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Are there gender differences in sagittal spinal pelvic inclination before and after the adolescent pubertal growth spurt?

Abstract

Purpose

Significant progression of spinal deformity could occur during the peak of pubertal growth in adolescent idiopathic scoliosis (AIS). Gender differences in spinal and vertebral inclination have been reported in asymptomatic young adults and are thought to affect the risk of curve progression in male and female AIS. The present study aimed to investigate whether there were gender differences in the sagittal spinal-pelvic profile and whether any differences occurred before or developed during the normal pubertal growth spurt.

Methods

The sagittal up-right standing spine X-ray films from 71 male and 82 female asymptomatic adolescents were collected. The inclination of the global spine was analyzed by measuring the spino-sacral angle (SSA) and the spinal tilt (ST). Additionally, the inclination of the vertebrae (T1–L5), thoracic kyphosis (T4–T12) and lumbar lordosis were measured. These subjects were divided into the ascending phase (non-fused triradiate cartilage) G1 subgroup, the peak (fused triradiate cartilage and Risser grade 0–1) G2 subgroup and the late phase (Risser grade 2–5) of pubertal growth G3 subgroup. The comparisons between the males and females were carried out within the subgroups.

Results

In the subgroups G1 and G2, the females showed a trend of less ventral inclination in the upper thoracic vertebrae (T1–T5) and greater dorsal inclination in the lower thoracic vertebrae (T7–T12), although the differences were not statistically significant. In the G3 subgroup, the females showed significantly larger SSA (133.7° ± 4.5° vs. 128.4° ± 4.0°), ST (96.3° ± 2.6° vs. 94.8° ± 3.4°) and dorsal inclination of T1 and T12–L2 than did the males (p < 0.05).

Conclusions

Although a trend toward a more backward inclination of the spine and individual vertebrae might pre-exist during the ascending phase or peak of pubertal growth, the differences become more significant during the late stage of puberty. The observation could be related to relatively active anterior vertebral overgrowth that occurs in females during pubertal growth.

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References

  1. Weinstein SL, Dolan LA, Cheng JC et al (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537

    Article  PubMed  Google Scholar 

  2. Wang WJ, Yeung HY, Chu WC et al (2011) Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J Pediatr Orthop 31:S14–S27

    Article  PubMed  Google Scholar 

  3. Raggio CL (2006) Sexual dimorphism in adolescent idiopathic scoliosis. Orthop Clin North Am 37:555–558

    Article  PubMed  Google Scholar 

  4. Luk KD, Lee CF, Cheung KM et al (2010) Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine (Phila Pa 1976) 35:1607–1614

    Article  Google Scholar 

  5. Brooks HL, Azen SP, Gerberg E et al (1975) Scoliosis: A prospective epidemiological study. J Bone Joint Surg Am 57:968–972

    CAS  PubMed  Google Scholar 

  6. Kane WJ, Moe JH (1970) A scoliosis-prevalence survey in Minnesota. Clin Orthop Relat Res 69:216–218

    CAS  PubMed  Google Scholar 

  7. Ueno M, Takaso M, Nakazawa T et al (2011) A 5-year epidemiological study on the prevalence rate of idiopathic scoliosis in Tokyo: school screening of more than 250,000 children. J Orthop Sci 16:1–6

    Article  PubMed  Google Scholar 

  8. Richards BS, Herring JA, Johnston CE et al (1994) Treatment of adolescent idiopathic scoliosis using Texas Scottish Rite Hospital instrumentation. Spine (Phila Pa 1976) 19:1598–1605

    Article  CAS  Google Scholar 

  9. Lenke LG, Bridwell KH, Baldus C et al (1992) Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis. J Bone Joint Surg Am 74:1056–1067

    CAS  PubMed  Google Scholar 

  10. Castelein RM, van Dieen JH, Smit TH (2005) The role of dorsal shear forces in the pathogenesis of adolescent idiopathic scoliosis-a hypothesis. Med Hypotheses 65:501–508

    Article  PubMed  Google Scholar 

  11. Janssen MM, Kouwenhoven JW, Schlosser TP et al (2011) Analysis of preexistent vertebral rotation in the normal infantile, juvenile, and adolescent spine. Spine (Phila Pa 1976) 36:E486–E491

    Article  Google Scholar 

  12. Janssen MM, Drevelle X, Humbert L et al (2009) Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976) 34:E826–E832

    Article  Google Scholar 

  13. Wong HK, Hui JH, Rajan U et al (2005) Idiopathic scoliosis in Singapore school children: a prevalence study 15 years into the screening program. Spine (Phila Pa 1976) 30:1188–1196

    Article  Google Scholar 

  14. Bitan FD, Veliskakis KP, Campbell BC (2005) Differences in the Risser grading systems in the United States and France. Clin Orthop Relat Res 436:190–195

    Article  PubMed  Google Scholar 

  15. Dimeglio A (2001) Growth in pediatric orthopaedics. J Pediatr Orthop 21:549–555

    CAS  PubMed  Google Scholar 

  16. Barrey C, Jund J, Noseda O et al (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kouwenhoven JW, Smit TH, van der Veen AJ et al (2007) Effects of dorsal versus ventral shear loads on the rotational stability of the thoracic spine: a biomechanical porcine and human cadaveric study. Spine (Phila Pa 1976) 32:2545–2550

    Article  Google Scholar 

  18. Stokes IA, Windisch L (2006) Vertebral height growth predominates over intervertebral disc height growth in adolescents with scoliosis. Spine (Phila Pa 1976) 31:1600–1604

    Article  Google Scholar 

  19. Dimeglio AMD, Canavese F, Charles P (2011) Growth and adolescent idiopathic scoliosis: when and how much? J Pediatr Orthop 31:S28–S36

    Article  PubMed  Google Scholar 

  20. Wang WW, Xia CW, Zhu F et al (2009) Correlation of Risser sign, radiographs of hand and wrist with the histological grade of iliac crest apophysis in girls with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 34:1849–1854

    Article  Google Scholar 

  21. Wang SF, Qiu Y, Ma ZL et al (2007) Histologic, Risser sign, and digital skeletal age evaluation for residual spine growth potential in Chinese female idiopathic scoliosis. Spine (Phila Pa 1976) 32:1648–1654

    Article  Google Scholar 

  22. Cheung CSK, Lee WTK, Tse YK et al (2003) Abnormal peri-pubertal anthropometric measurements and growth pattern in adolescent idiopathic scoliosis: a study of 598 patients. Spine (Phila Pa 1976) 28:2152–2157

    Article  Google Scholar 

  23. Yim AP, Yeung HY, Hung VW et al (2012) Abnormal skeletal growth patterns in adolescent idiopathic scoliosis–a longitudinal study until skeletal maturity. Spine (Phila Pa 1976) 37:E1148–E1154

    Article  Google Scholar 

  24. Funao H, Tsuji T, Hosogane N et al (2012) Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J 21:2181–2187

    Article  PubMed Central  PubMed  Google Scholar 

  25. Porter RW (2001) The pathogenesis of idiopathic scoliosis: uncoupled neuro-osseous growth? Eur Spine J 10:473–481

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Guo X, Chau WW, Chan YL et al (2003) Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth. J Bone Joint Surg Br 85:1026–1031

    Article  CAS  PubMed  Google Scholar 

  27. Zhu F, Qiu Y, Yeung HY et al (2006) Histomorphometric study of the spinal growth plates in idiopathic scoliosis and congenital scoliosis. Pediatr Int 48:591–598

    Article  PubMed  Google Scholar 

  28. Vrtovec T, Janssen MM, Pernus F et al (2012) Analysis of pelvic incidence from 3-dimensional images of a normal population. Spine (Phila Pa 1976) 37:E479–E485

    Article  Google Scholar 

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Acknowledgments

This work was supported by National Natural Science Foundation of China (81101335), National Post-doctoral Foundation of China (2012M52101062), National Key Clinical Specialty Construction Project in Orthopaedics and Jiangsu Province’s Key Medical Talents Project (RC2011149).

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Correspondence to Yong Qiu.

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Wang, W., Wang, Z., Liu, Z. et al. Are there gender differences in sagittal spinal pelvic inclination before and after the adolescent pubertal growth spurt?. Eur Spine J 24, 1168–1174 (2015). https://doi.org/10.1007/s00586-014-3563-9

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  • DOI: https://doi.org/10.1007/s00586-014-3563-9

Keywords

  • Vertebral inclination
  • Gender differences
  • Puberty
  • Spinal alignment
  • Idiopathic scoliosis