Abstract
There are many conflicting actiological theories for adolescent idiopathic scoliosis. We present a simple new model of scoliosis and a mechanism by which it is initiated and progresses. This mechanism provides a final common pathway for the multiple aetiological factors. A simple model of the spine, incorporating its fundamental mechanical features, was constructed. The model consisted of interconnected anterior compression and posterior tension columns. It allowed normal spinal movements, with flexion limited by the posterior column and rotation centred around the anterior column. It also allowed deformities to develop. The ends of the model were fixed in the position of the vertebrae they represented. Overgrowth of the anterior column relative to the posterior column caused the model to take up the shape of an idiopathic scoliosis. The greater the overgrowth, the more marked the deformity. Normally anterior and posterior column growth are coupled. During the growth spurt the thoracic kyphosis flattens indicating that anterior growth temporarily exceeds posterior growth. If this overgrowth is marked a scoliosis will develop, as demonstrated by the model. Once this occurs the coupling is lost, anterior growth further outstrips posterior growth and the deformity progresses. Not all scolioses worsen, as the tendency to progress is balanced by neuromuscular factors and remodelling. Factors that increase the growth rate, induce asymmetry or decrease the inherent stability of the spine all encourage the development and progression of a scoliosis. This explains the complex biomechanics of scoliosis and provides a final common pathway by which the multiple aetiological factors can induce idiopathic scoliosis. It has important implications for the understanding and treatment of this condition.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Alexander MA, Bunch WH, Ebbesson SOE (1972) Can experimental dorsal rhizotomy produce scoliosis? J Bone Joint Surg [Am] 54:1509–1513
Andriacchi TP, Schultz AB, Belytschko T, Galante JO (1974) A model for studies of mechanical interactions between the human spine and rib cage. J Biomech 7:497–507
Arkin AM (1949) The mechanism of the structural changes in scoliosis. J Bone Joint Surg [Am] 31:519–528
Arkin AM (1950) The mechanism of rotation in combination with lateral deviation in the normal spine. J Bone Joint Surg [Am] 32:180–188
Bisgard JD (1935) Experimental thoracogenic scoliosis. J Thorac Surg 4: 435–442
Deacon P, Flood BM, Dickson RA (1984) Idiopathic scoliosis in three dimensions. A radiographic and morphometric analysis. J Bone Joint Surg [Br] 66:509–512
Deacon P, Archer IA, Dickson RA (1987) The anatomy of spinal deformity: a biomechanical analysis. Orthopaedics 10:897–903
Deane G, Duthie RB (1973) A new projectional look at articulated scoliotic spines. Acta Orthop Scand 44: 351–365
Dickson RA, Leatherman KD (1988) The pathogenesis of idiopathic scoliosis. In: Dickson RA, Leatherman KD (eds) The management of spinal deformities. Wright, London, pp 41–54
Dickson RA, Leatherman KD (1990) Spinal deformities. In: Dickson RA (ed) Spinal surgery. Butterworths, London, pp 368–435
Dickson RA, Lawton JO, Archer IA, Butt WP (1984) The pathogenesis of idiopathic scoliosis. Biplanar spinal asymmetry. J Bone Joint Surg [Br] 66: 8–15
Drerup B, Hierholzer E (1992) Evaluation of frontal radiographs of scoliotic spines. 2. Relations between lateral deviation, lateral tilt and axial rotation of vertebrac. J Biomech 25:1443–1450
Herzenberg JE, Waanders BS, Closkey RF, Schultz AB, Hensinger RN (1990) Cobb angle versus spinous process angle in adolescent idiopathic scoliosis. The relationship of the anterior and posterior deformities. Spine 15:874–879
Jarvis JGF, Ashman RB, Johnson CE, Herring JA (1988) The posterior tether in scoliosis. Clin Orthop 227:126–134
Lovett RW (1905) The mechanism of the normal spine and its relation to scoliosis. Boston Med Surg J 153:349–358
Lovett RW (1916) Lateral curvature of the spine and round shoulders, 3rd edn. Blakiston, Philadelphia
MacLennan A (1922) Scoliosis. Br Med J:864–866
Meyer GHV (1866) Die Mechanik der Skoliose. Arch Pathol Anat 35: 225–253
Myklebust JB, Pintar F, Yoganandan N, Cusick JF, Maiman D, Myers TJ, Sances A (1988) Tensile strength of spinal ligaments. Spine 13:526–531
Nachemson AL, Sahlstrand T (1977) Etiologic factors in adolescent idiopathic scoliosis. Spine 2:176–184
Panjabi MM, White AA (1990a) Physical properties and functional biomechanics of the spine. In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine. Lippincott, Philadelphia, pp 1–83
Panjabi MM, White AA (1990b) Practical biomechanics of scoliosis and kyphosis. In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine. Lippincott, Philadelphia, pp 140–141
Pauwels F (1980) Biomechanics of the locomotor apparatus. Springer Berlin
Peloux J, Fauchet R, Faucon B, Stagnara P (1965) Le plan d'election pour l'examen radiologique des cypho-scolioses. Rev Chir Orthop 51:517–524
Phemister DB (1933) Operative arrestment of longitudinal growth of bones in treatment of deformities. J Bone Joint Surg 15:1–15
Propst-Proctor SL, Bleck EE (1983) Radiographic determination of lordosis and kyphosis in normal and scoliotic children. J Pediatr Orthop 3:344–346
Raso VJ, Russell GG, Hill DL, Moreau M, McIvor J (1991) Thoracic lordosis in idiopathic scoliosis. J Pediatr Orthop 11:599–602
Roaf R (1966) The basic anatomy of scoliosis. J Bone Surg Br 48:786–792
Robin GC (1990) The aetiology of idiopathic scoliosis. CRC, Florida
Rogers SP (1933) Mechanics of scoliosis. Arch Surg 26:962–980
Schwartzmann JR, Miles M (1945) Experimental production of scoliosis in rats and mice. J Bone Joint Surg 27: 59–69
Sevastik JA, Aaro S, Normelli H (1984) Scoliosis. Experimental and clinical studies. Clin Orthop 191:27–34
Sevastik JA, Agadir M, Sevastik B (1990) Effects of rib elongation on the spine. 1. Distortion of the vertebral alignment in the rabbit. Spine 15: 822–825
Silver PHS (1954) Direct observation of changes in tension in the supraspinous and interspinous ligaments during flexion and extension of the vertebral column in man. J Anat 88: 550–551
Smith MS, Dickson RA (1987) Experimental structural scoliosis. J Bone Joint Surg Br 69:576–584
Smith MS, Pool RB, Butt WP, Dickson RA (1991) The transverse plane deformity of structural scoliosis. Spine 16: 1126–1129
Somerville EW (1952) Rotational lordosis. The development of the single curve. J Bone Joint Surg [Br] 34:421–427
Stillwell DL (1962) Structural deformities of vertebrae: bone adaption and modelling in experimental scoliosis and kyphosis. J Bone Joint Surg [Am] 44:611–634
Stokes IAF, Gardner-Morse M (1991) Analysis of the interaction between vertebral lateral deviation and axial rotation in scoliosis. J Biomech 24:753–759
Stokes IAF, Moreland MS (1987) Measurement of the shape of the surface of the back in patients with scoliosis. J Bone Joint Surg [Am] 69:203–211
Upadhyay SS, Burwell RG, Webb JK (1988) Hump changes on forward flexion of the lumbar spine in patients with idiopathic scoliosis. Spine 13:146–151
Volkmann R (1862) Chirurgische Erfahrungen ueber Knochenverbiegungen und Knochenwachstum. Arch Pathol Anat 24:512
Wagner H (1977) Surgical lengthening or shortening of femur and tibia. Technique and indications. In: Hungerford DS (ed) Progress in orthopaedic surgery, vol 1. Springer, Berlin Heidelberg New York, pp 71–94
White AA (1969) Analysis of the mechanics of the thoracic spine in man. Acta Orthop Scand [Suppl] 127:1–105
White AA, Panjabi MM (1978) The basic kinematics of the human spine: a review of past and current knowledge. Spine 3:12–20
White AA, Panjabi MM (1990) Kinematics of the spine. In: White AA, Panjabi MM (eds) Clinical biomechanics of the spine, 2nd edn. Lippincott, Philadelphia, pp 85–125
Willner S (1975) A study of height, weight and menarche in girls with idiopathic structural scoliosis. Acta Orthop Scand 46:71–83
Willner S, Johnsson B (1983) Thoracic kyphosis and lumbar lordosis during the growth period in boys and girls. Acta Pediatr Scand 72:873–878
Wilson-MacDonald J, Houghton GR, Bradley J, Morscher E (1990) The relationship between periosteal division and compression or distraction of the growth plate. An experimental study in the rabbit. J Bone Joint Surg [Br] 72:303–308
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Murray, D.W., Bulstrode, C.J. The development of adolescent idiopathic scoliosis. Eur Spine J 5, 251–257 (1996). https://doi.org/10.1007/BF00301328
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00301328