Pathogenesis of progressive adolescent idiopathic scoliosis. Platelet activation and vascular biology in immature vertebrae: an alternative molecular hypothesis

Altered paraspinal muscle activity was suggested by Lowe et al (2002) to explain a relationship between Cobb angle changes and platelet calmodulin level changes in adolescent idiopathic scoliosis (AIS). We formulate an alternative platelet-skeletal hypothesis which involves: (1) a small scoliosis curve; (2) axial loads transmitted directly from the intervertebral discs to vertebral body growth plates (endplate physes) as axial inward bulges that create mechanical micro-insults; (3) the latter cause dilatation of juxta-physeal vessels and, in deforming vertebrae, vascular damage with exposure of subendothelial collagen and other agonist proteins; (4) subject to predisposition, platelet activation with calmodulin changes occurs within dilated vessels of deforming vertebral bodies; (5) the activated platelets in juxta-physeal vessels release growth factors that, after extravasation, abet the hormone-driven growth of the already mechanically-compromised vertebral endplate physes to promote the relative anterior spinal overgrowth and curve progression of AIS. The hypothesis links several fields in each of which research within ethical restraints is suggested to refute it.     

Imaging study of wedge changes in the vertebral bodies and intervertebral discs in adolescent idiopathic scoliosis

Objective: To observe wedge changes in the vertebral bodies and intervertebral discs in progressive adolescent idiopathic scoliosis before and after conservative treatment with braces, and to explore the correlation between wedge changes in the vertebral bodies or intervertebral discs and scoliosis curves. Methods: Thirty‐seven consecutive patients with adolescent idiopathic scoliosis were included in this study from June 2001 to August 2003. There were 31 female and 6 male patients, with an average age of 14.9 years. According to the Peking Union Medical College (PUMC) grading system, eight cases were Ia, three Ib, five Ic, twelve IIb1, three IIb2, three IIc1, one IIc3, and two IId1. Wedge changes in the vertebral bodies and intervertebral discs, and the scoliosis angles were measured by radiographic evaluation before conservative treatment with braces and before surgery. Results: In the mature patients (Risser sign IV, V, menarche two years or more previously), wedge changes in the vertebral bodies and intervertebral discs worsened with curve progression, and were poorly correlated with the degree of curve (r= 0.17). But in the developmentally immature patients (Risser sign 0–III, pre‐menarche), there was a significant correlation with the degree of curve (r= 0.69). Wedge changes in the vertebral bodies and intervertebral discs worsened with curve progression, and were significantly correlated with the degree of curve. Conclusion: Wedge changes in the vertebral bodies and intervertebral discs have a positive correlation with degree of curve, which indicates that asymmetric growth of the cartilaginous endplate might be the primary cause of wedge change in the vertebral bodies.     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth

We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb's angles of between 20 degrees and 90 degrees, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic spines had longer vertebral bodies between T1 and T12 in the anterior column and shorter pedicles with a larger interpedicular distance in the posterior column. The differential growth between the anterior and the posterior elements of each thoracic vertebra in the patients with AIS was significantly different from that in the controls (p < 0.01). There was also a significant positive correlation between the scoliosis severity score and the ratio of differential growth between the anterior and posterior columns for each thoracic vertebra (p < 0.01). Compared with age-matched controls, the longitudinal growth of the vertebral bodies in patients with AIS is disproportionate and faster and mainly occurs by endochondral ossification. In contrast, the circumferential growth by membranous ossification is slower in both the vertebral bodies and pedicles.     

Spine slenderness and wedging in adolescent idiopathic scoliosis and in asymptomatic population: an observational retrospective study

The origin of the deformity due to adolescent idiopathic scoliosis (AIS) is not known, but mechanical instability of the spine could be involved in its progression. Spine slenderness (the ratio of vertebral height to transversal size) could facilitate this instability, thus playing a role in scoliosis progression. The purpose of this work was to investigate slenderness and wedging of vertebrae and intervertebral discs in AIS patients, relative to their curve topology and to the morphology of control subjects. A total of 321 AIS patients (272 girls, 14 ± 2 years old, median Risser sign 3, Cobb angle 35° ± 18°) and 83 controls were retrospectively included (56 girls, median Risser 2, 14 ± 3 years). Standing biplanar radiography and 3D reconstruction of the spine were performed. Geometrical features were computed: spinal length, vertebral and disc sizes, slenderness ratio, frontal and sagittal wedging angles. Measurement reproducibility was evaluated. AIS girls before 11 years of age had slightly longer spines than controls (p = 0.04, Mann–Whitney test). AIS vertebrae were significantly more slender than controls at almost all levels, almost independently of topology. Frontal wedging of apical vertebrae was higher in AIS, as expected, but also lower junctional discs showed higher wedging than controls. AIS patients showed more slender spines than the asymptomatic population. Analysis of wedging suggests that lower junctional discs and apex vertebra could be locations of mechanical instability. Numerical simulation and longitudinal clinical follow-up of patients could clarify the impact of wedging, slenderness and growth on the biomechanics of scoliosis progression. These slides can be retrieved under Electronic Supplementary Material.     

脊柱侧凸顶椎区椎间盘纤维环中多聚蛋白多糖的表达及意义

目的：探讨脊柱侧凸患者顶椎区椎间盘纤维环中多聚蛋白多糖的表达及其意义。方法：采集2003年7月至2004年9月间行前路松解或矫形手术的40例脊柱侧凸患者侧凸顶椎区椎间盘组织。青少年特发性脊柱侧凸患者（adolescent idiopathic scoliosis，AIS）25例，胸椎椎间盘11例，腰椎椎间盘14例；先天性脊柱侧凸患者（congenital scoliosis，CS）15例，胸椎椎间盘6例，腰椎椎间盘9例。利用RT—PCR扩增多聚蛋白多糖（Aguecan），琼脂糖凝胶电泳，在UVP（紫外光测定法）成像系统进行扫描．GelWork图像分析系统中进行灰度测定半定量分析。分别计算AIS组和CS组凹侧、凸侧纤维环中Aggrecan含量，并对CS组和AIS组胸椎和腰椎以及椎间盘的凹侧和凸侧进行比较。结果：AIS组和CS组椎间盘凹侧纤维环中Aggrecan含量低于凸侧．差异有显著性（P〈0．01），胸椎椎间盘纤维环中Aggrecan的含量低于腰椎，但无统计学差异。AIS组Aggrecan的含量和CS组相应部位Aggrecan的含量无明显差别。结论：AIS椎间盘纤维环凹凸侧存在Aggrecan代谢差异．并且可能是脊柱侧凸所致的继发改变．但也可能是脊柱侧凸发生、发展中的重要因素。     

青少年特发性脊柱侧凸与神经源性脊柱侧凸患者椎体和椎间盘的楔形变及其临床意义

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)与神经源性脊柱侧凸(neurological scoliosis,NS)患者的椎体和椎间盘的楔形变情况,探讨其临床意义。方法:对35例AIS患者和31例NS患者(继发于Chiari畸形)应用Cobb法测量胸椎和腰椎每个侧凸范围内顶椎及其上、下各两个椎体和相应椎间盘的楔变角,计算其占整个侧凸角度的百分比(楔变率),得出侧凸范围内5个椎体的平均楔变率和4个椎间盘的平均楔变率。应用SPSS10.0统计软件进行统计分析,组间比较采用单因素方差分析。结果:相同病因、相同侧凸部位、相同Cobb角分组情况下,椎体与椎间盘的楔变率存在显著性差异(P0.05)。相同病因、相同侧凸部位,Cobb角60°组的椎体楔变率和椎间盘楔变率与Cobb角≥60°组比较均无显著性差异(P0.05)。相同侧凸部位、相同Cobb角分组,AIS组椎体和椎间盘的楔变率分别与NS组比较均无显著性差异(P0.05)。结论:AIS与NS患者椎体与椎间盘的相对楔形变方式相同,AIS患者的椎体楔形变可能是继发的。在治疗脊柱侧凸时,即便是较小角度的脊柱侧凸,都应该考虑到其存在椎体和椎间盘的楔形变。     

前路胸腔镜下青少年特发性胸椎侧凸矫形的初步临床结果

目的回顾胸腔镜下青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）前路矫形的初步临床疗效。方法 2007年8月~2008年11月行胸腔镜下前路矫形患者8例,均为女性Lenkel A-型AIS患者,平均年龄为13.8岁。对手术前后及末次随访时的胸椎侧凸Cobb角、腰椎侧凸Cobb角、顶椎中点与C7中点垂线或骶骨平分线垂直距离（apical vertebral translation,AVT）、顶椎旋转角、胸椎后凸Cobb角及双肩高度差进行分析。结果所有患者术后随访3~12个月,胸椎侧凸Cobb角平均改善率为71%、矫形丢失率为6%;腰椎侧凸Cobb角平均改善率为60%、矫形丢失率为6%;AVT改善率为73%,丢失率为6%。所有患者顶椎旋转角度均无改善;胸椎后凸Cobb角无改变。双肩高度差除1例患者随访时丢失50%,其余改善率均为100%。结论柔韧度好的Lenkel A-型AIS行胸腔镜下前路矫形可获得良好的冠状面矫形,但矢状面矫形及椎体去旋转效果不佳,长期疗效有待继续观察。     

Anterior-posterior length discrepancy of the spinal column in adolescent idiopathic scoliosis—a 3D CT study

Background Context

One of the characteristics of reported observations in adolescent idiopathic scoliosis (AIS) is that the thoracic spine is longer anteriorly than posteriorly, more pronounced around the apex than the transitional zones. This reversal of the normal kyphotic anatomy of the thoracic spine is related to questions of etiopathogenesis of AIS. The changes in the anatomy of the anterior column have been described rather in detail; however, the role of the posterior spinal column and the laminae has so far not been elucidated. If the posterior column exhibits a longitudinal growth disturbance, it could act as a tether, leading to a more or less normal anterior column with a deformed and shorter posterior aspect of the spine. So far, it has remained unclear whether this anterior-posterior length discrepancy is the result of relative anterior lengthening or relative posterior shortening, and which tissues (bone, disc, intervertebral soft tissue) are involved.

青少年特发性脊柱侧凸患者的椎体及椎间盘楔形变的影像学研究

目的 观察进展型青少年特发性脊柱侧凸支具治疗前及手术治疗前椎体和椎间盘楔形角的变化,并探讨椎体和椎间盘楔形变与侧凸之间的相关性.方法 对2001年6月至2003年8月间37例青少年特发性脊柱侧凸患者支具治疗前和手术治疗前影像学上椎体和椎问盘的楔形变及侧弯的角度进行测量,本组男6例,女31例,年龄11～18岁,平均14.9岁.根据PUMC分型:PUMC la 8例,PUMC I b 3例,PUMC I c 5例,PUMC Ⅱ bl 12例,PUMCⅡ b2 3例,PUMC Ⅱ cl 3例,PUMC Ⅱ e3 l例,PUMC Ⅱ dl 2例.结果 发育成熟(Risser征Ⅳ～V)及月经初潮2年以上的患儿支具治疗前后的椎体、椎问盘楔形角与侧凸Cobb角的相关程度较低(r=0.17),而发育不成熟的患儿(Risser征0～Ⅲ,月经未来潮)支具治疗前后的椎体、椎间盘楔形角与侧凸Cobb角的相关程度较高(r=O.69).随着侧凸的进展,椎体和椎间盘的楔形角明显增加,椎体和椎间盘的楔形变同侧凸的进展明显相关,并与侧凸的程度呈正相关.结论 在侧凸的发生和进展过程中椎体和椎间盘出现明显的楔形变,并随着侧凸的加重而变得更加明显,表明椎体软骨终板的不对称生长可能是导致椎体楔形变的关键因素.     

Comparison of somatosensory evoked potentials between adolescent idiopathic scoliosis and congenital scoliosis without neural axis abnormalities

Background contextAbnormal somatosensory evoked potentials (SEPs) have been documented in patients with adolescent idiopathic scoliosis (AIS) with different cure severity. However, few studies investigated whether abnormal SEPs were the cause or effect of idiopathic scoliosis.PurposeThe purpose of this study was to investigate the significance of abnormal SEPs in patients with AIS, and to explore its effect on the etiopathogenesis of AIS.Study design/SettingThis study evaluated SEPs in patients with AIS and congenital scoliosis (CS) with similar curve pattern and severity both in coronal and sagittal planes.Patient sampleFemale patients with AIS and CS in our spine surgery center from 2000 to 2009 were recruited for this study.Outcome measuresRate of abnormal SEPs.MethodsPosterior tibial nerve SEPs (PTN-SEPs) were performed on female patients with AIS and CS. The inclusion criteria were patients with AIS with a Lenke type 1 curve and patients with CS with right thoracic curve (apex between T5 and T12) and normal sagittal profile (kyphosis less than 50° measured from T2 to T12). All patients were evaluated with total spine magnetic resonance imaging, and those with neural axis abnormalities were excluded. The patients with neurological deficits on detailed physical examination were also excluded. Absence of SEPs waveforms or prolongation of peak latency or asymmetrical peak latency were defined as pathological change. The incidence of pathological SEPs and clinical characteristics were compared between patients with AIS and patients with CS.ResultsForty-six patients with AIS and 33 patients with CS were included in this study. There was no significant difference in coronal and sagittal Cobb angle between the two groups. The rate of abnormal SEPs was 32.6% (15/46) and 12.1% (4/33) in AIS and CS groups, respectively, and the difference was statistically significant (p<.05).ConclusionSomatosensory pathway dysfunction could be found in both AIS and CS without neural axis abnormalities, and the patients with AIS tended to have higher rates of somatosensory disorders than patients with CS with similar scoliosis curve, which indicates that both scoliosis curve and primary etiopathogenic factor contribute to the sensory deficit in patients with AIS.     

Transverse plane pelvic rotation in adolescent idiopathic scoliosis: primary or compensatory?

Several studies have suggested that the pelvis is involved in the etiology or pathogenesis of adolescent idiopathic scoliosis (AIS). The purpose of this retrospective, cross-sectional radiographic study is to identify any correlation between the transverse plane rotational position of the pelvis in stance and operative-size idiopathic or congenital scoliosis deformities, using Scheuermann’s kyphosis and isthmic spondylolisthesis patients for comparison. The hypothesis tested was that the direction of transverse pelvic rotation is the same as that for a thoracic scoliosis. As a group, AIS patients had a significant transverse plane pelvic rotation in the same direction as the thoracic curve. When subdivided into the six Lenke curve patterns, this was true for the groups with a major thoracic curve: thoracic (1), double thoracic (2) and double curve patterns (3). It was not true for patterns with a major thoracolumbar/lumbar curve: single thoracolumbar/lumbar (5) and double thoracic-thoracolumbar/lumbar (6). Nor was it true for triple (4) curves. The Lenke 1 and 2 major thoracic curves without compensatory thoracolumbar/lumbar curves did not have the predicted pelvic rotation. All congenital scoliosis patients studied had main thoracic curves and significant transverse plane pelvic rotation in the same direction as the thoracic curve. There was no transverse plane pelvic rotation in the Scheuermann’s kyphosis or isthmic spondylolisthesis patients. We interpret these findings as consistent with a compensatory rotation of the pelvis in the same direction as the main thoracic curve in most patients with a compensatory thoracolumbar/lumbar curve as well as in patients with main thoracic congenital scoliosis.     

青少年特发性脊柱侧凸软骨终板蛋白质组学研究

目的 通过对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者侧凸顶椎椎间盘软骨终板进行蛋白质组学鉴定,尝试寻找诱发或加重椎间盘不均衡发育的分子因素.方法 经一期前路脊柱侧凸矫形术获取6例AIS患者主弯顶椎椎间盘的软骨终板组织,提取蛋白组织,用Brad-ford法对所获取蛋白质样品进行浓度测定;通过SDS-聚丙烯酰胺凝胶蛋白电泳(sodium dodecyl sulfate-polyacrylamide gel electrophoresis,SDS-PAGE)对蛋白质总量和分子量范围进行初步鉴定;最后用鸟枪法蛋白质组鉴定技术比较凸、凹侧所含蛋白成分的异同,分析蛋白的种类和功能.结果 Bradford法测量软骨组织中获得的平均蛋白质浓度为3.02 mg/ml;SDS-PAGE显示顶椎凸侧终板软骨内所含蛋白质的种类明显多于凹侧;从凸侧软骨终板中鉴定出103种蛋白质,凹侧软骨终板内鉴定出55种蛋白质,其中凸侧特有蛋白58种,凹侧特有蛋白10种.结论 对AIS患者侧凸顶椎软骨终板蛋白质进行分类研究后表明侧凸顶椎软骨终板凸、凹两侧的特有蛋白与脊柱侧凸顶椎椎间盘的不对称发育存在一定的联系.     

Anterior surgery for adolescent idiopathic scoliosis

Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50–60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.     

Postural control in siblings to scoliosis patients and scoliosis patients

The etiologic importance of postural dysfunction, as shown by many authors in adolescent idiopathic scoliosis (AIS), has been under great debate. The authors' hypothesis was that a factor that is involved in the development of the scoliotic curvature, would be present also in nonscoliotic siblings to scoliosis patients, as AIS is a hereditary transmitted disease. Postural function in 100 siblings to scoliotic children was investigated by means of stabilometry, and compared with a matched control group of healthy children, as well as a group of scoliotic children. The siblings showed a postural control function that was significantly different from both of the other groups. The siblings had a postural sway that was less than the sway measured in both controls and scoliosis patients. The sway was also more asymmetrical than in the two other groups. In the authors' opinion, the presence of this postural aberration in siblings indicates that it is a factor in the etiology of AIS.     

青少年特发性脊柱侧弯胸腰椎生理曲度的影像学研究

目的:探讨青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)胸腰椎生理曲度变化情况以及不同类型侧弯之间胸腰椎生理曲度的差异。方法:自2017年1月至2021年12月回顾性分析305例脊柱全长正侧位X线片的青少年患者,根据有无侧弯分为正常组和侧弯组。正常组179例,男79例,女100例;年龄10~18(12.84±2.10)岁。侧弯组126例,男33例,女93例;年龄10~18(13.92±2.20)岁。观察并比较两组Risser征、胸椎后凸角(thoracic kyphosis,TK)与腰椎前凸角(lumbar lordosis,LL),并分析比较不同性别、不同程度侧弯与不同节段侧弯TK值与LL值。结果:侧弯组在女性比率(P=0.001)、年龄(P<0.001)方面均明显高于正常组;Risser征方面,正常组低级别骨化程度比率明显高于侧弯组(P=0.038)。侧弯组TK值明显小于正常组(P<0.001),而两组LL值比较,差异无统计学意义(P=0.147)。男性与女性之间比较,TK值与LL值差异无统计学意义。轻度侧弯TK值明显大于中度侧弯(P<0.05),但LL值比较,差异无统计学意义(P>0.05)。不同节段侧弯之间TK值与LL值比较,差异均无统计学意义(P>0.05)。结论:胸椎与腰椎生理曲度均与性别无关;AIS患者胸椎生理曲度变小,但是腰椎生理曲度基本不变。轻度AIS患者的胸椎生理曲度大于中度AIS患者,但是腰椎生理曲度在轻中度患者之间几乎无差异,且与正常青少年相似。AIS患者胸腰椎生理曲度变化可能与脊柱前柱相对生长过快有关,其具体机制有待进一步研究。     

退变性腰椎侧凸形成和发展的相关因素分析

目的 探讨退变性腰椎侧凸患者椎问盘的不对称指数、腰椎间盘退变程度以及骨密度降低对侧凸角度的影响.方法 采用回顾性研究的方法,选取2002年1月至2010年8月,共96例退变性腰椎侧凸患者为研究对象(侧凸组);2002年1月至2010年8月确诊为腰椎管狭窄症并且资料齐全的患者96例为对照组;两组间性别、年龄、体质量指数匹配.侧凸组:在腰椎正位X线片上测量凸凹侧顶椎间盘及其上下椎间盘的高度和顶椎及其上下椎体的高度,利用Adobe Photoshop 6.0软件,测量MRI图像T2WI顶椎及其上下椎间盘内髓核与脑脊液的相对信号强度.对照组:取2～3、L3-4、L4-5这3个椎间盘为研究对象测定上述指标.应用双能X线吸收法测定两组患者腰椎(L2-4)及股骨颈、股骨粗隆和Ward's三角的T值.结果 侧凸组凸侧椎间盘高度和为(40±7)mm高于凹侧的(28±7)mm(P<0.01),凸侧椎体高度和为(76±12)mm高于凹侧的(72±10)mm(P=0.016):两组之间的椎间盘退变程度差异有统计学差异(P=0.003);两组之间骨密度T值的平均值和骨质疏松的发生率差异有统计学意义(均P<0.01).通过多元线性回归分析结果 显示患者椎间盘的不对称指数、椎间盘的退变程度、骨密度T值影响退变性腰椎侧凸角度.结论 退变性腰椎侧凸常伴有凸凹两侧椎间盘高度以及椎体高度不对称.侧凸角度与椎间盘的不对称指数、椎间盘的退变程度呈正相关,与骨密度值T值呈负相关.

Abstract：

Objectives To investigate the correlation between scoliosis angle and the asymmetric index of degenerative lumbar scoliosis, the degree of intervertebral disc degeneration, decreased bone density. Methods As a retrospectively study, a total of 96 patients with degenerative lumbar scoliosis were retrospectively enrolled from January 2002 to August 2010 as scoliosis group, meanwhile % patients with lumbar spinal stenosis matched in gender, age and body mass index (BMI) were selected as control group.All patients were studied with plain radiographs, MRI and dual energy X-ray absorptiometry at presentation. Radiographic measurements include Cobb angle, the height of the convex and concave side of the apical disc and the contiguous disc superiorly and inferiorly, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly in scoliosis group, the height of L2-3, L3-4, L4-5 discs and the height of L2-4 vertebral body in control group. The average relative signal intensity of lumbar intervertebral disc and cerebrospinal fluid in T2WI sagittal image was measured in apex intervertebral disc and adjacent discs by Adobe Photoshop 6.0 in scoliosis group, which was measured in L2-3, L3-4, L4-5 disc in control group. The bone density of lumbar, femoral neck, trochanter, and Ward's triangle regions were measured with dual-energy X-ray absorptiometry. Results The intervertebral disc height in convex side was greater than the height in the concave side [(40 ± 7) mm vs. (28 ± 7) mm, P < 0. 01] , the vertebral body height in convex side was greater than the height in the concave side [(76 ± 12) mm vs. (72 ± 10) mm, P =0.016] in scoliosis group. There was significant statistically difference in the degenerative degree of intervertebral discs between two groups (P = 0. 003). There was significant statistically difference of the average T-value and the rate of osteoporosis between two groups (P < 0. 01). Multiple linear regression analysis showed that the asymmetric disc index, the degenerative degree of intervertebral disc and osteoporosis were the predominant correlative factors, which affected the development of degenerative lumbar scoliosis. Conclusions Degenerative lumbar scoliosis is always accompanied by the height asymmetry of intervertebral discs and vertebral body from convex and concavity sides. There is positive correlation between the angle of scoliosis and the asymmetric disc index, the degeneration of intervertebral disc, and negative correlation between the angle of scoliosis and the bone density (T-value).     

凸侧骨骺阻滞术对阻止半椎体所致脊柱侧凸的进展疗效分析

目的：探讨凸侧骨骺阻滞术对先天性脊柱侧凸患者的治疗效果。方法：回顾分析1998年10月至2008年2月行Ⅰ期前后路联合骨骺阻滞术的胸腰椎半椎体畸形22例患者,其中男12例,女10例。测量术前、术后及末次随访时主弯及代偿弯角度,同时计算术后进展率及年进展量。观察侧凸进展率和年进展量与年龄、性别、半椎体数目、半椎体位置、术前主弯Cobb角及代偿弯Cobb角之间有无相关性,比较不同年龄、性别、半椎体数目、半椎体位置以及术前主弯Cobb角对术后侧弯进展的影响。结果：22例主弯Cobb角术前为（40.5±9.8）°,术后3个月为（39.5±11.1）°,末次随访时为（46.8±13.9）°。代偿弯Cobb角术前为（20.1±10.8）°,术后3个月为（23.0±11.1）°,末次随访为（29.9±11.5）°。术前主弯及代偿弯Cobb角与术后3个月比较,差异无统计学意义（P>0.05）,末次随访与术前、术后3个月比较差异有统计学意义（P<0.01）。术后共有20例出现主弯角度进展,平均进展率为（19.2±17.9）%,年进展量为（1.5±1.4）°,共有20例患者出现代偿弯进展,平均进展率为（39.6±37.0）%,年进展量为（1.4±1.3）°。3例因术后侧凸进展明显行侧凸矫形内固定。22例患者手术时年龄及半椎体数分别与术后主弯进展率之间存在显著相关性,手术时年龄、主弯角度及术前代偿弯角度分别与术后主弯年进展量之间存在显著相关性（P<0.05）。结论：凸侧骨骺阻滞术不能获得即刻的矫形效果,长期随访发现,也不能有效阻止侧凸的进展,可认为凸侧骨骺阻滞术对于先天性半椎体畸形患者而言是一种无效的手术方式。     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis—result of disproportionate endochondral-membranous bone growth?

There is no generally accepted scientific theory for the etiology 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 EFG was written by Professor Jack Cheng and his colleagues who used whole spine magnetic resonance imaging (MRI) to re-investigate the relative anterior spinal overgrowth of progressive AIS in a cross-sectional study. The text is drawn from research carried out with his co-workers including measurement of the height of vertebral components anteriorly (vertebral body) and posteriorly (pedicles) in girls with AIS and in normal subjects. The findings confirm previous anatomical studies and support the consensus view that in patients with thoracic AIS there is relatively faster growth of anterior and slower growth of posterior elements of thoracic vertebrae. The disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves. In interpretating the findings they consider the Roth/Porter hypothesis of uncoupled neuro-osseous growth in the spine but point out that knowledge of normal vertebral growth supports the view that the scoliosis deformity in AIS is related to longitudinal vertebral body growth rather than growth of the canal. In the mechanical mechanism (pathomechanism) they implicitly adopt the concept of primary skeletal change as it affects the sagittal plane of the spine with anterior increments and posterior decrements of vertebral growth and, in the biological mechanism (pathogenesis) propose a novel histogenetic hypothesis of uncoupled endochondral-membranous bone formation. The latter is viewed as part of an intrinsic abnormality of skeletal growth in patients with AIS which may be genetic. The hypothesis that AIS girls have intrinsic anomalies (not abnormalities) of skeletal growth related to curve progression and involving genetic and/or environmental factors acting in early life is not original. While the findings of Professor Cheng and his colleagues have added MRI data to the field of relative anterior spinal overgrowth in AIS their interpretation engenders controversy. Three new hypotheses are proposed to interpret their findings: (1) hypoplasia of articular processes as a risk factor for AIS; (2) selection from the normal population to AIS involves anomalous vertebral morphology and soft tissue factors—this hypothesis may also apply to certain types of secondary scoliosis; and (3) a new method to predict the natural history of AIS curves by evaluating cerebro-spinal fluid (CSF) motion at the cranio–cervical junction. What is not controversial is the need for whole spine MRI research on subjects with non-idiopathic scoliosis.This paper provides an edited summary of the third electronic focus group (EFG) of the International Federated Body on Scoliosis Etiology (IBSE). It contains the research of Professor JCY Cheng MD and his colleagues on relative anterior spinal overgrowth in adolescent idiopathic scoliosis (AIS) that was debated by via e-mail by IBSE members in three rounds during November 2003–October 2004. The summary including Professor Chengs statement, comments, questions, answers, and responses 1–26 was circulated by e-mail to IBSE members on 19 October 2004 and no further comments were received. Ideas presented in this summary are personal opinions and are not necessarily shared by all those within IBSE. Some details about IBSE are contained in the edited summary of the first EFG of the IBSE [59].     

Adolescent idiopathic scoliosis, bracing, and the Hueter-Volkmann principle.

BACKGROUND CONTEXT: Evidence demonstrating the biomechanical effects of the Hueter-Volkmann principle on vertebral body growth in spinal deformities is lacking. Bracing a scoliotic curve should, in theory, unload the growth plates on the concave side of the vertebral bodies near the curve's apex. Growth stimulation, leading to structural remodeling of the vertebral bodies, on the curve's concave side may explain the improvement or lack of curve progression, as measured by Cobb angles, reported with successful brace management of adolescent idiopathic scoliosis (AIS). PURPOSE: To determine whether brace treatment stimulated asymmetric chondrogenesis in the apical three vertebral bodies. STUDY DESIGN: A prospective cohort of patients with AIS receiving brace treatment were followed from the initiation of brace treatment until skeletal maturity. Patients were then retrospectively divided into those with and without radiographic progression. This post hoc analysis was included to determine risk factors for curve progression. PATIENT SAMPLE: Forty-one skeletally immature patients with AIS meeting criteria for brace treatment were followed until skeletal maturity. All patients were treated with thoracolumbosacral orthotics (TLSOs). OUTCOME MEASURES: The positional derotation of the TLSO on the spine was measured by comparing the initial radiograph with the first radiograph in a brace. The long-term structural changes of the vertebral bodies were determined by comparing the initial and final radiographs. Differences in initial radiographic parameters between the groups of patients with AIS with and without curve progression indicated predictive factors for successful brace treatment. METHODS: Initial radiographic measurements were compared with those observed in a brace and those observed at final follow-up. The same analysis was retrospectively repeated comparing patients with AIS with and without radiographic progression. RESULTS: Cobb measurements (p=.0001) and concave-to-convex height ratios of the apical three vertebral bodies improved when the brace was initially applied (p=.0035). Structural remodeling or a rotational correction of the apical three vertebral bodies was appreciated only in patients with flexible curves (p=.01). CONCLUSION: Brace application results in immediate positional derotations of the spine in patients with AIS. These positional derotations were maintained only in patients with flexible curves, at final follow-up. Brace treatment was not recommended in patients whose curves did not correct at least 20% in a TLSO.     

Sagittal spinal profile and spinopelvic balance in parents of scoliotic children

Background contextIt is well known that spinal biomechanics and familial predisposition play an important role in the onset and evolution of idiopathic scoliosis. The relationship between the sagittal profile of the spine and spinal biomechanics has also been established in a number of studies. It has been suggested previously that a certain sagittal spinal configuration with implications for spinal rotational stiffness is inherited, thus providing a possible explanation for the well-known hereditary component in adolescent idiopathic scoliosis (AIS).PurposeTo test the hypothesis that the familial trend in AIS may be partially explained by the inheritance of a sagittal spinal profile, which has been shown to make the spine less resistant to rotatory decompensation.Study designA prospective case controlled radiographic analysis of the sagittal profile of the spine and spinopelvic alignment.Patient sampleOne hundred two parents of scoliotic children, compared with 102 age-matched controls (parents of nonscoliotic children).Outcome measuresPhysiologic measures: sagittal profile of the spine and spinopelvic alignment.MethodsFreestanding lateral radiographs of 51 parent couples of girls with severe (Cobb angle >30°) progressive AIS (AIS group) and 102 age-matched controls (control group) were taken. Parents with manifest spinal deformities or spinal pathology of any kind were excluded based on history or spinal X-ray to avoid distorted sagittal images with unreliable measurements. Values were calculated for thoracic kyphosis (T4–T12), lumbar lordosis (L1–L5), spinal balance (sagittal plumb line of C7 and T4, T1–L5 sagittal spinal inclination, T9 sagittal offset), curvature parameters (expressed in the area under the curve [AUC]), and pelvic parameters (pelvic tilt, pelvic incidence, and sacral slope). In addition, the height, offset, and length of the posteriorly inclined spinal segment, inclination of each vertebra, and normalized sagittal spinal profile were calculated. Differences in spinopelvic alignment between fathers and mothers of both groups were analyzed.ResultsIn the fathers of the AIS group, the plumb line of T4 was significantly less posteriorly positioned relative to the hip axis (79 mm vs. 92 mm; p=.009); the overall AUC and the lumbar AUC were significantly smaller (p=.002 and p=.008, respectively) as compared with the fathers in the control group. Vertebrae T11–L2 were significantly less backwardly inclined in the fathers of the AIS group (T11, L2: p<.05 and T12–L1: p<.01). An analysis of sagittal spinal profile showed a significantly flatter spine in the fathers of the AIS group (p=.01). No significant differences were observed in height, offset, and length of the backwardly inclined spinal segment. In the mothers of the AIS group, no statistically significant differences were observed in the spinopelvic parameters, spinal curvature, inclination of the vertebrae, and declive spinal segment parameters or sagittal spinal profile as compared with the mothers in the control group.ConclusionsThe sagittal spinal profile of the fathers of scoliotic children was significantly flatter than the sagittal spinal profile of fathers of nonscoliotic children. No difference was found in the sagittal spinal profile of the mothers of scoliotic children as compared with mothers of nonscoliotic children. Although it is well known that scoliotic mothers have an increased risk of having a scoliotic offspring, this study indicates that fathers may possibly contribute as well through their sagittal spinal profile to the inheritance of idiopathic scoliosis.