Theory on Cause of Scoliosis

[Celia]

Here's another interesting study:

1: Stud Health Technol Inform. 2002;88:38-43. Related Articles, Links


The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis.

Grivas TB, Dangas S, Polyzois BD, Samelis P.

Orthopaedic Department, Thriasio General Hospital, Magula, 19600 Greece. grivas@dias.itel.gr

All lateral spinal radiographs in idiopathic scoliosis show a DRC sign of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The aim of this study is to assess this DRC sign in children with and without Late Onset Idiopathic Scoliosis (LOIS) with 10 degrees -20 degrees Cobb angle, and to examine whether in scoliosis the deformity of the thorax or that of the spine develops first. METHODS AND MATERIAL: The radiographs of 133 children referred to hospital in a school screening study were examined. There were 47 boys and 86 girls, 13.28 and 13.39 years old respectively. The Cobb angle was measured and the radiological lateral spinal profile (LSP) was appraised from an angle made by a line drawn down the posterior surface of each vertebral body (T1-L5) and by the vertical. The children, boys and girls, were divided in 5 groups, namely: 1) with straight spines, 2) with spinal curvature having a Cobb angle <10 degrees, 3) with thoracic, 4) thoracolumbar and 4) lumbar curves 10 degrees -20 degrees. For quantification of the DRC sign, the "rib index" was defined as d1/d2 ratio, where dl expresses the distance from the most extended point of the most projecting rib contour (RC) to the posterior margin of the corresponding to point vertebra and d2 expresses the distance from the posterior margin of the same vertebra to the most protruding point of the least projecting RC. In a symmetric and non-deformed thorax, these two RC lines are superimposed and the "rib index" is 1. RESULTS: The statistical descriptive of d1 and d2 in boys and girls are presented together because they are not statistically different. There are no sex differences of the "rib index" which is 1.45, 1.51, 1.56, 1.59, 1.47 for the 5 respectively aforementioned groups. According to statistical analysis, there is no correlation of the Cobb angle with the "rib index" of thoracic, thoracolumbar and lumbar scoliosis groups. The DRC sign is present in all referrals and scoliotics. The data show a correlation of the "rib index" with each of T2, T3, T4, T5, T6 and T7 LSP in girls with lumbar curvatures. DISCUSSION: The DRCS primarily appears because of the rib deformation and secondarily because of the vertebral rotation, as it could be present in straight spines with no vertebral rotation. In all our school-screening referrals, (having ATI > or = 7 degrees), the thorax deformity, in terms of the DRC sign, has already been developed. 70% of these children were scoliotic. The others had a curvature of less than 9 degrees of Cobb angle (10%) or they were children with straight spines (20%) who were followed because of their existing rib hump. The non-scoliotics were 1,5-2 years younger than the ones who had already developed scoliosis, and they had both approximately a "rib index" of 1,5. The DRC sign is present in all referrals. In contrary, there is no scoliotic spine without it, as the DRC sign is always present in scoliotic lateral spinal radiographs with no exception. This observation supports our hypothesis that in idiopathic scoliosis, the deformity of the thorax develops first and then the deformity of the spine follows.

PMID: 15456003 [PubMed - indexed for MEDLINE]

[1boy1girl]

theory

I was born with arthritis. I guess I just assumed the scoliosis I have now may have resulted from the wear and tear of arthritis for 30 years. I don't have any studies to back up that theory. I was diagnosed with arthritis at 3 but was told I was born with it. I have had to deal with pain from that all my life. When this "new" pain came along I thought it was arthritis of the spine and did not go to the doctor for a long time. The pain level became too high to ignore it and I went to the doctor. The first doctor didn't want to test. With my history he just said arthritis spreads. I told him the pain level was different and the type of pain wasn't the same either. He said it was fibro. UGH We moved back home and I went to a doctor here. He ran tests, did x-rays etc. He says I do have arthritis but also degenerative scoliosis and senosis. Because of the arthritis being here first I just assume it, at the very least, contributed to the scoliosis.

Tammy

[Celia]

Here's another interesting idea....although I still like the rib theory

1: Scoliosis. 2006 Oct 18;1(1):16 [Epub ahead of print] Links

Biomechanical spinal growth modulation and progressive adolescent scoliosis - a test of the 'vicious cycle' pathogenetic hypothesis:Summary of an electronic focus group debate of the IBSE Summary of an electronic focus group debate of the IBSE.Stokes IA, Burwell RG, Dangerfield PH.


ABSTRACT: There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this debate was written by Dr Ian A Stokes. It evaluates the hypothesis that in progressive scoliosis vertebral body wedging during adolescent growth results from asymmetric muscular loading in a “vicious cycle” (vicious cycle hypothesis of pathogenesis) by affecting vertebral body growth plates (endplate physes). A frontal plane mathematical simulation tested whether the calculated loading asymmetry created by muscles in a scoliotic spine could explain the observed rate of scoliosis increase by measuring the vertebral growth modulation by altered compression. The model deals only with vertebral (not disc) wedging. It assumes that a pre-existing scoliosis curve initiates the mechanically-modulated alteration of vertebral body growth that in turn causes worsening of the scoliosis, while everything else is anatomically and physiologically ‘normal’ The results provide quantitative data consistent with the vicious cycle hypothesis. Dr Stokes’ biomechanical research engenders controversy. A new speculative concept is proposed of vertebral symphyseal dysplasia with implications for Dr Stokes’ research and the etiology of AIS. What is not controversial is the need to test this hypothesis using additional factors in his current model and in three-dimensional quantitative models that incorporate intervertebral discs and simulate thoracic as well as lumbar scoliosis. The growth modulation process in the vertebral body can be viewed as one type of the biologic phenomenon of mechanotransduction. In certain connective tissues this involves the effects of mechanical strain on chondrocytic metabolism a possible target for novel therapeutic intervention.

PMID: 17049077 [PubMed - as supplied by publisher]

[gerbo]

I came across his website two years ago http://www.uvm.edu/~istokes/#lsm , and to me his theories, as far as I understand them, make completely sense. It is a similar theory as described by martha Hawes in http://www.scoliosisjournal.com/content/1/1/3. I did write to him and he did reassure me that taking these theories into account, it was worthwhile (and safe) to try the torsorotation exercises as a way of equalising muscle strength, and thus (partially) breaking this viscious cycle

[scoliocolorado]

This is very interesting information. Thanks for sharing this with us.