Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present

Abstract

Adolescent idiopathic scoliosis is one of the most common spinal deformities, yet its cause is unknown. Various theories look to biomechanical, neuromuscular, genetic, and environmental origins, yet our understanding of scoliosis etiology is still limited. Determining the cause of a disease is crucial to developing the most effective treatment. Associations made with scoliosis do not necessarily point to causality, and it is difficult to determine whether said associations are primary (playing a role in development) or secondary (develop as a result of scoliosis). Scoliosis is a complex condition with highly variable expression, even among family members, and likely has many causes. These causes could be similar among homogenous groups of AIS patients, or they could be individual. Here, we review the most prevalent theories of scoliosis etiology and recent trends in research.

Current concepts in the diagnosis and management of adolescent idiopathic scoliosis

“…Asynchronous neuro-osseous growth of the spinal column and cord has also been suggested to play a role in AIS [9]. The observation that the thoracic spine is longer anteriorly than posteriorly in AIS patients, a phenomenon known as relative anterior spinal overgrowth (RASO) or an uncoupled neuroosseous growth, has now been corroborated with many anatomical and MRI studies [25][26][27][28][29][30]. Brink et al evaluated the cause of anterior-posterior length discrepancy and showed that it was a consequence of both anterior and posterior column shortening and whilst the vertebrae contribute to the length discrepancy, it is mostly due to the secondary increased anterior intervertebral discs height [29].…”

“…Stokes et al later proposed their vicious cycle hypothesis whereby asymmetric loading in a "vicious cycle" causes vertebral wedging during growth in progressive scoliosis curves. Their hypothesis implies that regardless of the initial cause of scoliosis, mechanical factors increase significantly during periods of rapid adolescent growth, when risk of curve progression is greatest [28,34].…”

Low Body Mass Index for Early Screening of Adolescent Idiopathic Scoliosis: A Comparison Based on Standardized Body Mass Index Classifications

“…However, a review article reported that there is no perfect study of the etiopathogenesis of AIS with advanced understanding of the mechanisms of melatonin in the development of AIS in humans [42]. In addition, the prevalence of scoliosis was higher in adolescents who participated in various sport activities [14]. However, most studies were retrospective caseecontrol studies; hence, further studies are needed to suggest that flexibility or hypermobility in some sports leads to AIS.…”

“…Puberty is thought to be initiated by genetic and lifestyle factors, leading to the development of AIS [13]. In addition, melatonin deficiency and joint hypermobility during exercise have been shown to be related to increased prevalence of scoliosis [14].…”

Factors affecting puberty gingivitis in Polish girls with adolescent idiopathic scoliosis

“…Adolescent idiopathic scoliosis (AIS) is the most common form and in 80% of cases occurs in girls. The etiopathogensis of this disorder appears to be multifactorial with a genetic tendency to the deformity, which is triggered by biomechanical, neuromuscular, genetic, hormonal and environmental factors [1,2].…”