Scoliosis - a Universal Rotational (De)compensation of the Spine

Abstract

The uniqueness of human sagittal spinal alignment, and its link to the distinct phenomenon of idiopathic scoliosis are studied in this thesis, with an emphasis on contemporary imaging techniques. Spinal ultrasound is introduced in this thesis as a radiation-free alternative to X-rays, thereafter verified and implemented in standard scoliosis care. Furthermore, it was discovered that already discrete differences are present in the straight spines of healthy children, that may play a role in the development of scoliosis later in life: e.g. intervertebral disc slenderness, observed to be especially present in girls in their mid-thoracic area during early adolescence. In scoliosis of different etiologies it was demonstrated that axial rotation into the curve convexity combined with lordosis, i.e. anterior opening of the rotated intervertebral discs, is a universal phenomenon among idiopathic, non-idiopathic and compensatory scoliotic curves, that can occur in the spine of any species. Therefore, scoliosis seems to be a universal rotational (de)compensation to any cause of disturbance of spinal equilibrium, hence the title of this thesis.

Scoliosis has a 20-fold increased prevalence in 22q11.2 deletion syndrome, this thesis demonstrated that scoliosis in these children morphologically and dynamically resembles idiopathic scoliosis, supporting the use of these patients as a ‘model’ to prospectively study scoliosis in general. In this thesis this model provided prospective evidence that the severity of the posteriorly inclined segment (part of any spine) is a risk factor for scoliosis. While important clues in idiopathic scoliosis etiology have historically been drawn from retrospective studies, this model enables prospective research, which is the only way to truly confirm or discard these clues, distinguishing between cause and effect of the disorder and contribute certainties to the ongoing effort of taking the ‘I’ out of AIS (Adolescent Idiopathic Scoliosis). Identifying causal factors that are already present before scoliosis development may be used as biomarkers in identifying those at risk in the general population. Screening and prevention currently have next to no place in scoliosis clinical care, while this has been proven to be the most effective way in battling any disease, especially on population level.

It is time to take the big leap, and transfer the focus from watchful waiting and treatment of secondary symptoms, towards developing prevention that targets the primary disease process.