APB). ppTMS was obtained at interval ratios (ISI) of 1, 2, 3, 6, 10, 15 and 20 ms. The cortical silent period (CoSP) was recorded from the APB. The cutaneous silent period (CuSP) was measured after painful stimuli delivered to the thumb while the subjects maintained voluntary contraction of the intrinsic hand muscles. The data were analyzed and compared with those from healthy subjects.Results: The CoSP duration was significantly prolonged in AIS patients. A significantly higher amplitude of ppTMS for ISI was found in all AIS patients, without remarkable left-right side differences. No significant difference in MEP latency or amplitude nor in the CuSP duration was obtained.Conclusion: Our observation demonstrates evidence of central nervous system involvement in adolescent idiopathic scoliosis (AIS). Lower intracortical inhibition, higher motor cortex excitability, and preserved spinal inhibitory circuits are the main findings of this study. A possible explanation of these changes could be attributed to impaired sensorimotor integration predominantly at the cortical level.
Collapse
Affiliation(s)
- Václav Boček
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Correspondence to: Václav Boček, Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Ruska 87, 100 00Prague 10, Czech Republic.
| | - Martin Krbec
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vaško
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karel Brabec
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| |
Collapse
|
12
|
Mecanismos neurológicos involucrados en la escoliosis idiopática. Revisión sistemática de la literatura. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Akçay B, İnanç G, Elvan A, Selmani M, Çakiroğlu MA, Akçali Ö, Satoğlu İS, Oniz A, Şimşek İE, Ozgoren M. Investigation of the perceptual and cognitive asymmetry in the auditory system in patients with adolescent idiopathic scoliosis. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1583. [PMID: 34722944 PMCID: PMC8546268 DOI: 10.4102/sajp.v77i2.1583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Studies have shown that perceptual and cognitive asymmetries are present in the auditory system in patients with adolescent idiopathic scoliosis (AIS). The Dichotic Listening (DL) paradigm was formerly performed in non-forced (NF) conditions only, and no study has examined the conditions of attention to one ear. OBJECTIVE To investigate the perceptual and cognitive asymmetry in the auditory system in patients with AIS as well as the asymmetry changes according to the curvature characteristics of patients with AIS. METHOD The DL paradigm was performed on 38 patients with AIS and 10 healthy individuals in all conditions (NF, Forced Right [FR], Forced Left [FL]). RESULTS In the NF and FL conditions, the mean number of correct responses for the left ear was significantly lower in patients with AIS than in healthy individuals (p < 0.05). The correct responses for the right ear in the NF condition, right and left ear in the FR condition, and right ear in the FL condition did not show a significant difference between the groups (p > 0.05). Also, there was no difference between patients with AIS with both functional 3-curve and 4-curve (p > 0.05). CONCLUSION Our study indicates perceptual and cognitive asymmetry or lateralisation in the auditory system in patients with AIS. The asymmetry might be caused by the inability to direct their attention to the left ear, which is not affected by their curvature type. Further studies are needed to investigate perceptual and cognitive asymmetry behaviour models in the auditory system in patients with AIS. CLINICAL IMPLICATIONS Determination of perceptual and cognitive asymmetry in the auditory system may offer a new perspective on conservative treatment protocols for AIS patients. Besides, the DL paradigm can be easily used in patients with AIS as a non-invasive evaluation method in clinics.
Collapse
Affiliation(s)
- Burçin Akçay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandırma Onyedi Eylül University, Balıkesir, Turkey
| | - Gonca İnanç
- Faculty of Health Sciences, Near East University, Mersin, Turkey
| | - Ata Elvan
- Department of Prosthesis-Orthosis, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | | | - Mehmet A. Çakiroğlu
- Department of Therapy and Rehabilitation, İzmir Kavram Vocational School, Izmir, Turkey
| | - Ömer Akçali
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - İsmail S. Satoğlu
- Department of Orthopaedics and Traumatology, Özel Sağlık Hastanesi, İzmir, Turkey
| | - Adile Oniz
- Faculty of Health Sciences, Near East University, Mersin, Turkey
| | - İbrahim E. Şimşek
- Department of Prosthesis-Orthosis, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Murat Ozgoren
- Department of Biophysics, Faculty of Medicine, Near East University, Mersin, Turkey
| |
Collapse
|
14
|
Analysis of the Degree of Involvement of the Lower Limb Muscles in the Pathological Process in Adolescents with Idiopathic Scoliosis. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. The problem of the effect of adolescent idiopathic scoliosis on the functional condition of the lower limb muscles is still highlighted insufficiently.Aim. Analysis of the degree of involvement of the lower limb muscles in the pathological process in adolescents with idiopathic scoliosis.Methods. A comparative analysis has been made on the results of examination of 209 adolescents: 25 adolescents with idiopathic scoliosis; 170 normal adolescents; 14 adolescents with congenital scoliosis. The moments of force ofthe lower limb muscles were evaluated using dynamometric stands. Electrophysiological characteristics of the lower limb muscles were registered by the method of global and stimulation electroneuromyography.Results. The decrease in the amplitude of voluntary EMG of the femoral muscles in adolescents with idiopathic and congenital scoliosis is accompanied by dropping the moments of force relative to the values of the control group. The leg muscles are characterized by the preservation of the values of force at the level of normal test subjects under the conditions of the reduced voluntary EMG of high frequency. The amplitude of the M-responses of the indicator muscles and the values of the excitation propagation velocity along the motor fibers were also preserved. There are no statistically significant correlations between the amount of the spine deformity, on the one hand, and the values of asymmetry of the characteristics of the muscles in adolescents with idiopathic scoliosis.Conclusion. In adolescents with idiopathic scoliosis the function of femoral muscles is decreased, and there is no relationship between the amount of the spine deformity and the values of asymmetry of the characteristics of the lower limb muscles. The similar character of muscle function changes in adolescents with idiopathic and congenital scoliosis can testify that the cause of the observed changes is not the disease etiology, but the insufficient level of motor activity.
Collapse
|
15
|
Wilczyński J, Karolak P. Relationship Between Electromyographic Frequency of the Erector Spinae and Location, Direction, and Number of Spinal Curvatures in Children with Scoliotic Changes. Risk Manag Healthc Policy 2021; 14:1881-1896. [PMID: 34007226 PMCID: PMC8121675 DOI: 10.2147/rmhp.s302360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of the study was to assess the relationship between erector spinae electromyographic frequency (SEMG) and the location, direction and number of spinal curvatures in children with scoliotic changes. METHODS Analysis comprised 103 (42,21%) children with scoliosis and 141 (57.79%) with scoliotic posture. Body posture and the spine were examined using the Diers formetric III 4D optoelectronic method. Electromyographic analysis was performed using a 14-channel Noraxon TeleMyo DTS apparatus. RESULTS In girls, the highest mean SEMG frequency of the erector spinae, calculated from 16 measurements, occurred in the case of scoliotic posture (Mean = 73.69 Hz), while in boys, the greatest values were noted for scoliosis (Mean = 79.75 Hz). There was a significant correlation between erector spinae SEMG frequency and curvature location, both in the scoliosis group (p = 0.003) and in the group with scoliotic posture (p = 0.04). There was also a significant correlation between SEMG frequency of the erector spinae and direction of the curvature, both in the scoliosis (p = 0.01) and scoliotic posture groups (p = 0.04), as well as between the erector spinae SEMG frequency and the number of spinal curvatures (scoliosis group: p = 0.03; scoliotic posture group: p = 0.03). CONCLUSION The study is of applicative value and fills the gap in research on erector spinae SEMG frequency of in low-grade scoliosis among small children. Our research can also be used in research on the etiology and progression scoliosis. Visible disturbances in the erector spinae SEMG frequency (activity and tension) contribute to the development of curvature and testify to the fact that these changes are the primary cause of idiopathic scoliosis. Scoliosis is merely a symptom, an external expression of CNS dysfunction that is not fully recognised. It is also visible on the SEMG record of postural muscles. Our objective is to contribute to creating a future model record for SEMG of the postural muscles, characteristic for children with scoliosis. Then, based on electromyographic examination, it will be possible to identify initial symptoms of scoliosis and start preventive rehabilitation before irreversible bone changes occur.
Collapse
Affiliation(s)
- Jacek Wilczyński
- Laboratory of Posturology, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Przemysław Karolak
- Laboratory of Posturology, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| |
Collapse
|
16
|
Wang L, Wang C, Youssef ASA, Xu J, Huang X, Xia N. Physiotherapeutic scoliosis-specific exercises performed immediately after spinal manipulative therapy for the treatment of mild adolescent idiopathic scoliosis: study protocol for a randomized controlled pilot trial. Trials 2021; 22:58. [PMID: 33446270 PMCID: PMC7807706 DOI: 10.1186/s13063-020-05000-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy is commonly used in the treatment of adolescent idiopathic scoliosis. Some therapists also rely on physiotherapeutic scoliosis-specific exercise (PSSE). Combining these two modalities seems reasonable, but the effectiveness of this combination has never been rigorously tested. Here, a protocol for a pilot study is proposed to determine the feasibility of conducting a larger randomized trial. The pilot study was designed to test the hypothesis that spinal manipulative therapy followed by PSSE is more effective than PSSE alone in improving the Cobb angle, sensorimotor integration, the angle of trunk rotation (ATR), body symmetry, and quality of life. METHODS The protocol describes a randomized controlled pilot trial with 40 subjects divided into study and control groups. Both groups will receive 8 weeks of PSSE, but the study group will also receive spinal manipulative therapy during the first 2 weeks before PSSE. The primary outcome will be an estimate of the feasibility of conducting a full-scale experiment. The influencing factors will be the time to complete enrollment, the recruitment rate, subject retention, and adherence to the treatment allocations. The secondary outcomes that will be used to assess the efficacy of treatment will include the Cobb angle, somatosensory evoked potentials, ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire. The Cobb angle will be measured at baseline and at the end of 8 weeks of training. The somatosensory evoked potentials will be measured at baseline and at the end of 2 weeks of training. The ATR, three-dimensional postural parameters, and scores on the 22-item Scoliosis Research Society outcomes questionnaire will be measured at baseline and at 2 weeks, 4 weeks, and 8 weeks of treatment. DISCUSSION This study will inform the design of a future full-scale trial. The outcomes will provide preliminary data about the efficacy of the combination of spinal manipulative therapy and exercise in treating scoliosis. TRIAL REGISTRATION Prospectively registered at Chinese clinical trial registry, ChiCTR1900027037 . Registered on 29 October 2019. http://www.chictr.org.cn/edit.aspx?pid=44954&htm=4.
Collapse
Affiliation(s)
- Li Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Rehabilitation Medicine, Shantou Central Hospital, Shantou, China
| | - Ahmed S A Youssef
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
17
|
Arestova YS, Sayfutdinov MS, Savin DM, Nasyrov MZ, Ryabykh TV, Ryabykh SO. Intraoperative Neurophysiological Monitoring during Surgical Correction of Scoliosis for Postoperative Recovery of the Patient's Motor Function. Sovrem Tekhnologii Med 2021; 13:55-60. [PMID: 35265350 PMCID: PMC8858412 DOI: 10.17691/stm2021.13.5.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of the investigation was to study the effect of adverse intraoperative events on the subclinical decrease in the functional state of the sensorimotor system of patients with scoliosis and their early postoperative rehabilitation.
Collapse
Affiliation(s)
- Yu S Arestova
- Specialist, Clinic for Spine Pathology and Rare Diseases National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| | - M S Sayfutdinov
- Leading Researcher National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| | - D M Savin
- Head of Traumatology and Orthopedics Department No.9 National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| | - M Z Nasyrov
- Head of the Department of Rehabilitation National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| | - T V Ryabykh
- Doctor of Functional Diagnostics National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| | - S O Ryabykh
- Deputy Director National Ilizarov Medical Research Center for Traumatology and Orthopedics, Ministry of Health of the Russian Federation, 6 M. Ulyanova St., Kurgan, 640014, Russia
| |
Collapse
|
18
|
Increased EEG alpha peak frequency in adolescents with idiopathic scoliosis during balance control in normal upright standing. Neurosci Lett 2020; 722:134836. [PMID: 32057922 DOI: 10.1016/j.neulet.2020.134836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a multifactorial disorder characterized by a tridimensional deformation of the spine. AIS pathophysiology is still unclear and its aetiology is unknown. Results from several studies revealed balance control alterations in adolescents with AIS suggesting cortical sensorimotor processing impairments. Studies assessing cortical activity involved in balance control revealed an increase in alpha peak frequency (APF), which is a neurophysiological marker of thalamo-cortical transmission, related to a more challenging balance task. The objective of this study is to assess APF of adolescents with AIS during balance control in upright standing posture using electroencephalography (EEG). EEG was recorded in 16 girls with AIS and 15 control girls in normal standing posture on a force platform. The participants stood upright for 2 min with eyes open and 2 min with eyes closed. Fast Fourier transformations of EEG data were calculated to obtain APF. Balance performances were assessed through the area of an ellipse covering the center of pressure (COP) displacement and the root mean square value of the COP velocity. Compared to the control group, APF was higher in the AIS group at central, frontal, parietal and occipital regions. Further, COP analyses did not reveal any difference between AIS and control groups. A higher APF may indicate the need for increased cortical processing to maintain balance control in normal upright standing in adolescents with AIS compared to healthy controls. We suggest that this may be a compensatory strategy to overcome balance control challenges.
Collapse
|
19
|
Fortin C, Pialasse JP, Knoth IS, Lippé S, Duclos C, Simoneau M. Cortical dynamics of sensorimotor information processing associated with balance control in adolescents with and without idiopathic scoliosis. Clin Neurophysiol 2019; 130:1752-1761. [PMID: 31401484 DOI: 10.1016/j.clinph.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims at examining the cortical dynamics of sensorimotor information processing related to balance control in participants with adolescent idiopathic scoliosis (AIS) and in age-matched controls (CTL). METHODS Cortical dynamics during standing balance control were assessed in 13 girls with AIS and 13 age-matched controls using electroencephalography. Time-frequency analysis were used to determine frequency power during ankle proprioception alteration (ankle tendons co-vibration interval) or reintegration of ankle proprioception (post-vibration interval) with or without vision. RESULTS Balance control did not differ between groups. In the co-vibration interval, a significant suppression in alpha (8-12 Hz) and beta (13-30 Hz) band power and a significant increase in theta (4-7 Hz) band power were found respectively in the vision and non-vision condition in the AIS group compared to the CTL group. In the post-vibration interval, significant suppressions in beta (13-30 Hz) and gamma (30-50 Hz) band power were observed in the AIS group in the non-vision condition. CONCLUSION Participants with AIS showed brain oscillations differences compared to CTL in the sensorimotor cortex while controlling their balance in various sensory conditions. SIGNIFICANCE Future study using evaluation of cortical dynamics could serve documenting whether rehabilitation programs have an effect on sensorimotor function in AIS.
Collapse
Affiliation(s)
- Carole Fortin
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada.
| | - Jean-Philippe Pialasse
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada
| | | | - Sarah Lippé
- Centre de recherche, CHU Sainte-Justine, Montréal, Québec, Canada; Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Cyril Duclos
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Institut de Réadaptation Gingras-Lindsay-de-Montréal, Montréal, Québec, Canada
| | - Martin Simoneau
- Département de kinésiologie, Faculté de médecine, Université Laval, Québec, Québec, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec, Québec, Canada
| |
Collapse
|
20
|
Xue C, Shi L, Hui SCN, Wang D, Lam TP, Ip CB, Ng BKW, Cheng JCY, Chu WCW. Altered White Matter Microstructure in the Corpus Callosum and Its Cerebral Interhemispheric Tracts in Adolescent Idiopathic Scoliosis: Diffusion Tensor Imaging Analysis. AJNR Am J Neuroradiol 2018; 39:1177-1184. [PMID: 29674416 DOI: 10.3174/ajnr.a5634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Neural system was one of the important contributors to the etiopathogenesis of adolescent idiopathic scoliosis; additionally, the morphology of corpus callosum interconnecting both hemispheres of the brain was found to be altered morphologically. Our aim was to evaluate and compare the microstructural changes of the corpus callosum and its interhemispheric white matter fiber tracts interconnecting both cerebral hemispheres in patients with adolescent idiopathic scoliosis and matched controls using diffusion tensor imaging. MATERIALS AND METHODS Brain DTI was performed in 69 patients with adolescent idiopathic scoliosis (female, right thoracic/thoracolumbar curve) and 40 age-matched controls without adolescent idiopathic scoliosis (female). 2D and 3D segmentation of the corpus callosum were performed using a region-growing method, and the corpus callosum was further divided into 6 regions, including the rostrum, genu, anterior and posterior midbodies, isthmus, and splenium. The laterality index was calculated to quantify the asymmetry of the corpus callosum. Interhemispheric fiber tractography were performed using the Brodmann atlas. RESULTS 2D ROI analysis revealed reduced fractional anisotropy in the genu and splenium (P = .075 and P = .024, respectively). Consistently reduced fractional anisotropy on the left sides of the genu and splenium was also found in 3D ROI analysis (P = .03 and P = .012, respectively). The laterality index analysis revealed a pseudo-right lateralization of the corpus callosum in adolescent idiopathic scoliosis. Interhemispheric fibers via the splenium interconnecting Brodmann 3, 1, and 2; Brodmann 17; and Brodmann 18 (corresponding to the primary somatosensory cortex and primary and secondary visual cortices) were also found to have reduced fractional anisotropy (P ≤ .05). CONCLUSIONS Reduced fractional anisotropy was found in the genu and splenium of the corpus callosum and corresponding interhemispheric fiber tracts interconnecting the somatosensory and visual cortices via the splenium. Our results are suggestive of altered white matter microstructure within the brain of those with adolescent idiopathic scoliosis, which could be related to abnormal brain maturation during adolescence in adolescent idiopathic scoliosis and could possibly explain the previously documented somatosensory function impairment and visuo-oculomotor dysfunction in this condition.
Collapse
Affiliation(s)
- C Xue
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - L Shi
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - S C N Hui
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - D Wang
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - T P Lam
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - C-B Ip
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| | - B K W Ng
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - J C Y Cheng
- Orthopedics and Traumatology (T.P.L., B.K.W.N., J.C.Y.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - W C W Chu
- From the Departments of Imaging and Interventional Radiology (C.X., L.S., S.C.N.H., D.W., C.-B.I., W.C.W.C.)
| |
Collapse
|
21
|
Lin CW, Lo CP, Tu MC. Horizontal gaze palsy with progressive scoliosis: a case report with magnetic resonance tractography and electrophysiological study. BMC Neurol 2018; 18:75. [PMID: 29843650 PMCID: PMC5972445 DOI: 10.1186/s12883-018-1081-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare autosomal recessive congenital anomaly characterized by horizontal gaze limitation and progressive scoliosis. We investigated the underlying pathogenesis by incorporating diffusion tensor imaging and an electrophysiological study. Case presentation A 55-year-old female patient presented to our clinic due to a chronic history of eye movement limitation since childhood. Her eye problem was followed by a progressive scoliotic change in her torso during junior high school. Neurological examinations revealed remarkable conjugate horizontal but not vertical gaze palsy. Her pupils were isocoric, with a prompt response to light reflex and convergence. Her vision, including visual acuity and field, were normal. No pathological signs of muscle tone, muscle power, deep tendon reflex or coordination were revealed. There was no associated family history, and no diseases involving other systems were noted. On reviewing her past medical history, X-rays revealed scoliotic changes of her thoracic and lumbar spine. Brain magnetic resonance imaging showed a midline cleavage at the tegmentum (split pons sign) and butterfly configuration of the medulla, consistent with HGPPS. Color-coded diffusion tensor imaging in our patient revealed absence of decussation of the superior cerebellar peduncle. In tractography, the pontocerebellar tracts and fibers within the inferior cerebellar peduncle, deemed to be primarily dorsal spinocerebellar and vestibulocerebellar tracts, appeared to be agenetic. The tegmentum was compromised secondary to dorsal displacement of the corticospinal tracts. Of note, the bilateral corticospinal tracts remained uncrossed at the level presumed to be the pyramidal decussation. A somatosensory evoked potential study also revealed predominantly ipsilateral cortical sensory responses. Conclusions Our study confirmed that a compromised tegmentum secondary to dorsal displacement of the corticospinal tracts and poorly-developed afferent fibers within the pontocerebellar tracts and inferior cerebellar peduncle to be the main neuroanatomical anomalies responsible for the clinical presentations of HGPPS. In addition, the uncrossed nature of the majority of pyramidal and proprioceptive sensory systems was confirmed. Electronic supplementary material The online version of this article (10.1186/s12883-018-1081-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chi-Wei Lin
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chung-Ping Lo
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
22
|
Verticality perception reveals a vestibular deficit in adolescents with idiopathic scoliosis. Exp Brain Res 2018; 236:1725-1734. [DOI: 10.1007/s00221-018-5256-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
|
23
|
Pialasse JP, Mercier P, Descarreaux M, Simoneau M. A procedure to detect abnormal sensorimotor control in adolescents with idiopathic scoliosis. Gait Posture 2017; 57:124-129. [PMID: 28605674 DOI: 10.1016/j.gaitpost.2017.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 02/02/2023]
Abstract
This work identifies, among adolescents with idiopathic scoliosis, those demonstrating impaired sensorimotor control through a classification procedure comparing the amplitude of their vestibular-evoked postural responses. The sensorimotor control of healthy adolescents (n=17) and adolescents with idiopathic scoliosis (n=52) with either mild (Cobb angle≥15° and ≤30°) or severe (Cobb angle >30°) spine deformation was assessed through galvanic vestibular stimulation. A classification procedure sorted out adolescents with idiopathic scoliosis whether the amplitude of their vestibular-evoked postural response was dissimilar or similar to controls. Compared to controls, galvanic vestibular stimulation evoked larger postural response in adolescents with idiopathic scoliosis. Nonetheless, the classification procedure revealed that only 42.5% of all patients showed impaired sensorimotor control. Consequently, identifying patients with sensorimotor control impairment would allow to apply personalized treatments, help clinicians to establish prognosis and hopefully improve the condition of patients with adolescent idiopathic scoliosis.
Collapse
Affiliation(s)
- Jean-Philippe Pialasse
- Faculté de médecine, Département de kinésiologie, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Québec, Canada
| | - Pierre Mercier
- Clinique d'orthopédie infantile de Québec and Département de Chirurgie, Université Laval, Québec, Canada
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Simoneau
- Faculté de médecine, Département de kinésiologie, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Québec, Canada.
| |
Collapse
|
24
|
Comparison of segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit. PLoS One 2017; 12:e0181915. [PMID: 28753636 PMCID: PMC5533341 DOI: 10.1371/journal.pone.0181915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/13/2017] [Indexed: 11/19/2022] Open
Abstract
Background Postural rehabilitation emphasizing on motor control training of segmental spinal movements has been proposed to effectively reduce the scoliotic spinal deformities in adolescent idiopathic scoliosis (AIS). However, information regarding the impairments of segmental spinal movement control involving segmental spinal stabilizers in adolescent idiopathic scoliosis remains limited. Examination of segmental spinal movement control may provide a window for investigating the features of impaired movement control specific to spinal segments that may assist in the development of physiotherapeutic management of AIS. Objectives To compare segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit. Methods Segmental spinal movement control was assessed in twenty adolescents with idiopathic scoliosis (AISG) and twenty healthy adolescents (CG) using a modified pressure biofeedback unit. Participants performed segmental spinal movements that primarily involved segmental spinal stabilizing muscles with graded and sustained muscle contraction against/off a pressure cuff from baseline to target pressures and then maintained for 1 min. Pressure data during the 1-minute maintenance phase were collected for further analysis. Pressure deviation were calculated and compared between groups. Results The AISG had significantly greater pressure deviations for all segmental spinal movements of cervical, thoracic, and lumbar spine than the CG. Conclusion Pressure biofeedback unit was feasible for assessing segmental spinal movement control in AIS. AISG exhibited poorer ability to grade and sustain muscle activities for local movements of cervical, thoracic, and lumbar spine, suggesting motor control training of segmental spinal movements involving segmental spinal stabilizing muscles on frontal, sagittal, and transverse planes were required.
Collapse
|
25
|
Zhong XP, Chen YX, Li ZY, Shen ZW, Kong KM, Wu RH. Cervical spinal functional magnetic resonance imaging of the spinal cord injured patient during electrical stimulation. 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 2017; 26:71-77. [PMID: 27311305 DOI: 10.1007/s00586-016-4646-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the spatial distribution and signal intensity changes following spinal cord activation in patients with spinal cord injury. METHODS This study used spinal functional magnetic resonance imaging (fMRI) based on signal enhancement by extra-vascular water protons (SEEP) to assess elicited responses during subcutaneous electrical stimulation at the right elbow and right thumb in the cervical spinal cord. RESULTS Seven healthy volunteers and seven patients with cervical spinal cord injury (SCI) were included in this study. Significant functional activation was observed mainly in the right side of the spinal cord at the level of the C5-C6 cervical vertebra in both the axial and sagittal planes. A higher percentage of signal changes (4.66 ± 2.08 % in injured subjects vs. 2.78 ± 1.66 % in normal) and more average activation voxels (4.69 ± 2.59 in injured subjects vs. 2.56 ± 1.13 in normal subject) in axial plane at the C5-C6 cervical vertebra with a statistically significant difference. The same trends were observed in the sagittal plane with higher percentage of signal changes and more average activation voxels, though no statistically significant difference compared with the control group. CONCLUSIONS Spinal SEEP fMRI is a powerful noninvasive method for the study of local neuronal activation in the human spinal cord, which may be of clinical value for evaluating the effectiveness of interventions aimed at promoting recovery of function using electrical stimulation.
Collapse
Affiliation(s)
- Xiao-Ping Zhong
- Department of Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Ye-Xi Chen
- Department of Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Zhi-Yang Li
- Department of Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhi-Wei Shen
- Department of Medical Imaging, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China.
| | - Kang-Mei Kong
- Department of Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Ren-Hua Wu
- Department of Medical Imaging, 2nd Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| |
Collapse
|
26
|
Stetkarova I, Zamecnik J, Bocek V, Vasko P, Brabec K, Krbec M. Electrophysiological and histological changes of paraspinal muscles in 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 2016; 25:3146-3153. [DOI: 10.1007/s00586-016-4628-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
|
27
|
Joly O, Rousié D, Frankó E. Reply to the letter to the editor of J. Domenech et al. concerning "A new approach to corpus callosum anomalies in idiopathic scoliosis using diffusion tensor magnetic resonance imaging" by O. Joly et al. (2014) Eur Spine J; 23:2643-9. 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 2016; 25:1291-2. [PMID: 26935194 DOI: 10.1007/s00586-016-4468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Olivier Joly
- Institute of Neuroscience, Newcastle University, Newcastle, NE2 4HH, UK.
| | - Dominique Rousié
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Regional Universitaire de Lille, Lille, France
- Chirurgie Orthopedique, Clinique Lille Sud, 96 rue Gustave Delory, 59810, Lesquin, France
| | - Edit Frankó
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, WC1N 3BG, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, WC1N 3BG, UK
| |
Collapse
|
28
|
Pialasse JP, Mercier P, Descarreaux M, Simoneau M. Assessment of sensorimotor control in adults with surgical correction for 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 2016; 25:3347-3352. [DOI: 10.1007/s00586-016-4421-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/24/2015] [Accepted: 01/24/2016] [Indexed: 11/30/2022]
|
29
|
Burwell RG, Clark EM, Dangerfield PH, Moulton A. Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:8. [PMID: 27252984 PMCID: PMC4888516 DOI: 10.1186/s13013-016-0063-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023]
Abstract
This paper formulates a novel multifactorial Cascade Concept for the pathogenesis of adolescent idiopathic scoliosis (AIS). This Concept stems from the longitudinal findings of Clark et al. (J Bone Miner Res 29(8):1729-36, 2014) who identified leptin body composition factors at 10 years of age associated with a scoliosis deformity found at 15 years. We interpret these findings in the light of some concepts for AIS pathogenesis. In particular, we speculate that the leptin body composition effect is linked to central nervous system development and the initiation of the asynchronous neuro-osseous growth mechanism that involves the creation of a neuraxis tether of relative anterior vertebral overgrowth. The latter mechanism in combination with age and gender-related anatomical variants of vertebral backward tilt (dorsal shear concept), human upright posture, adolescent growth factors, Hueter-Volkmann effect in vertebrae and vertebral bone mass abnormalities, lead to AIS, possibly both initiation and progression of scoliosis curvatures. Being multifactorial, while the Cascade Concept cannot be tested for all its components, some components should be testable by the method of numerical simulation. Clark et al. (J Bone Miner Res 29(8):1729-36, 2014) also suggested the origin of scoliosis was in the embryonic stages of life from cell types, including adipocytes and osteoblasts, derived from the same progenitor cells, and myoblasts from mesodermal somites. The involvement of cell types from different developmental origins suggests a process acting in embryonic life at a similar time, probably environmental, as previously proposed from anthropometric studies. As a Complex disease, AIS will involve genetic, environmental and life style factors operating in development and growth; this possibility needs evaluating in epidemiological studies.
Collapse
Affiliation(s)
- R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals Trust, Nottingham, UK
| | - Emma M Clark
- Academic Rheumatology, Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Alan Moulton
- Department of Orthopaedic Surgery, King's Mill Hospital, Mansfield, UK
| |
Collapse
|
30
|
Pialasse JP, Descarreaux M, Mercier P, Blouin J, Simoneau M. The Vestibular-Evoked Postural Response of Adolescents with Idiopathic Scoliosis Is Altered. PLoS One 2015; 10:e0143124. [PMID: 26580068 PMCID: PMC4651355 DOI: 10.1371/journal.pone.0143124] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022] Open
Abstract
Adolescent idiopathic scoliosis is a multifactorial disorder including neurological factors. A dysfunction of the sensorimotor networks processing vestibular information could be related to spine deformation. This study investigates whether feed-forward vestibulomotor control or sensory reweighting mechanisms are impaired in adolescent scoliosis patients. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation while participants stood with their eyes closed and head facing forward. Lateral forces under each foot and lateral displacement of the upper body of adolescents with mild (n = 20) or severe (n = 16) spine deformation were compared to those of healthy control adolescents (n = 16). Adolescent idiopathic scoliosis patients demonstrated greater lateral displacement and net lateral forces than controls both during and immediately after vestibular stimulation. Altered sensory reweighting of vestibular and proprioceptive information changed balance control of AIS patients during and after vestibular stimulation. Therefore, scoliosis onset could be related to abnormal sensory reweighting, leading to altered sensorimotor processes.
Collapse
Affiliation(s)
- Jean-Philippe Pialasse
- Faculté de médecine, Département de kinésiologie, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
| | - Martin Descarreaux
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Pierre Mercier
- Clinique d’Orthopédie Infantile de Québec, Québec, QC, Canada
| | - Jean Blouin
- Laboratoire de neurosciences cognitives, FR 3C 3512, CNRS—Aix-Marseille Université, Marseille, France
| | - Martin Simoneau
- Faculté de médecine, Département de kinésiologie, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Québec, QC, Canada
- * E-mail:
| |
Collapse
|
31
|
Motor and somatosensory abnormalities are significant etiological factors for adolescent idiopathic scoliosis. J Neurol Sci 2015; 359:117-23. [PMID: 26671099 DOI: 10.1016/j.jns.2015.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/13/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In adolescent idiopathic scoliosis (AIS), we explore the role of lateralized motor and somatosensory abnormalities as a possible etiological factor. METHODS Intraoperative transcranial electrical stimulation was performed in 15 AIS and 14 adult degenerative scoliosis (ADS) patients. Inter-side motor output balance (MOB) by comparing the ratios of right to left motor evoked potentials (MEP) amplitudes, and inter-side motor output excitability (MOE) computed with MEP amplitude, was determined separately for both patients groups. For somatosensory evoked potentials (SSEP), peak to peak P37 amplitudes from right and left lower limb SSEP and inter-side P37 amplitude ratios were obtained. RESULTS Inter-side MOB was significantly asymmetric in AIS patients, contributed mainly by inter-side MOB changes in the upper than the lower limbs. Inter-side MOE comparisons of ipsilateral and contralateral MEP amplitudes were significantly different between AIS and ADS patients. Mean upper limb MEP amplitudes were significantly reduced in AIS patients. Amplitude of the right upper limb MEPs were positively correlated with inter-side MEP ratio. AIS patients show larger mean MEP amplitudes on the same side as the scoliotic curve. Overall, no correlation of Cobb's angle or total levels of scoliosis involvement with inter-side MOB and MOE parameters was found. Inter-side SSEP ratios were significantly higher in AIS patients. CONCLUSIONS Primary dysfunctional and distributed motor output contributing to abnormalities of inter-side MOB and MOE changes involving the upper limbs is evident in AIS. Simultaneous but independent somatosensory and motor observations seen these patients suggest a central mechanism as an etiological factor.
Collapse
|
32
|
Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG. Adolescent idiopathic scoliosis. Nat Rev Dis Primers 2015; 1:15030. [PMID: 27188385 DOI: 10.1038/nrdp.2015.30] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of structural spinal deformities that have a radiological lateral Cobb angle - a measure of spinal curvature - of ≥10(°). AIS affects between 1% and 4% of adolescents in the early stages of puberty and is more common in young women than in young men. The condition occurs in otherwise healthy individuals and currently has no recognizable cause. In the past few decades, considerable progress has been made towards understanding the clinical patterns and the three-dimensional pathoanatomy of AIS. Advances in biomechanics and technology and their clinical application, supported by limited evidence-based research, have led to improvements in the safety and outcomes of surgical and non-surgical treatments. However, the definite aetiology and aetiopathogenetic mechanisms that underlie AIS are still unclear. Thus, at present, both the prevention of AIS and the treatment of its direct underlying cause are not possible.
Collapse
Affiliation(s)
- Jack C Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Centre of The Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Aina J Danielsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthew B Dobbs
- Departments of Orthopaedic Surgery Neurology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Theodoros B Grivas
- Trauma and Orthopaedic Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Keith D Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Alain Moreau
- Viscogliosi Laboratory in Molecular Genetics of Musculoskeletal Diseases, Sainte-Justine University Hospital Research Center, Montreal, Quebéc, Canada.,Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, Quebéc, Canada.,Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada
| | - Peter O Newton
- Department of Orthopedic Surgery, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Ian A Stokes
- Department of Orthopedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Stuart L Weinstein
- Department of Orthopedic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - R Geoffrey Burwell
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust - Queen's Medical Centre Campus, Nottingham, UK
| |
Collapse
|
33
|
Kong Y, Shi L, Hui SCN, Wang D, Deng M, Chu WCW, Cheng JCY. Variation in anisotropy and diffusivity along the medulla oblongata and the whole spinal cord in adolescent idiopathic scoliosis: a pilot study using diffusion tensor imaging. AJNR Am J Neuroradiol 2014; 35:1621-7. [PMID: 24788126 DOI: 10.3174/ajnr.a3912] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Disturbed somatosensory evoked potentials have been demonstrated in patients with adolescent idiopathic scoliosis (but this functional delay was found to originate above the C5-6 level, while the lower cord level was unaffected). Together with MR imaging observation of tonsillar ectopia and a relatively tethered cord, we hypothesized that there is disturbed mean diffusivity integrity along the spinal cord. In this study, advanced DTI was used to evaluate whether there was underlying decreased WM integrity within the brain stem and spinal cord in adolescent idiopathic scoliosis and any relationship to cerebellar tonsillar ectopia. Clinical impact on balance testing was also correlated. MATERIALS AND METHODS Thirteen girls with adolescent idiopathic scoliosis with right thoracic curves were compared with 13 age-matched healthy girls. DTI of the brain and whole spinal cord was performed. ROIs were manually defined for the medulla oblongata and along each intervertebral segment of the cord. Mean values of fractional anisotropy and mean diffusivity were computed at the defined regions. Between-group comparisons were performed by 1-way ANOVA. RESULTS Significantly decreased fractional anisotropy values and increased mean diffusivity values were found at the medulla oblongata and C1-2, C2-3, C3-4, and C4-5 segments in patients with adolescent idiopathic scoliosis compared with healthy subjects. No significant difference was found in the lower cord levels. Significant correlation was found between the tonsillar level and fractional anisotropy value at the C4-5 level in patients with adolescent idiopathic scoliosis only. CONCLUSIONS The findings from this study are in agreement with previous findings showing abnormal somatosensory evoked potential readings occurring only above the C5-6 level in patients with adolescent idiopathic scoliosis; these findings might partially explain the pathophysiology of the neural pathway involved.
Collapse
Affiliation(s)
- Y Kong
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)
| | - L Shi
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)Shenzhen Institutes of Advanced Technology (L.S.), Chinese Academy of Sciences, Shenzhen, China
| | - S C N Hui
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)
| | - D Wang
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)Biomedical Engineering and Shun Hing Institute of Advanced Engineering (D.W.)The Chinese University of Hong Kong Shenzhen Research Institute (D.W.), Shenzhen, China.
| | - M Deng
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)
| | - W C W Chu
- From the Departments of Imaging and Interventional Radiology (Y.K., L.S., S.C.N.H., D.W., M.D., W.C.W.C.)
| | - J C Y Cheng
- Orthopaedics and Traumatology (J.C.Y.C.), The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| |
Collapse
|
34
|
A new approach to corpus callosum anomalies in idiopathic scoliosis using diffusion tensor magnetic resonance imaging. 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 2014; 23:2643-9. [DOI: 10.1007/s00586-014-3435-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/21/2014] [Accepted: 06/21/2014] [Indexed: 11/25/2022]
|
35
|
Wang D, Shi L, Liu S, Hui SCN, Wang Y, Cheng JCY, Chu WCW. Altered topological organization of cortical network in adolescent girls with idiopathic scoliosis. PLoS One 2013; 8:e83767. [PMID: 24376742 PMCID: PMC3869815 DOI: 10.1371/journal.pone.0083767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/07/2013] [Indexed: 11/18/2022] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a multifactorial disease affecting approximately 1-4% of teenagers especially girls at the age of 10-16, but its etiopathogenesis remains uncertain. Previous study has revealed that the cortical thickness in AIS patients is different from that in normal controls. Cortical thickness measurements are known to be strongly correlated between regions that are axonally connected. Hence, a hypothesis is proposed to study the possibility to demonstrate abnormal structural network revealed by cortical thickness in AIS patients. The aim of the study is to investigate abnormalities in the organization of the brain cortical network in AIS patients. This study included 42 girls with severe idiopathic scoliosis (14.7±1.3 years old) and 41 age-matched normal controls (NC, 14.6±1.4 years old). The brain cortex was partitioned into 154 cortical regions based on gyral and sulcal structure. The interregional connectivity was measured as the statistical correlations between the regional mean thicknesses across the subjects. We employed the graph theoretic analysis to examine the alteration in interregional correlation, small-world efficiency, hub distribution, and regional nodal characteristics in AIS patients. We demonstrated that the cortical network of AIS patients fully preserved the small-world architecture and organization, and further verified the hemispheric asymmetry of AIS brain. Our results indicated increased central role of temporal and occipital cortex and decreased central role of limbic cortex in AIS patients compared with controls. Furthermore, decreased structural connectivity between hemispheres and increased connectivity in several cortical regions were observed. The findings of the study reveal the pattern of structural network alteration in AIS brain, and would help in understanding the mechanism and etiopathogenesis of AIS.
Collapse
Affiliation(s)
- Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Research Center for Medical Image Computing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Department of Biomedical Engineering and Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Research Center for Medical Image Computing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Shangping Liu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Steve C. N. Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Research Center for Medical Image Computing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jack C. Y. Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Research Center for Medical Image Computing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| |
Collapse
|
36
|
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is characterized by a complex curvature of the spine of unknown etiology. Unknown genetic factors likely play a role in disease pathogenesis. Recent studies suggest that AIS could result from central nervous system dysfunction and be related to dystonia. On the basis of this information, we hypothesized that genes linked to dystonia contribute to the pathogenesis of AIS. METHODS To test this hypothesis, we evaluated the potential association between sequence variants in candidate dystonia genes and AIS. We sequenced the coding region of 5 selected dystonia-causing genes in 24 subjects with AIS, followed by targeted confirmation in additional 89 patients and 73 controls. RESULTS No mutations were identified in any of the dystonia genes studied. CONCLUSIONS We found no genetic link between dystonia and AIS. CLINICAL RELEVANCE This investigation is a genetic evaluation of the association between dystonia and AIS. Despite the support in the literature for a pathogenic link between both the disorders, we have not identified any mutations in dystonia genes in patients with AIS.
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Pialasse JP, Laurendeau S, Descarreaux M, Blouin J, Simoneau M. Is abnormal vestibulomotor responses related to idiopathic scoliosis onset or severity? Med Hypotheses 2013; 80:234-6. [DOI: 10.1016/j.mehy.2012.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
|
39
|
Burwell RG, Dangerfield PH, Moulton A, Grivas TB, Cheng JC. Whither the etiopathogenesis (and scoliogeny) of adolescent idiopathic scoliosis? Incorporating presentations on scoliogeny at the 2012 IRSSD and SRS meetings. SCOLIOSIS 2013; 8:4. [PMID: 23448588 PMCID: PMC3608974 DOI: 10.1186/1748-7161-8-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/09/2013] [Indexed: 01/01/2023]
Abstract
This paper aims to integrate into current understanding of AIS causation, etiopathogenetic information presented at two Meetings during 2012 namely, the International Research Society of Spinal Deformities (IRSSD) and the Scoliosis Research Society (SRS). The ultimate hope is to prevent the occurrence or progression of the spinal deformity of AIS with non-invasive treatment, possibly medical. This might be attained by personalised polymechanistic preventive therapy targeting the appropriate etiology and/or etiopathogenetic pathways, to avoid fusion and maintain spinal mobility. Although considerable progress had been made in the past two decades in understanding the etiopathogenesis of adolescent idiopathic scoliosis (AIS), it still lacks an agreed theory of etiopathogenesis. One problem may be that AIS results not from one cause, but several that interact with various genetic predisposing factors. There is a view there are two other pathogenic processes for idiopathic scoliosis namely, initiating (or inducing), and those that cause curve progression. Twin studies and observations of family aggregation have revealed significant genetic contributions to idiopathic scoliosis, that place AIS among other common disease or complex traits with a high heritability interpreted by the genetic variant hypothesis of disease. We summarize etiopathogenetic knowledge of AIS as theories of pathogenesis including recent multiple concepts, and blood tests for AIS based on predictive biomarkers and genetic variants that signify disease risk. There is increasing evidence for the possibility of an underlying neurological disorder for AIS, research which holds promise. Like brain research, most AIS workers focus on their own corner and there is a need for greater integration of research effort. Epigenetics, a relatively recent field, evaluates factors concerned with gene expression in relation to environment, disease, normal development and aging, with a complex regulation across the genome during the first decade of life. Research on the role of environmental factors, epigenetics and chronic non-communicable diseases (NCDs) including adiposity, after a slow start, has exploded in the last decade. Not so for AIS research and the environment where, except for monozygotic twin studies, there are only sporadic reports to suggest that environmental factors are at work in etiology. Here, we examine epigenetic concepts as they may relate to human development, normal life history phases and AIS pathogenesis. Although AIS is not regarded as an NCD, like them, it is associated with whole organism metabolic phenomena, including lower body mass index, lower circulating leptin levels and other systemic disorders. Some epigenetic research applied to Silver-Russell syndrome and adiposity is examined, from which suggestions are made for consideration of AIS epigenetic research, cross-sectional and longitudinal. The word scoliogeny is suggested to include etiology, pathogenesis and pathomechanism.
Collapse
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.
| | | | | | | | | |
Collapse
|
40
|
Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "medical" articles in the European Spine Journal, 2011. 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 2011; 21:185-94. [PMID: 22189696 DOI: 10.1007/s00586-011-2126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 01/07/2023]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118 Clichy, France.
| |
Collapse
|
41
|
Burwell RG, Dangerfield PH, Moulton A, Grivas TB. Adolescent idiopathic scoliosis (AIS), environment, exposome and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy. SCOLIOSIS 2011; 6:26. [PMID: 22136338 PMCID: PMC3293085 DOI: 10.1186/1748-7161-6-26] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 12/02/2011] [Indexed: 12/22/2022]
Abstract
Genetic factors are believed to play an important role in the etiology of adolescent idiopathic scoliosis (AIS). Discordant findings for monozygotic (MZ) twins with AIS show that environmental factors including different intrauterine environments are important in etiology, but what these environmental factors may be is unknown. Recent evidence for common chronic non-communicable diseases suggests epigenetic differences may underlie MZ twin discordance, and be the link between environmental factors and phenotypic differences. DNA methylation is one important epigenetic mechanism operating at the interface between genome and environment to regulate phenotypic plasticity with a complex regulation across the genome during the first decade of life. The word exposome refers to the totality of environmental exposures from conception onwards, comprising factors in external and internal environments. The word exposome is used here also in relation to physiologic and etiopathogenetic factors that affect normal spinal growth and may induce the deformity of AIS. In normal postnatal spinal growth we propose a new term and concept, physiologic growth-plate exposome for the normal processes particularly of the internal environments that may have epigenetic effects on growth plates of vertebrae. In AIS, we propose a new term and concept pathophysiologic scoliogenic exposome for the abnormal processes in molecular pathways particularly of the internal environment currently expressed as etiopathogenetic hypotheses; these are suggested to have deforming effects on the growth plates of vertebrae at cell, tissue, structure and/or organ levels that are considered to be epigenetic. New research is required for chromatin modifications including DNA methylation in AIS subjects and vertebral growth plates excised at surgery. In addition, consideration is needed for a possible network approach to etiopathogenesis by constructing AIS diseasomes. These approaches may lead through screening, genetic, epigenetic, biochemical, metabolic phenotypes and pharmacogenomic research to identify susceptible individuals at risk and modulate abnormal molecular pathways of AIS. The potential of epigenetic-based medical therapy for AIS cannot be assessed at present, and must await new research derived from the evaluation of epigenetic concepts of spinal growth in health and deformity. The tenets outlined here for AIS are applicable to other musculoskeletal growth disorders including infantile and juvenile idiopathic scoliosis.
Collapse
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
| | - Peter H Dangerfield
- University of Liverpool, Ashton Street, L69 3GE, UK
- Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF. UK
- Royal Liverpool Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK
| | - Alan Moulton
- Department of Orthopaedic Surgery, King's Mill Hospital, Sutton Road, Mansfield NG17 4JL, UK
| | - Theodoros B Grivas
- Department of Trauma and Orthopedics, "Tzanio" General Hospital, Tzani and Afendouli 1 st, Piraeus 18536, Greece.co.uk
| |
Collapse
|
42
|
McMaster ME. Heated indoor swimming pools, infants, and the pathogenesis of adolescent idiopathic scoliosis: a neurogenic hypothesis. Environ Health 2011; 10:86. [PMID: 21975145 PMCID: PMC3213202 DOI: 10.1186/1476-069x-10-86] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/05/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND In a case-control study a statistically significant association was recorded between the introduction of infants to heated indoor swimming pools and the development of adolescent idiopathic scoliosis (AIS). In this paper, a neurogenic hypothesis is formulated to explain how toxins produced by chlorine in such pools may act deleteriously on the infant's immature central nervous system, comprising brain and spinal cord, to produce the deformity of AIS. PRESENTATION OF THE HYPOTHESIS Through vulnerability of the developing central nervous system to circulating toxins, and because of delayed epigenetic effects, the trunk deformity of AIS does not become evident until adolescence. In mature healthy swimmers using such pools, the circulating neurotoxins detected are chloroform, bromodichloromethane, dibromochloromethane, and bromoform. Cyanogen chloride and dichloroacetonitrile have also been detected. TESTING THE HYPOTHESIS In infants, the putative portals of entry to the blood could be dermal, oral, or respiratory; and entry of such circulating small molecules to the brain are via the blood-brain barrier, blood-cerebrospinal fluid barrier, and circumventricular organs. Barrier mechanisms of the developing brain differ from those of adult brain and have been linked to brain development. During the first 6 months of life cerebrospinal fluid contains higher concentrations of specific proteins relative to plasma, attributed to mechanisms continued from fetal brain development rather than immaturity. IMPLICATIONS OF THE HYPOTHESIS The hypothesis can be tested. If confirmed, there is potential to prevent some children from developing AIS.
Collapse
Affiliation(s)
- Marianne E McMaster
- Scottish National Paediatric Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK.
| |
Collapse
|