Quantifying Muscle Size Asymmetry in Adolescent Idiopathic Scoliosis Using Three-dimensional Magnetic Resonance Imaging

Abstract

Study Design: This is a case-control study of prospectively collected data. Objective: To quantify paraspinal muscle size asymmetry in adolescent idiopathic scoliosis (AIS) and determine if this asymmetry is i) greater than observed in adolescent controls with symmetrical spines; and ii) positively associated with skeletal maturity using Risser grade, scoliosis severity using the Cobb angle, and chronological age in years. Summary of Background Data: AIS is a three-dimensional deformity of the spine which occurs in 2.5-3.7% of the Australian population. There is some evidence of asymmetry in paraspinal-muscle activation and morphology in AIS. Asymmetrical paraspinal muscle forces may facilitate asymmetrical vertebral growth during adolescence. Methods: An asymmetryindex [Ln(concave/convex volume)] of i) deep and ii) superficial paraspinal-muscle volumes, at the level of the i) major curve apex (Thoracic 8-9th vertebral level) and ii) lower-end vertebrae (LEV, Thoracic 10-12th vertebral level), was determined from 3D Magnetic Resonance Imaging (MRI) of 25 adolescents with AIS (all right thoracic curves), and 22 healthy controls (convex=left); all female, 10-16 years. Results: Asymmetryindex of deep paraspinal-muscle volumes was greater in AIS (0.16±0.20) than healthy spine controls (-0.06±0.13) at the level of the apex (P<0.01, linear mixed-effects analysis), but not LEV (P>0.05). Asymmetryindex was positively correlated with Risser grade (r=0.50, P<0.05) and scoliosis Cobb angle (r=0.45, P<0.05), but not age (r=0.34, P>0.05). There was no difference in the asymmetryindex of superficial paraspinal muscle volumes between AIS and controls (P>0.05). Conclusions: The asymmetry of deep apical paraspinal-muscle volume in AIS at the scoliosis apex is greater than that observed at equivalent vertebral levels in controls and may play a role in the pathogenesis of AIS.