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

Brink, Rob C.; Schlösser, Tom P. C.; Colo, Dino; Vavruch, Ludvig; Stralen, Marijn van; Vincken, Koen L.; Malmqvist, Marcus; Kruyt, Moyo C.; Tropp, Hans; Castelein, René M.

doi:10.1097/brs.0000000000001919

Cited by 49 publications

(48 citation statements)

References 12 publications

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“…Most of the excess anterior length in the scoliotic thoracic spine, both in idiopathic as well as in neuromuscular cases, appeared to be caused by a substantial difference in height of the anterior portion of the disc compared to its posterior aspect, whereas the vertebral bodies showed almost no relative anterior overgrowth compared to normal children. 65,76 The conclusions of this and the previous study are that excess of anterior length is not a global, but rather a regional phenomenon, and that since the deformity is much more in the disc than in the bone, it seems more of a passive phenomenon than an active growth process. The anterior wedging of the discs could be a mechanical effect caused by unloading of the anterior spine by its position rotated away from the midline in both types of scoliosis.…”

Section: B Segmental 3-d Morphology Of Adolescent Idiopathic Scoliosismentioning

confidence: 79%

“…1,53,55,63,64 However, our recent research has shown that neuromuscular scoliosis demonstrates the same pattern of relative anterior spinal overgrowth as idiopathic scoliosis. 65 This suggests that anterior lengthening of the spine is part of a more generalized mechanism that is the consequence of the curvature, not its cause. …”

Section: A Global 3-d Alignment Of Adolescent Idiopathic Scoliosismentioning

confidence: 99%

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The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

2017

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Despite many years of dedicated research into the etiopathogenesis of adolescent idiopathic scoliosis, there is still no single distinct cause for this puzzling condition. In this overview, we attempt to link knowledge on the complex three-dimensional pathoanatomy of AIS, based on our ongoing research in this field, with etiopathogenic questions. Evidence from multiple recent cross-sectional imaging studies is provided that supports the hypothesis that AIS has an intrinsic biomechanical basis: an imbalance between the biomechanical loading of the upright human spine due to its unique sagittal configuration on the one hand, and the body's compensating mechanisms on the other. The question that remains in the etiology of AIS, and the focus of our ongoing research, is to determine what causes or induces this imbalance.Keywords: Scoliosis; Etiology; Pathogenesis; Research. RESUMO Apesar dos muitos anos de pesquisa dedicada à etiopatogenia da escoliose idiopática do adolescente, ainda não existe uma única causa distinta para essa afecção intrigante. Nesta visão geral, tentamos fazer a ligação do conhecimento sobre a complexa anatomia patológica tridimensional da EIA, com base em nossas pesquisas em andamento nessa área, com as questões da etiopatogenia da doença. As evidências dos diversos estudos transversais recentes são apresentadas e corroboram a hipótese de que a EIA tem base biomecânica intrínseca: o desequilíbrio entre a carga biomecânica devido à sua configuração sagital única por um lado, e os mecanismos compensatórios

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Section: B Segmental 3-d Morphology Of Adolescent Idiopathic Scoliosismentioning

confidence: 79%

Section: A Global 3-d Alignment Of Adolescent Idiopathic Scoliosismentioning

confidence: 99%

The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

2017

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“…The present study confirms that, in scoliosis, unlike what is described for the normal spine, the longitudinal rotation axis consistently lies behind the spinal column and its position along the curve shows a parabolic distribution, implying that during the derotation procedure of the treatment, different strategies are necessary for the vertebrae along the curve. It is well known that the thoracic kyphosis of the normal anatomy is deformed in a thoracic lordosis in moderate to severe scoliosis [24,[32][33][34][35][36]. This mechanism influences partly the posterior position of the rotation axis as well.…”

Section: Discussionmentioning

confidence: 99%

CT-based study of vertebral and intravertebral rotation in right thoracic adolescent idiopathic scoliosis

et al. 2019

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Purpose To define the longitudinal rotation axis around which individual vertebrae rotate, and to establish the various extraand intravertebral rotation patterns in thoracic adolescent idiopathic scoliosis (AIS) patients, for better understanding of the 3D development of the rotational deformity. Methods Seventy high-resolution CT scans from an existing database of thoracic AIS patients (Cobb angle: 46°-109°) were included to determine the vertebral axial rotation, rotation radius, intravertebral axial rotation, and local mechanical torsion for each spinal level, using previously validated image processing techniques. Results For all levels, the longitudinal rotation axis, from which the vertebrae rotate away from the midline, was localized posterior to the spine. The axis became closer to the spine at the apex: apex, r = 11.5 ± 5.1 cm versus two levels above (radius = 15.8 ± 8.5 cm; p < 0.001) and beneath (radius = 14.2 ± 8.2 cm; p < 0.001). The vertebral axial rotation, intravertebral axial rotation, and local mechanical torsion of the vertebral bodies were largest at the apex (21.9° ± 7.4°, 8.7° ± 13.5° and 3.0° ± 2.5°) and decreased toward the neutral, junctional zones (p < 0.001). Conclusion In AIS, the vertebrae rotate away around an axis that is localized posterior to the spine. The distance between this axis and the spine is minimal at the apex and increases gradually to the neutral zones. The vertebral axial rotation is accompanied by smaller amounts of intravertebral rotation and local mechanical torsion, which increases toward the apical region. The altered morphology and alignment are important for a better understanding of the 3D pathoanatomical development of AIS and better therapeutic planning for bracing and surgical intervention.

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“…Sprednje preraščanje obstaja tudi pri živčno-mišični skoliozi z znanim vzrokom. Dejstvo, da k povečani sprednji dolžini več prispevajo medvretenčne ploščice kot telesa vretenc, bolj kaže na prilagoditev spremenjeni obremenitvi kot na motnjo primarne rasti (16). Ne glede na vzrok za krivljenje in sukanje, ostaja biomehanika prsnega koša enaka.…”

Section: Krivina In Zasukanostunclassified

Vloga reber pri nastanku in napredovanju idiopatske skolioze

Gogala

2017

SlovMedJour

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Vloga reber pri nastanku in napredovanju idiopatske skoliozeRole of the ribs in the onset and progression of idiopathic scoliosis andrej gogala IzvlečekPatogeneza idiopatske skolioze je še vedno predmet razprave, saj skupni vzrok ni bil odkrit. A pri njenem nastanku in napredovanju obstaja nekaj osnovnih načel. Krivino hrbtenice vedno spremlja zasukanost vretenc in prsnega koša. Če želimo razložiti načela, po katerih se ravna nastanek in napredovanje skolioze, moramo odgovoriti na nekaj vprašanj: 1. Zakaj stransko ukrivljenost hrbtenice vedno spremlja sukanje prsnega koša in vretenc, da so najbolj zasukana vretenca pri vrhu krivine; 2. Ali strukturno skoliozo določa primarna rast kosti v rastnih ploskvah vretenc ali kostno preoblikovanje, s katerim se kosti prilagajajo zunanjim obremenitvam; 3. Zakaj je večina prsnih krivin usmerjenih v desno; in 4. Kaj vodi v napredovanje skolioze? V tukaj predstavljeni teoriji je pozornost namenjena vlogi reber. Someren prsni koš drži vretenca v središčni osi telesa in preprečuje obračanje vretenc z dvojnimi sklepnimi površinami na vsaki strani vretenca. Rebra so povezana z medrebrnimi mišicami in se ne morejo razmakniti na izbočeni strani, ko se hrbtenica upogne. Krivina hrbtenice v prsnem predelu ni možna brez obračanja vretenc in deformacije reber. Rebra pri vrhu krivine povleče navznoter proti vretencem, ker so premaknjena dlje od sredine kot druga rebra. Z obračanjem vretenc pri vrhu krivine, ki jih rebra stiskajo, se prsni obseg zmanjša in napetost v steni popusti. Deformacija postane nepovratna, če nova rast ali razgradnja in preoblikovanje kosti spremenijo obliko reber in vretenc ali če vezi niso dovolj čvrste. Pri utrjevanju strukturne skolioze je preoblikovanje kosti verjetno pomembnejše kot primarna rast kosti. Ko prsni koš in vretenca postanejo strukturno zasukani, vretenca izgubijo ravnovesno podporo reber z obeh strani. Strižne sile reber dodatno obračajo vretenca in potiskajo telesa vretenc na izbočeno stran. Neprenehno napredovanje skolioze se začne. AbstractThe pathogenesis of idiopathic scoliosis is still a matter of debate as its common cause has not been found. But some basic principles of its onset and progression do exist. The curvature of the spine is always accompanied by rotation of the vertebrae and rib cage. If we want to explain the principles governing scoliosis onset and progression, we should answer some questions. First, why is side curvature of the spine always accompanied by rotation of the rib cage and vertebrae and vertebral rotation is maximal at the curve apex? Second, is structural scoliosis fixed by primary bone growth in growth plates of the vertebrae or by bone remodeling by which bones adapt to external loads? Third, why most of the curvatures are right thoracic? And fourth, what drives the progression of scoliosis? In the theory presented here, attention is given to the role of the ribs. Symmetrical rib cage fixes vertebrae in the midline of the body and prevents rotation of the vertebrae with dual articulating surfaces on each side ...

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

Abstract: 4.

Cited by 49 publications

References 12 publications

The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

CT-based study of vertebral and intravertebral rotation in right thoracic adolescent idiopathic scoliosis

Vloga reber pri nastanku in napredovanju idiopatske skolioze

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