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Thread: Anterior spinal overgrowth not the cause of Scoliosis

  1. #1
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    Anterior spinal overgrowth not the cause of Scoliosis

    Another one bites the dust.

    Anterior Spinal Overgrowth is the Result of the Scoliotic Mechanism and is Located in the Disc.

    OBJECTIVE: To investigate the presence and magnitude of anterior spinal overgrowth in neuromuscular scoliosis and compare this to the same measurements in idiopathic scoliosis and healthy spines.

    SUMMARY OF BACKGROUND DATA: Anterior spinal overgrowth has been described as a potential driver for the onset and progression of adolescent idiopathic scoliosis (AIS). Whether this anterior overgrowth is specific for AIS or also present in non-idiopathic scoliosis has not been reported.

    METHODS: Supine CT scans of thirty AIS patients (thoracic Cobb 21-81°), thirty neuromuscular (NM) scoliotic patients (thoracic Cobb 19-101°) and thirty non-scoliotic controls were used. The difference in length in per cents between the anterior and posterior side (((ΔA-P)/P)*100%, abbreviated to A-P%) of each vertebral body and intervertebral disc, and between the anterior side of the spine and the spinal canal (A-C%) were determined.

    RESULTS: The A-P% of the thoracic curves did not differ between the AIS (+1.2 ± 2.2%) and NM patients (+0.9 ± 4.1%, P = 0.663), both did differ, however, from the same measurements in controls (-3.0 ± 1.6%; P < 0.001) and correlated linearly with the Cobb angle (AIS r = 0.678, NM r = 0.687). Additional anterior length was caused by anterior elongation of the discs (AIS: A-P% disc +17.5 ± 12.7% versus A-P% body -2.5 ± 2.6%; P < 0.001, NM: A-P% disc +19.1 ± 18.0% versus A-P% body -3.5 ± 5.1%; P < 0.001). The A-C% T1-S1 in AIS and NM patients were similar (+7.9 ± 1.8% and +8.7 ± 4.0%, P = 0.273), but differed from the controls (+4.2 ± 3.3%; P < 0.001).

    CONCLUSIONS: So called anterior overgrowth has been postulated as a possible cause for idiopathic scoliosis, but apparently it occurs in scoliosis with a known origin as well. This suggests that it is part of a more generalized scoliotic mechanism, rather than its cause. The fact that the intervertebral discs contribute more to this increased anterior length than the vertebral bodies suggests an adaptation to altered loading, rather than a primary growth disturbance.

  2. #2
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    This literature is all over the place. There are other papers that agree with the one posted above and there is another set that disagree. Here is one example (and references within) of direct measurements that show the anterior bone is longer in AIS, not the disc.

    http://www.bjj.boneandjoint.org.uk/c.../1026.full.pdf

    There is some evidence that the way people are imaging/measuring these various anatomical structures affects the conclusions. That seems to be the key point at this point. One paper rarely settles a topic and that is certainly not the case here. All the researchers in this area now have to work on the issue of how the choice of imaging affects the conclusions.

    The way to investigate an area of science is to read every paper on the topic, honestly portray the range of evidence and thought, and then form a personal opinion. One paper posted in isolation is meaningless.
    Last edited by Pooka1; 11-24-2016 at 11:16 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  3. #3
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    I have highlighted a potential reason why these researchers measured more increased height in the disc than in the vertebra. If they repeated this study with standing radiographs, they may have gotten completely different results, results that match with the researchers who measure increased height of the anterior side of the vertebra in AIS. Who knows.

    But the real take home message is that cherry-picking papers that appeal to individual lay people isn't going to get anyone anywhere. Science is complex and that's why there are graduate schools. If scientific questions could be answered by random people doing 5 minute google searches, we wouldn't need grad schools.



    Quote Originally Posted by Dingo View Post
    Another one bites the dust.

    Anterior Spinal Overgrowth is the Result of the Scoliotic Mechanism and is Located in the Disc.

    OBJECTIVE: To investigate the presence and magnitude of anterior spinal overgrowth in neuromuscular scoliosis and compare this to the same measurements in idiopathic scoliosis and healthy spines.

    SUMMARY OF BACKGROUND DATA: Anterior spinal overgrowth has been described as a potential driver for the onset and progression of adolescent idiopathic scoliosis (AIS). Whether this anterior overgrowth is specific for AIS or also present in non-idiopathic scoliosis has not been reported.

    METHODS: Supine CT scans of thirty AIS patients (thoracic Cobb 21-81°), thirty neuromuscular (NM) scoliotic patients (thoracic Cobb 19-101°) and thirty non-scoliotic controls were used. The difference in length in per cents between the anterior and posterior side (((ΔA-P)/P)*100%, abbreviated to A-P%) of each vertebral body and intervertebral disc, and between the anterior side of the spine and the spinal canal (A-C%) were determined.

    RESULTS: The A-P% of the thoracic curves did not differ between the AIS (+1.2 ± 2.2%) and NM patients (+0.9 ± 4.1%, P = 0.663), both did differ, however, from the same measurements in controls (-3.0 ± 1.6%; P < 0.001) and correlated linearly with the Cobb angle (AIS r = 0.678, NM r = 0.687). Additional anterior length was caused by anterior elongation of the discs (AIS: A-P% disc +17.5 ± 12.7% versus A-P% body -2.5 ± 2.6%; P < 0.001, NM: A-P% disc +19.1 ± 18.0% versus A-P% body -3.5 ± 5.1%; P < 0.001). The A-C% T1-S1 in AIS and NM patients were similar (+7.9 ± 1.8% and +8.7 ± 4.0%, P = 0.273), but differed from the controls (+4.2 ± 3.3%; P < 0.001).

    CONCLUSIONS: So called anterior overgrowth has been postulated as a possible cause for idiopathic scoliosis, but apparently it occurs in scoliosis with a known origin as well. This suggests that it is part of a more generalized scoliotic mechanism, rather than its cause. The fact that the intervertebral discs contribute more to this increased anterior length than the vertebral bodies suggests an adaptation to altered loading, rather than a primary growth disturbance.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    Author: Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands †Department of Clinical and Experimental Medicine, Linköping University, Sweden

    They had a very good idea, if it's also present in other kind of scoliosis then it would not be the AIS cause. It would be a very good point in favour of the Spain study concluding that Ais is soft kind of dysthonia.
    Supine CT scans: I suppose is the right way, since they are in 2D and in fllexible spines curves could be avoided in every plane and discs are not under pressure.

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    Quote Originally Posted by flerc View Post
    Author: Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands †Department of Clinical and Experimental Medicine, Linköping University, Sweden

    They had a very good idea, if it's also present in other kind of scoliosis then it would not be the AIS cause. It would be a very good point in favour of the Spain study concluding that Ais is soft kind of dysthonia.
    Supine CT scans: I suppose is the right way, since they are in 2D and in fllexible spines curves could be avoided in every plane and discs are not under pressure.
    You don't know what you don't know. Please consider that.

    I KNOW I don't know.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Quote Originally Posted by Pooka1 View Post
    You don't know what you don't know. Please consider that.

    I KNOW I don't know.
    Sure?? Why then do you say all what you say?

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