The cause of scoliosis is based on the following readings - I know some of them are a little dated but I think a lot of the research done in the 70's and 80's by doctors such as Min Mehta and the like was actually pivotal to a better understanding.... I do believe idiopathic scoliosis is genetic but what causes it is not so much muscular imbalances/ligaments and such because all those things are secondary to the condition. I think the answer lies in the asymmetric shape of the ribs which causes a chain reaction.
The Role Of The Ribs In The Pathogenesis Of Idiopathic Scoliosis
J.A. Sevastik, MD
Department of Orthopaedic Surgery, Huddinge University Hospital, Karolinska,
Institute,Stockholm, Sweden
The main results of a series of experimental and clinical investigations have shown: a) that rib osteotomy/shortening in growing rabbits induces scoliosis which was ascribed to stimulation of the longitudinal rib growth because of the fracture and led to the hypothesis that the spinal deformity in IS can be triggered by asymmetric longitudinal rib growth, b) that in 5 of 6 deceased women with right convex thoracic IS, the left ribs were somewhat longer than the right ones c) that the left breast in scoliotic, but not in normal, girls was significantly more vascularized than that of the right one, c) that there is a slight vertebral rotation towards the right predisposing the normal spine to rotate to the same direction, d) that in growing rabbits resection of 4 intercostal nerves, including the sympathetic fibres, leads to increased vascularity of the denervated hemithorax, increased osteogenetic activity at the costochondral junction, increased longitudinal rib growth and progressive scoliosis concave to the side of denervation,with decreased kyphosis and vertebral rotation to the convexity, e) that similar results were obtained by forced mechanical lengthening of one rib in rabbits and f) that in girls with early IS the 3-D structural vertebral changes appear simultaneously and not in any particular plane. The presented set of facts when analysed in relation to one another, lend strong support to a new, the thoracospinal theory of the pathogenesis of IS according to which overgrowth of the left ribs, due to hypervascularity of the ipsilateral anterior hemithorax, alters the equilibrium of forces controlling the alignment of the normal spine, as it is predisposed to rotate to the right, and triggers the thoracospinal deformity in IS. The theory better than any other hypothesis explains the mode of origin of at least the most common form of IS, with location on the thoracic spine, concavity to the left, apex at the T7-T9 level, vertebral rotation to the right, decreased kyphosis and almost exclusive affection of adolescent girls.
The Role Of The Rib Cage In Infantile Idiopathic Scoliosis (IIS)
R. K. Pratt, R. G. Burwell and J. K. Webb
The Centre for Spinal Studies and Surgery and the School of Biomedical
Sciences, Queen’s Medical Centre, Nottingham, England
The ribs may cause scoliosis by transmission of abnormal muscle forces to the spine (Stromeyer 1836, Taylor 1904, Wojcik 1990), by unbalanced load transmission (Pal 1991) or by asymmetric rib growth (Sevastik 1984). What is the evidence for these mechanisms in IIS?
The X-ray films were reviewed of 13 patients with IIS treated by Luque trolley and convex epiphysiodesis who had 5 year follow-up. Spinal curvature (Cobb angle), vertebral tilt and rotation and the angle the ribs at the apex of the curve made with the T1S1 line were measured. Spearman rank correlation coefficients and multiple linear regression analysis were used.
The findings are as follows:
Pre-operative concave rib angle predicts both the change in spinal curvature due to surgery (p= 0.003) and the spinal curvature at 5 year follow-up (p= 0.038).
During follow-up, the concave and convex apical ribs tend to move together (p= 0.027, r= 0.58). The direction of movement of the convex apical rib during follow-up correlates negatively with the direction of movement of both convex (p= 0.019) and concave apical ribs (p= 0.031) with surgery.
Apical rib angle changes were not associated with changes in spine length (T1S1) at surgery (concave p= 0.31; convex p= 0.20) or during follow-up (concave p= 0.148; convex p= 0.886).
It is suggested that the concave apical rib angle indicates the extent to which the rib cage allows surgical correction of spinal curvature. Surgery forces a change in rib cage configuration which reverses during follow-up. Consideration of changes in spine length does not reveal evidence for the action of a muscle tether on the apical ribs.
In conclusion, the rib cage appears to act as a buttress to the spine, stabilising it against both deforming and correcting forces.
(Supported by AO/ASIF Research Commission Project 96-W21)
http://www.jbjs.org.uk/cgi/reprint/58-B/1/64
Journal of Bone and Joint Surgery British Volume 1972, 54-B, pages 230-43, titled - The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis.
The Role Of The Ribs In The Pathogenesis Of Idiopathic Scoliosis
J.A. Sevastik, MD
Department of Orthopaedic Surgery, Huddinge University Hospital, Karolinska,
Institute,Stockholm, Sweden
The main results of a series of experimental and clinical investigations have shown: a) that rib osteotomy/shortening in growing rabbits induces scoliosis which was ascribed to stimulation of the longitudinal rib growth because of the fracture and led to the hypothesis that the spinal deformity in IS can be triggered by asymmetric longitudinal rib growth, b) that in 5 of 6 deceased women with right convex thoracic IS, the left ribs were somewhat longer than the right ones c) that the left breast in scoliotic, but not in normal, girls was significantly more vascularized than that of the right one, c) that there is a slight vertebral rotation towards the right predisposing the normal spine to rotate to the same direction, d) that in growing rabbits resection of 4 intercostal nerves, including the sympathetic fibres, leads to increased vascularity of the denervated hemithorax, increased osteogenetic activity at the costochondral junction, increased longitudinal rib growth and progressive scoliosis concave to the side of denervation,with decreased kyphosis and vertebral rotation to the convexity, e) that similar results were obtained by forced mechanical lengthening of one rib in rabbits and f) that in girls with early IS the 3-D structural vertebral changes appear simultaneously and not in any particular plane. The presented set of facts when analysed in relation to one another, lend strong support to a new, the thoracospinal theory of the pathogenesis of IS according to which overgrowth of the left ribs, due to hypervascularity of the ipsilateral anterior hemithorax, alters the equilibrium of forces controlling the alignment of the normal spine, as it is predisposed to rotate to the right, and triggers the thoracospinal deformity in IS. The theory better than any other hypothesis explains the mode of origin of at least the most common form of IS, with location on the thoracic spine, concavity to the left, apex at the T7-T9 level, vertebral rotation to the right, decreased kyphosis and almost exclusive affection of adolescent girls.
The Role Of The Rib Cage In Infantile Idiopathic Scoliosis (IIS)
R. K. Pratt, R. G. Burwell and J. K. Webb
The Centre for Spinal Studies and Surgery and the School of Biomedical
Sciences, Queen’s Medical Centre, Nottingham, England
The ribs may cause scoliosis by transmission of abnormal muscle forces to the spine (Stromeyer 1836, Taylor 1904, Wojcik 1990), by unbalanced load transmission (Pal 1991) or by asymmetric rib growth (Sevastik 1984). What is the evidence for these mechanisms in IIS?
The X-ray films were reviewed of 13 patients with IIS treated by Luque trolley and convex epiphysiodesis who had 5 year follow-up. Spinal curvature (Cobb angle), vertebral tilt and rotation and the angle the ribs at the apex of the curve made with the T1S1 line were measured. Spearman rank correlation coefficients and multiple linear regression analysis were used.
The findings are as follows:
Pre-operative concave rib angle predicts both the change in spinal curvature due to surgery (p= 0.003) and the spinal curvature at 5 year follow-up (p= 0.038).
During follow-up, the concave and convex apical ribs tend to move together (p= 0.027, r= 0.58). The direction of movement of the convex apical rib during follow-up correlates negatively with the direction of movement of both convex (p= 0.019) and concave apical ribs (p= 0.031) with surgery.
Apical rib angle changes were not associated with changes in spine length (T1S1) at surgery (concave p= 0.31; convex p= 0.20) or during follow-up (concave p= 0.148; convex p= 0.886).
It is suggested that the concave apical rib angle indicates the extent to which the rib cage allows surgical correction of spinal curvature. Surgery forces a change in rib cage configuration which reverses during follow-up. Consideration of changes in spine length does not reveal evidence for the action of a muscle tether on the apical ribs.
In conclusion, the rib cage appears to act as a buttress to the spine, stabilising it against both deforming and correcting forces.
(Supported by AO/ASIF Research Commission Project 96-W21)
http://www.jbjs.org.uk/cgi/reprint/58-B/1/64
Journal of Bone and Joint Surgery British Volume 1972, 54-B, pages 230-43, titled - The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis.
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