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Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis

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Abstract

Purpose

There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior.

Methods

In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis.

Results

The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis.

Conclusion

The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.

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Data availability

It is a literature review article, data shown here comes from the references compiled in the text. No patient raw data was used.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Javier Pizones

  2. Department of Orthopedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, 50834, Korea

    Dong-Gune Chang & Se-Il Suk

  3. Spine Unit, Hospital Universitario de Getafe, 28901, Madrid, Spain

    Enrique Izquierdo

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JP, D-GC, S-IS and EI have done: Substantial contributions to the conception and design of the work, acquisition, analysis, or interpretation of data. Drafting the work and revising it critically for important intellectual content. Final approval of the version to be published and JP, D-GC, S-IS and EI agree to be accountable for the author’s own contributions and for ensuring that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and documented in the literature.

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Javier Pizones declares that he has no conflict of interest. Dong-Gune Chang declares that he has no conflict of interest. Se-Il Suk declares that he has no conflict of interest. Enrique Izquierdo declares that he has no conflict of interest.

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Pizones, J., Chang, DG., Suk, SI. et al. Current biomechanical theories on the etiopathogenesis of idiopathic scoliosis. Spine Deform 12, 247–255 (2024). https://doi.org/10.1007/s43390-023-00787-7

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