Asymmetric evolution of anterior chest wall blood supply in female adolescents with progressive right-convex thoracic idiopathic scoliosis

Iliopoulos, Panagiotis; Korovessis, Panagiotis; Κουρέας, Γεώργιος; Zacharatos, Spyridon; Stergiou, Panagiotis

doi:10.1007/s00586-007-0322-1

“…The LHS concept extends, and provides a wider scientific framework for, the thoraco-spinal pathogenetic concept for right thoracic (RT) AIS of girls [ 76 , 97 , 98 ]. A longitudinal study of anterior chest wall blood supply of girls with progressive right thoracic (RT) AIS, supports the view that RT AIS in females is associated with a disturbance in the autonomic nervous system regulating blood flow to the anterior chest wall [ 77 , 78 ]. The thoraco-spinal concept is supported by recent peripheral nerve studies [ 79 ].…”

Section: Discussionmentioning

confidence: 87%

Relatively lower body mass index is associated with an excess of severe truncal asymmetry in healthy adolescents: Do white adipose tissue, leptin, hypothalamus and sympathetic nervous system influence truncal growth asymmetry?

Grivas

¹

,

Burwell

²

,

Mihas

³

et al. 2009

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BMI is a surrogate measure for body fat and circulating leptin levels. The finding that girls with relatively lower BMI have significantly later menarche, and a significant excess of TAs, suggests a relation to energy homeostasis through the hypothalamus. The hypothesis we suggest for the pathogenesis of severe TA in girls and boys has the same mechanism as that proposed recently for AIS girls, namely: severe TAs are initiated by a genetically-determined selectively increased hypothalamic sensitivity (up-regulation, i.e. increased sensitivity) to leptin with asymmetry as an adverse response to stress (hormesis), mediated bilaterally mainly to the growing trunk via the sympathetic nervous system (leptin-hypothalamic-sympathetic nervous system (LHS) concept). The putative autonomic dysfunction is thought to be increased by any lower circulating leptin levels associated with relatively lower BMIs. Sympathetic nervous system activation with asymmetry leads to asymmetries in ribs and/or vertebrae producing severe TA when beyond the capacity of postural mechanisms of the somatic nervous system to control the shape distortion of the trunk. A test of this hypothesis testing skin sympathetic responses, as in the Rett syndrome, is suggested.

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“…Despite the many reports on the development of scoliosis following iatrogenically induced rib asymmetry, few have focused on the association of rib length asymmetry with idiopathic scoliosis. Furthermore, it has not been clearly documented whether the presence of rib asymmetry in idiopathic scoliosis was primary or secondary [5,6]. In the present study, the lengths of the 1st to 12th ribs (both the concave and convex side) in patients with AIS and scoliosis with syringomyelia (SS) were measured by computed tomography (CT) using multi-projection volume reconstruction method.…”

Section: Introductionmentioning

confidence: 93%

Rib length asymmetry in thoracic adolescent idiopathic scoliosis: is it primary or secondary?

Zhu

¹

,

Chu

²

,

Sun

³

et al. 2010

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The development of scoliosis in animal models after inducing asymmetric rib growth suggests the possible role of asymmetric rib growth in the etiopathogenesis of adolescent idiopathic scoliosis (AIS). Asymmetric rib length is well recognized in idiopathic scoliosis; however, whether this rib asymmetry is primary or secondary has not been clearly documented. The objectives of this study were to investigate any rib length asymmetry in patients with AIS and compare those with scoliosis with syringomyelia (SS) with the intention of elucidating any relationship between rib growth and pathogenesis of AIS. Forty-eight AIS and 29 SS with apical vertebrae located between T7 and T9 were recruited. The average age was 13.5 ± 2.3 versus 12.5 ± 3.4 years, and the average Cobb angle of thoracic curve was 43.3° ± 16.4° versus 45.6° ± 22.6° in patients with AIS or SS, respectively. The length of all ribs was measured from the tip of costal head to the end of the same rib by built-in software on spiral computed tomography. At the levels of the apical vertebrae, the vertebrae above and below the apex, the mean discrepancy in rib length (concave minus convex rib) was 7, 4 and 7 mm, respectively, in AIS group (p < 0.01), and 6, 5 and 7 mm in SS group, respectively (p < 0.01). The rib length discrepancy between concave and convex sides was significantly correlated with the magnitude of the Cobb angle of thoracic curve in both AIS and SS groups (p < 0.01). Similar findings of the asymmetry of rib length in both AIS and SS patients pointed strongly to the fact that the rib length asymmetry in apical region is most likely secondary to the scoliosis deformity rather than playing a primary role in the etiopathogenesis.

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“…A longitudinal study of anterior chest wall blood supply of girls with progressive right thoracic (RT) AIS, supports the view that RT AIS in females is associated with a disturbance in the autonomic nervous system regulating blood flow to the anterior chest wall [77,78]. The thoraco-spinal concept is supported by recent peripheral nerve studies [79].…”

Section: Discussionmentioning

confidence: 78%

Changing a "progressive" factor into a "corrective" factor: the effect of intervertebral disc modulation in treatment of idiopathic scoliosis

Grivas

¹

,

Vasiliadis

²

,

Rodopoulos

³

et al. 2009

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BMI is a surrogate measure for body fat and circulating leptin levels. The finding that girls with relatively lower BMI have significantly later menarche, and a significant excess of TAs, suggests a relation to energy homeostasis through the hypothalamus. The hypothesis we suggest for the pathogenesis of severe TA in girls and boys has the same mechanism as that proposed recently for AIS girls, namely: severe TAs are initiated by a genetically-determined selectively increased hypothalamic sensitivity (up-regulation, i.e. increased sensitivity) to leptin with asymmetry as an adverse response to stress (hormesis), mediated bilaterally mainly to the growing trunk via the sympathetic nervous system (leptin-hypothalamic-sympathetic nervous system (LHS) concept). The putative autonomic dysfunction is thought to be increased by any lower circulating leptin levels associated with relatively lower BMIs. Sympathetic nervous system activation with asymmetry leads to asymmetries in ribs and/or vertebrae producing severe TA when beyond the capacity of postural mechanisms of the somatic nervous system to control the shape distortion of the trunk. A test of this hypothesis testing skin sympathetic responses, as in the Rett syndrome, is suggested.

show abstract

Asymmetric evolution of anterior chest wall blood supply in female adolescents with progressive right-convex thoracic idiopathic scoliosis

Cited by 12 publications

References 11 publications

Relatively lower body mass index is associated with an excess of severe truncal asymmetry in healthy adolescents: Do white adipose tissue, leptin, hypothalamus and sympathetic nervous system influence truncal growth asymmetry?

Relatively lower body mass index is associated with an excess of severe truncal asymmetry in healthy adolescents: Do white adipose tissue, leptin, hypothalamus and sympathetic nervous system influence truncal growth asymmetry?

Rib length asymmetry in thoracic adolescent idiopathic scoliosis: is it primary or secondary?

Changing a "progressive" factor into a "corrective" factor: the effect of intervertebral disc modulation in treatment of idiopathic scoliosis

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