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Grivas TB, Vasiliadis E, Mazioti C, Papagianni D, Mamzeri A, Chandrinos M, Vynichakis G, Athanasopoulos K, Christodoulides P, Jevtic N, Pjanic S, Ljubojevic D, Savvidou O, Kaspiris A, Grunstein J. Are the Spinal Changes in the Course of Scoliogeny Primary but Secondary? J Clin Med 2024; 13:2163. [PMID: 38673436 PMCID: PMC11051170 DOI: 10.3390/jcm13082163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity.
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Affiliation(s)
- Theodoros B. Grivas
- Trauma and Orthopaedic Department, Former Head, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (E.V.); (A.K.)
| | | | | | | | - Michail Chandrinos
- Orthopedic Department, Gen. Hospital of Argolida-N.M. Argous, 212 00 Argos, Greece; (M.C.); (G.V.)
| | - George Vynichakis
- Orthopedic Department, Gen. Hospital of Argolida-N.M. Argous, 212 00 Argos, Greece; (M.C.); (G.V.)
| | | | | | - Nikola Jevtic
- Scolio Centar, 403916 Novi Sad, Serbia; (N.J.); (D.L.)
| | - Samra Pjanic
- Department of Paediatric Rehabilitation, Institute for Physical, Rehabilitation Medicine and Orthopaedic Surgery “Dr Miroslav Zotovic”, 78000 Banja Luka, Bosnia and Herzegovina;
| | | | - Olga Savvidou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University General Hospital, Rimini 1, 124 62 Athens, Greece;
| | - Angelos Kaspiris
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (E.V.); (A.K.)
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, 265 04 Patras, Greece
| | - Jarrett Grunstein
- Chiropractic Center Livingston, 340 E Northfield Rd # 2E, Livingston, NJ 07039, USA;
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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.
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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
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Negrini S, Grivas TB. Introduction to the "Scoliosis" Journal Brace Technology Thematic Series: increasing existing knowledge and promoting future developments. SCOLIOSIS 2010; 5:2. [PMID: 20205874 PMCID: PMC2827401 DOI: 10.1186/1748-7161-5-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 11/15/2022]
Abstract
Bracing is the main non-surgical intervention in the treatment of idiopathic scoliosis during growth, in hyperkyphosis (and Scheuermann disease) and occasionally for spondylolisthesis; it can be used in adult scoliosis, in the elderly when pathological curves lead to a forward leaning posture or in adults after traumatic injuries. Bracing can be defined as the application of external corrective forces to the trunk; rigid supports or elastic bands can be used and braces can be custom-made or prefabricated. The state of research in the field of conservative treatment is insufficient and while it can be stated that there is some evidence to support bracing, we must also acknowledge that today we do not have a common and generally accepted knowledge base, and that instead, individual expertise still prevails, giving rise to different schools of thought on brace construction and principles of correction. The only way to improve the knowledge and understanding of brace type and brace function is to establish a single and comprehensive source of information about bracing. This is what the Scoliosis Journal is going to do through the "Brace Technology" Thematic Series, where technical papers coming from the different schools will be published.
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Affiliation(s)
- Stefano Negrini
- ISICO (Italian Scientific Spine Institute), Via R Bellarmino 13/1, 20141 Milan, Italy
| | - Theodoros B Grivas
- Orthopaedic and Trauma Department, "Tzanio" General Hospital of Piraeus, Piraeus, Greece
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