View Full Version : Theory on Cause of Scoliosis

04-12-2006, 02:38 AM
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)


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.

04-12-2006, 05:00 AM
mmhhhhh, if you understand all that you're a clever person, and claiming to know "the" cause of scoliosis is very brave

"my" theory remains on the lines of; whatever causes it, and likely there are lots of different factors, what is most important is what provides the force to steer the spine (and ribcage) into growing in a different than its natural direction and counterbalancing those forces is what is required to minimise the damage or even correct it. Not necessarily rocketscience. :) :)

04-12-2006, 07:10 AM
mmhhhhh, if you understand all that you're a clever person, and claiming to know "the" cause of scoliosis is like getting on thin ice, (in a snowstorm) (during a period of rapid global warming) without a lead dog to guide you. :rolleyes: :rolleyes: :) :)

Gerbo, Gerbo, Gerbo.....must you always fall back on the Inuit theme ? :D Refer back to thread title "Theory" I didn't do any of this research, I'm simply bringing it to the forefront so that people can take a look at it and say hmmmmmmm...... there is something here, no ? :cool:

04-12-2006, 07:38 AM
Gerbo, Gerbo, Gerbo.....must you always fall back on the Inuit theme ?

sorry and apologise, do have a bit of an obsessive element to my character, have removed that bit

04-12-2006, 07:44 AM
Refer back to thread title "Theory" I didn't do any of this research, I'm simply bringing it to the forefront so that people can take a look at it and say hmmmmmmm...... there is something here, no ?

ok, be interesting what others think and what other theories deserve attention. Surely many of us affected in one way or another by this condition will have tried to work out what causes it, and what therefore might be succesful in treating it

04-12-2006, 07:56 AM
sorry and apologise, do have a bit of an obsessive element to my character, have removed that bit

You don't have to apologize ! I find those comments really funny, honest Indian :D :D

04-12-2006, 07:59 AM
well, in that case, still got a few left to use at appropriate moments......

cheers ;) ;) ;)

Karen Ocker
04-12-2006, 01:31 PM
My ribs were perfectly normal until age 11 when my scoliosis saga began.

04-12-2006, 02:02 PM
In my daughter´s lastest x-rays, I see that the ribs are now more asymmetric than a year ago, although her Cobb angle is smaller. I´ve allways thouhgt, that the ribs´s deformity was one of the scoliosis effects.. But who knows??? :confused:
Reading your lastest post about ligaments, ribs, grown factors...everything seems to be posible with this "Unknown Scoliosis"!!
I wish my english was better, so I could join your discussions...I´ll improve it, and meanwhile I will try to learn more things reading your posts, they´re full of interesting information!

04-13-2006, 01:03 PM
I wish my english was better, so I could join your discussions...I´ll improve it,


Your English is GREAT !!!! I've seen worse grammar by native English speakers :D Don't let something like that stop you from joining in discussions.....

04-14-2006, 09:43 AM
Hola ailea, your english is miles better than my spanish.

How is your daughter doing, what are her latest cobbmeasurements? Is she coping with it all?


(2 words spanish, that's pathetic, believe it or not, used to be quite fluent, when i spend half a year in central america in the mid eighties)

04-15-2006, 12:32 PM
Don't you dare stay away because you are unsure about your English. First off, nobody would have guessed that English was not your first language, second of all, WHO CARES!!!!

We all speak the same language of scoliosis!!!!! There are no language barriers here. So join in and join in often. We need everybody's input. Especially if it's good news to share! We all love hearing good news!!!

Have a Happy Easter, Everyone!!


04-17-2006, 05:32 AM
Thanks for your words! It´s true we all here speak the same language of scoliosis; but .,..sometimes it´s difficult to follow the thread, and I don´t understand your "play on words" :o
If I don´t join in often, is because I don´t have new results to share. We have a spinecor appointment two weeks ago, and my daughter´s torsions seem to be lower, and she has a better posture, but she wasn´t x-rayed, so I don´t want to build up hopes, and I´d rather wait until the end of this week, when she is going to have her new x´rays. I´m especially waiting for the "in spinecor x-rays", because I need to know what is it exactly doing.

How is your daughter doing, what are her latest cobbmeasurements? Is she coping with it all?
She is a 15 year old teen. All her world is: music, dance, go out, friends (girls and boys :( ) fashion clothes.... she is trying to cope with this, but I suspect, and I see, somedays it´s very hard and now spring is coming.....


04-17-2006, 06:03 AM
I can relate to having a 15-year old daughter. My middle daughter is 15 and I can't imagaine having to deal with scoli for her. She has enough to deal with without having scoli. The teen years are not easy. I miss those little ones.
You can read all about Nicole and her visit to Shriner's on the bracing thread. We are going to the Spinecor Doc tomorrow or later this week.


04-17-2006, 06:41 AM
I read your post and I Know you´re going to the spinecor doc this week. I suppose you were expecting better results, but we must remember that "the goal" of bracing is to stop curves, to reduced them is an extra, and bracing is a long way. Perhaps at next appointment you could see a reduction !
Best wishes and good luck with your appointment.


06-08-2006, 07:59 AM
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]

09-20-2006, 06:30 AM
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.


10-24-2006, 09:01 AM
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]

10-24-2006, 11:20 AM
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

10-24-2006, 03:45 PM
This is very interesting information. Thanks for sharing this with us.