Skip to main content
Top
Published in:

Open Access 05-05-2024 | Adolescent Idiopathic Scoliosis | Original Article

On growth and scoliosis

Author: Theodoor H. Smit

Published in: European Spine Journal | Issue 6/2024

Login to get access

Abstract

Purpose

To describe the physiology of spinal growth in patients with adolescent idiopathic scoliosis (AIS).

Methods

Narrative review of the literature with a focus on mechanisms of growth.

Results

In his landmark publication On Growth and Form, D’Arcy Thompson wrote that the anatomy of an organism reflects the forces it is subjected to. This means that mechanical forces underlie the shape of tissues, organs and organisms, whether healthy or diseased. AIS is called idiopathic because the underlying cause of the deformation is unknown, although many factors are  associated. Eventually, however, any deformity is due to mechanical forces. It has long been shown that the typical curvature and rotation of the scoliotic spine could result from vertebrae and intervertebral discs growing faster than the ligaments attached to them. This raises the question why in AIS the ligaments do not keep up with the speed of spinal growth. The spine of an AIS patient deviates from healthy spines in various ways. Growth is later but faster, resulting in higher vertebrae and intervertebral discs. Vertebral bone density is lower, which suggests  less spinal compression. This also preserves the notochordal cells and the swelling pressure in the nucleus pulposus. Less spinal compression is due to limited muscular activity, and low muscle mass indeed underlies the lower body mass index (BMI) in AIS patients. Thus, AIS spines grow faster because there is less spinal compression that counteracts the force of growth (Hueter–Volkmann Law). Ligaments consist of collagen fibres that grow by tension, fibrillar sliding and the remodelling of cross-links. Growth and remodelling are enhanced by dynamic loading and by hormones like estrogen. However, they are opposed by static loading.

Conclusion

Increased spinal elongation and reduced ligamental growth result in differential strain and a vicious circle of scoliotic deformation. Recognising the physical and biological cues that contribute to differential growth  allows earlier diagnosis of AIS and prevention in children at risk.
Literature
5.
go back to reference Loncar-Dusek M, Pećina M, Prebeg Z (1991) A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis. Clin Orthop Rel Res 270:278–282CrossRef Loncar-Dusek M, Pećina M, Prebeg Z (1991) A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis. Clin Orthop Rel Res 270:278–282CrossRef
8.
go back to reference Thompson DW (1917) On growth and form. Cambridge University Press, EdinburghCrossRef Thompson DW (1917) On growth and form. Cambridge University Press, EdinburghCrossRef
16.
go back to reference Volkmann R (1862) Chirurgische erfahrungeu über knocheuverbiegungen und knochenwachsthum. Arch Pathol Anat Physiol Klin Med 24:512–540CrossRef Volkmann R (1862) Chirurgische erfahrungeu über knocheuverbiegungen und knochenwachsthum. Arch Pathol Anat Physiol Klin Med 24:512–540CrossRef
17.
go back to reference Mehlman C, Araghi A, Roy D (1997) Hyphenated history: the Hueter–Volkmann Law. Am J Orthop 26:798–800PubMed Mehlman C, Araghi A, Roy D (1997) Hyphenated history: the Hueter–Volkmann Law. Am J Orthop 26:798–800PubMed
20.
go back to reference Jarvis JG, Ashman RB, Johgnston CE, Herring JA (1988) The posterior tether in scoliosis. Clin Orthop Rel Res 227:126–134CrossRef Jarvis JG, Ashman RB, Johgnston CE, Herring JA (1988) The posterior tether in scoliosis. Clin Orthop Rel Res 227:126–134CrossRef
32.
go back to reference Emanuel KS, Peeters M, Holewijn RM et al (2015) Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system. Eur Cells Mater 29:330–341CrossRef Emanuel KS, Peeters M, Holewijn RM et al (2015) Poroelastic behaviour of the degenerating human intervertebral disc: a ten-day study in a loaded disc culture system. Eur Cells Mater 29:330–341CrossRef
33.
go back to reference Urban JPG, McMullin JF (1985) Swelling pressure of the intervertebral disc: influence of proteoglycan and collagen contents. Biorheology 22:145–157CrossRefPubMed Urban JPG, McMullin JF (1985) Swelling pressure of the intervertebral disc: influence of proteoglycan and collagen contents. Biorheology 22:145–157CrossRefPubMed
37.
go back to reference Tanaka A (1986) A histopathological study on the intervertebral discs of idiopathic and paralytic scoliosis—abnormalities in transition from the notochordal nucleus to the fibrocartilaginous nucleus. Nihon Seikeigeka Gakkai Zasshi 60:1227–1238PubMed Tanaka A (1986) A histopathological study on the intervertebral discs of idiopathic and paralytic scoliosis—abnormalities in transition from the notochordal nucleus to the fibrocartilaginous nucleus. Nihon Seikeigeka Gakkai Zasshi 60:1227–1238PubMed
39.
go back to reference Hong X, Zhang C, Wang F, Wu XT (2019) Large cytoplasmic vacuoles within notochordal nucleus pulposus cells: a possible regulator of intracellular pressure that shapes the cytoskeleton and controls proliferation. Cells Tissues Organs 206:9–15. https://doi.org/10.1159/000493258CrossRef Hong X, Zhang C, Wang F, Wu XT (2019) Large cytoplasmic vacuoles within notochordal nucleus pulposus cells: a possible regulator of intracellular pressure that shapes the cytoskeleton and controls proliferation. Cells Tissues Organs 206:9–15. https://​doi.​org/​10.​1159/​000493258CrossRef
46.
go back to reference Galileo G (1914) Two new sciences. The MacMillan Company, New York Galileo G (1914) Two new sciences. The MacMillan Company, New York
53.
go back to reference Cook SD, Harding AF, Morgan EL et al (1987) Trabecular bone mineral density in idiopathic scoliosis. J Pediatr Orthop 7(2):168CrossRefPubMed Cook SD, Harding AF, Morgan EL et al (1987) Trabecular bone mineral density in idiopathic scoliosis. J Pediatr Orthop 7(2):168CrossRefPubMed
55.
go back to reference Ramos O, Razzouk J, Chung J et al (2022) Opportunistic assessment of bone density in patients with adolescent idiopathic scoliosis using MRI-based vertebral bone quality. J Clin Neurosci 103:41–43CrossRefPubMed Ramos O, Razzouk J, Chung J et al (2022) Opportunistic assessment of bone density in patients with adolescent idiopathic scoliosis using MRI-based vertebral bone quality. J Clin Neurosci 103:41–43CrossRefPubMed
60.
go back to reference Starčević-Klasan G, Cvijanović O, Peharec S et al (2008) Anthropometric parameters as predictors for iliopsoas muscle strength in healthy girls and in girls with adolescent idiopathic scoliosis. Coll Antropol 32:461–466PubMed Starčević-Klasan G, Cvijanović O, Peharec S et al (2008) Anthropometric parameters as predictors for iliopsoas muscle strength in healthy girls and in girls with adolescent idiopathic scoliosis. Coll Antropol 32:461–466PubMed
68.
go back to reference Dahners L, Sykes K, Muller P (2013) A study of the mechanisms influencing ligament growth. Orthopedics 12:1569–1572CrossRef Dahners L, Sykes K, Muller P (2013) A study of the mechanisms influencing ligament growth. Orthopedics 12:1569–1572CrossRef
73.
go back to reference Lovett RW (1903) A contribution to the study of mechanics of the spine. Am J Anat 4:457–462CrossRef Lovett RW (1903) A contribution to the study of mechanics of the spine. Am J Anat 4:457–462CrossRef
74.
77.
go back to reference Mccallum-loudeac JAD (2021) Insights into spinal cord biology and its contributions to adolescent idiopathic scoliosis: from GWAS to animal models. University of Otago, Dunedin Mccallum-loudeac JAD (2021) Insights into spinal cord biology and its contributions to adolescent idiopathic scoliosis: from GWAS to animal models. University of Otago, Dunedin
79.
go back to reference Wood ML, Luthin WN, Lester GE, Dahners LE (2003) Tendon creep is potentiated by NKISK and relaxin which produce collagen fiber sliding. Iowa Orthop J 23:75–79PubMedPubMedCentral Wood ML, Luthin WN, Lester GE, Dahners LE (2003) Tendon creep is potentiated by NKISK and relaxin which produce collagen fiber sliding. Iowa Orthop J 23:75–79PubMedPubMedCentral
81.
go back to reference Ahl T, Albertsson-Wikland K, Kalém R (1988) Twenty-four-hour growth hormone profiles in pubertal girls with idiopathic scoliosis. Spine (Phila Pa 1976) 13:139–142CrossRefPubMed Ahl T, Albertsson-Wikland K, Kalém R (1988) Twenty-four-hour growth hormone profiles in pubertal girls with idiopathic scoliosis. Spine (Phila Pa 1976) 13:139–142CrossRefPubMed
83.
go back to reference Batin S, Ekinci Y, Gürbüz K et al (2022) The role of pineal gland volume in the development of scoliosis. Eur Spine J 32:181–189CrossRefPubMed Batin S, Ekinci Y, Gürbüz K et al (2022) The role of pineal gland volume in the development of scoliosis. Eur Spine J 32:181–189CrossRefPubMed
86.
go back to reference Gargano G, Oliva F, Migliorini C, Maffulli N (2022) Melatonin and adolescent idiopathic scoliosis: the present evidence. Surg 20:e315–e321 Gargano G, Oliva F, Migliorini C, Maffulli N (2022) Melatonin and adolescent idiopathic scoliosis: the present evidence. Surg 20:e315–e321
Metadata
Title
On growth and scoliosis
Author
Theodoor H. Smit
Publication date
05-05-2024
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 6/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-024-08276-9