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

Summary of an electronic focus group debate of the IBSE

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Abstract

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.

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Acknowledgement

IBSE is supported financially by the British Scoliosis Research Foundation.

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Authors and Affiliations

  1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

    X. Guo

  2. Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Shatin, New Territories, SAR

    W-W. Chau

  3. Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR

    Y-L. Chan

  4. Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Shatin, Hong Kong

    J-C-Y. Cheng

  5. Centre for Spinal Studies & Surgery, NG7 2UH, Nottingham, UK

    R.G. Burwell

  6. Sherrington Buildings, Ashton Street, L69 3GE, Liverpool, UK

    P.H. Dangerfield

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  1. X. Guo
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  2. W-W. Chau
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  3. Y-L. Chan
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  4. J-C-Y. Cheng
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  5. R.G. Burwell
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Correspondence to R.G. Burwell.

Additional information

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 Cheng’s 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].

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Guo, X., Chau, WW., Chan, YL. et al. Relative anterior spinal overgrowth in adolescent idiopathic scoliosis—result of disproportionate endochondral-membranous bone growth?. Eur Spine J 14, 862–873 (2005). https://doi.org/10.1007/s00586-005-1002-7

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