European Spine Journal

, Volume 16, Issue 10, pp 1579–1586 | Cite as

Transverse plane pelvic rotation in adolescent idiopathic scoliosis: primary or compensatory?

  • Jeff L. Gum
  • Marc A. AsherEmail author
  • Douglas C. Burton
  • Sue-Min Lai
  • Leah M. Lambart
Original Article


Several studies have suggested that the pelvis is involved in the etiology or pathogenesis of adolescent idiopathic scoliosis (AIS). The purpose of this retrospective, cross-sectional radiographic study is to identify any correlation between the transverse plane rotational position of the pelvis in stance and operative-size idiopathic or congenital scoliosis deformities, using Scheuermann’s kyphosis and isthmic spondylolisthesis patients for comparison. The hypothesis tested was that the direction of transverse pelvic rotation is the same as that for a thoracic scoliosis. As a group, AIS patients had a significant transverse plane pelvic rotation in the same direction as the thoracic curve. When subdivided into the six Lenke curve patterns, this was true for the groups with a major thoracic curve: thoracic (1), double thoracic (2) and double curve patterns (3). It was not true for patterns with a major thoracolumbar/lumbar curve: single thoracolumbar/lumbar (5) and double thoracic-thoracolumbar/lumbar (6). Nor was it true for triple (4) curves. The Lenke 1 and 2 major thoracic curves without compensatory thoracolumbar/lumbar curves did not have the predicted pelvic rotation. All congenital scoliosis patients studied had main thoracic curves and significant transverse plane pelvic rotation in the same direction as the thoracic curve. There was no transverse plane pelvic rotation in the Scheuermann’s kyphosis or isthmic spondylolisthesis patients. We interpret these findings as consistent with a compensatory rotation of the pelvis in the same direction as the main thoracic curve in most patients with a compensatory thoracolumbar/lumbar curve as well as in patients with main thoracic congenital scoliosis.


Adolescent idiopathic scoliosis Transverse plane Spinal deformity Pelvic rotation 


  1. 1.
    Asher MA, Cook LT (1995) The transverse plane evolution of the most common adolescent idiopathic scoliosis deformities. A cross-sectional study of 181 patients. Spine 20:1386–1391PubMedCrossRefGoogle Scholar
  2. 2.
    Asher MA, Burton DC (1999) A concept of idiopathic scoliosis deformities as imperfect torsion(s). Clin Orthop 364:11–25PubMedCrossRefGoogle Scholar
  3. 3.
    Bunnell WP (1984) An objective criterion for scoliosis screening. J Bone Joint Surg Am 66:1381–1387PubMedGoogle Scholar
  4. 4.
    Burton DC, Asher MA, Lai SM (1999) The selection of fusion levels using torsional correction techniques in the surgical treatment of idiopathic scoliosis. Spine 24:1728–1739PubMedCrossRefGoogle Scholar
  5. 5.
    Burwell RG, Cole AA, Cook TA, Grivas TA, Kiel AW, Moulton A, Thirlwall AS, Upadhyay SS, Webb JK, Wemyss-Holden SA, Whitwell DJ, Wojcik AS, Wythers DJ (1992) Pathogenesis of idiopathic scoliosis. The Nottingham concept. Acta Orthop Belg 58(Suppl 1):33–58PubMedGoogle Scholar
  6. 6.
    Burwell RG, Dangerfield PH, Vernon CL (1977) Anthropometry and scoliosis. In: Zorab PA (ed) Scoliosis. In: 5th Symposium. Academic, London, pp 123–163Google Scholar
  7. 7.
    Burwell RG, Kirby AS, Cole AA, Moulton A, Pratt RK, Webb JK (1997) Torsion in lower limb bones of patients with adolescent scoliosis (AIS) treated surgically. In: Sevastik JA, Diab KM (eds) Research into spinal deformities. IOS Press, Amsterdam, pp 123–126Google Scholar
  8. 8.
    Burwell RG, Aujla RK, Freeman BJC, Dangerfield PH, Cole AA, Kirby AS, Pratt RK, Webb JK, Moulton A (2006) Patterns of extra-spinal left–right skeletal asymmetries in adolescent girls with lower spine scoliosis: relative lengthening of the ilium on the curve concavity and of right lower limb segments. In: Uyttendaele D, Dangerfield PH (eds) Research into spinal deformities 5. IOS Press, Amsterdam, pp 57–65Google Scholar
  9. 9.
    Burwell RG, Freeman BJC, Dangerfield PH, Aujla RK, Cole AA, Kirby AS, Pratt PK, Webb JK, Moulton A (2006) Left–right upper arm length asymmetry associated with apical vertebral rotation in subjects with thoracic scoliosis: anomaly of bilateral symmetry affecting vertebral, costal and upper arm physes? In: Uyttendaele D, Dangerfield PH (eds) Research into spinal deformities 5. IOS Press, Amsterdam, pp 66–71Google Scholar
  10. 10.
    Burwell RG, Aujla RK, Freeman BJC, Dangerfield PH, Cole AA, Kirby AS, Pratt RK, Webb JK, Moulton A (2006) Patterns of extra-spinal left–right skeletal asymmetries and proximo-distal disproportion in adolescent girls with lower spine scoliosis: Ilio-femoral length asymmetry and bilateral tibial/foot length disproportion. In: Uyttendaele D, Dangerfield PH (eds) Research into spinal deformities 5. IOS Press, Amsterdam, pp 101–108Google Scholar
  11. 11.
    Cheng JCY, Chau WW, Guo X, Chan YL (2003) Redefining the magnetic resonance imaging reference for the cerebellar tonsil: a study of 170 adolescents with normal versus idiopathic scoliosis. Spine 28:815–818PubMedCrossRefGoogle Scholar
  12. 12.
    Cheung KMC, Wang T, Hu G, Leong JCY (2003) Primary thoracolumbar scoliosis in pinealectomized chickens. Spine 28:2499–2504PubMedCrossRefGoogle Scholar
  13. 13.
    Cheung KMC, Chooi YS (2005) Hip adduction differences in adolescent idiopathic scoliosis: a cause or effect of scoliosis? J Orthop Surg (Hong Kong) 9(Suppl):80 (Abstract)Google Scholar
  14. 14.
    Cheung CSK, Lee WTK, Tse YK, Lee KM, Guo X, Qin L, Cheng JCY (2006) Generalized osteopenia in adolescent idiopathic scoliosis-association with abnormal pubertal growth, bone turnover, and calcium intake? Spine 31:330–338PubMedCrossRefGoogle Scholar
  15. 15.
    Cole AA, Burwell RG, Dangerfield PH, Grivas TB, Webb JK, Moulton A (2000) Anthropometry. In: Burwell RG, Dangerfield PH, Lowe TG, Margulies JY (Ed) Etiology of adolescent idiopathic scoliosis. Hanley & Belfus, Philadelphia, pp 411–421Google Scholar
  16. 16.
    Chu WC, Lam WW, Chan YL, Ng BK, Lam TP, Lee KM, Guo X, Cheng JC (2006) Relative shortening and functional tethering of spinal cord in adolescent idiopathic scoliosis? Study with multiplanar reformat magnetic resonance imaging and somatosensory evoked potential. Spine 31:E19–E25PubMedCrossRefGoogle Scholar
  17. 17.
    Cobb JR (1948) Outline for the study of scoliosis. In: Edwards JE (ed) Instructional course lectures, vol 5. American Academy of Orthopaedic Surgeons, Ann Arbor, pp 261–276Google Scholar
  18. 18.
    DeSmet AA, Tarlton MA, Berridge AS, Asher MA (1983) The top view of analysis of scoliosis progression. Radiology 147:369–372Google Scholar
  19. 19.
    Dubousset J (1994) Three-dimensional analysis of the scoliosis deformity. In: Weinstein SL (ed) The pediatric spine. Raven, New York, pp 479–496Google Scholar
  20. 20.
    Dunn PM (1976) Congenital postural deformities. Br Med Bull 32:71–76PubMedGoogle Scholar
  21. 21.
    Goldberg CJ, Fogarty EE, Moore DP, Dowling FE (1997) Scoliosis and developmental theory: adolescent idiopathic scoliosis. Spine 22:2228–2238PubMedCrossRefGoogle Scholar
  22. 22.
    Gum J (2006) Transverse plane pelvic rotation in spinal deformity: measurement reliability and relationship to diagnosis and deformity.
  23. 23.
    ISO 2631-1978 (1978) Guide to Evaluation of Human Exposure to Whole Body VibrationGoogle Scholar
  24. 24.
    Jantz RL, Brehme H (1993) Directional and fluctuating asymmetry in the palmar interdigital ridge-counts. Anthropol Anz 51:59–67PubMedGoogle Scholar
  25. 25.
    Karski T (2002) The etiology of the so-called idiopathic scoliosis. The new rehabilitation treatment. Prophylaxis. FOLIUM, Lublin ISBN 83-910166-2-5 (Text in Polish, illustration captions in English)Google Scholar
  26. 26.
    Karski T (2005) Biomechanical explanation of etiology of the so-called idiopathic scoliosis. Two etiopathological groups—important for treatment and neo-prophylaxis. Pan Arab J Ortho Trauma 9(1):123–135Google Scholar
  27. 27.
    King HA, Moe JH, Bradford DS, Winter RB (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 65:1302–1313PubMedGoogle Scholar
  28. 28.
    Lucas B, Asher M, McIff T, Lark R, Burton D (2005) Estimation of transverse plane pelvic rotation using a posterior–anterior radiograph. Spine 30:E20–E27PubMedCrossRefGoogle Scholar
  29. 29.
    Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis. A new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181PubMedGoogle Scholar
  30. 30.
    McMaster M, Lee AJ, Burwell RG (2006) Physical activities of patients with adolescent idiopathic scoliosis (AIS) compared with a control group: implications for etiology and possible prevention. J Bone Joint Surg Br 88:225 (Abstract)CrossRefGoogle Scholar
  31. 31.
    Miyanji F, Newton PO, Perry A. Van Valin S, Pawelek J (2006) Analysis of the Lenke 1A classification: defining 2 sub-types based on L4 tilt. In: Scoliosis Research Society 41st Annual Meeting Program. SRS, Monterey, E-Poster #33, p 206Google Scholar
  32. 32.
    Normelli H, Sevastik J, Ljung G, Aaro S, Jönsson-Söderström AM (1985) Anthropometric data relating to normal and scoliotic Scandinavian girls. Spine 10:123–126PubMedCrossRefGoogle Scholar
  33. 33.
    Perdriolle R, Vidal J (1996) Thoracic idiopathic scoliosis curve evolution and prognosis. Spine 17:513–517Google Scholar
  34. 34.
    Rigo M (1997) Pelvis asymmetry in idiopathic scoliosis. Evidence of whole torsional body deformity? In: Sevastik JA, Diab KM (Ed) Research into spinal deformities. IOS Press, Amsterdam, pp 63–65Google Scholar
  35. 35.
    Ross B (1995) Fundamentals of biostatistics. Duxbury Press, New York, pp 518–519Google Scholar
  36. 36.
    Saji J, Upadhyay SS, Leong JCY (1995) Increased femoral neck-shaft angles in adolescent idiopathic scoliosis. Spine 20:303–311PubMedCrossRefGoogle Scholar
  37. 37.
    Schwender JD, Denis F (2000) Coronal plane imbalance in adolescent idiopathic scoliosis with left lumbar curves exceeding 40°. Spine 25:2358–2363PubMedCrossRefGoogle Scholar
  38. 38.
    Skalli W, Zeller RD, Miladi L, Bourcereau G, Savidan M, Lavaste F, Dubousset J (2006) Importance of pelvic compensation in posture and motion after posterior spinal fusion using CD instrumentation for idiopathic scoliosis. Spine 31:E359–E366PubMedCrossRefGoogle Scholar
  39. 39.
    Smith F, Latchford G, Hall R, Millner P, Dickson R (2002) Indications of disordered eating behavior in adolescent patients with idiopathic scoliosis. J Bone Joint Surg Br 84:392–394PubMedCrossRefGoogle Scholar
  40. 40.
    Sunnegårdh J, Bratteby L-E, Nordesjö L-O, Nordgren B (1988) Isometric and isokinetic muscle strength, anthropometry and physical activity in 8 and 13 year old Swedish children. Eur J Appl Physiol 58:291–297CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Jeff L. Gum
    • 1
  • Marc A. Asher
    • 1
    Email author
  • Douglas C. Burton
    • 1
  • Sue-Min Lai
    • 2
  • Leah M. Lambart
    • 1
  1. 1.Department of Orthopedic SurgeryKansas University Medical CenterKansas CityUSA
  2. 2.Department of Preventive Medicine and Public HealthKansas University Medical CenterKansas CityUSA

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