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In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity. [ABSTRACT FROM AUTHOR]

Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle–rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients. [ABSTRACT FROM AUTHOR]

The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistically significant relationship between these parameters would be very important for biomechanical relations in rib cage (RC) deformity presented as rib hump deformity (RHD) and deformity in the spine, and would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA was documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as rib hump deformity (RHD) in all IS patients, and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of thoracic asymmetry in relation to the spinal deformity, mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics was 14 years, which is when the RI shows a stronger correlation with spinal deformity, namely when thoracic deformity is decisively effective in the development of thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study may provide scoliogenic implications for IS, as far as the role of the thorax is concerned. [ABSTRACT FROM AUTHOR]

The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10°) is underlined. Additionally, guidelines are provided based on the segments T1–T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity. [ABSTRACT FROM AUTHOR]

As an important consideration in medical care, health-related quality of life (HRQoL) refers to the patient's ability to enjoy normal life activities. When assessing the effectiveness of conservative treatment of AIS, HRQoL variables are more important than the radiographic results or pulmonary function. The present study examines the impact of conservative treatment in HRQoL of the AIS patients. Thirty-two female patients with a mean age of 13.5 (range 12–16) years, a mean Cobb angle of 29.4° (range 21–38°) and a mean angle of trunk inclination (ATI) 7.9° (range 5°–18°) were treated with a full time application of a modified Boston brace and occasionally physiotherapy, for a minimum of 2 years. HRQoL was measured with the Brace Questionnaire (BrQ) at baseline and at the end of treatment. Correlations were determined by the Pearson correlation coefficient, with p<0.05 considered significant. AIS patients scored lower in all the domains of BrQ at the end of treatment. This difference was statistically significant for the mean overall score of BrQ and for the domains of general health perception, physical functioning, emotional functioning, self-esteem and aesthetics, bodily pain and social functioning. The scores in the domains of vitality and school activity were not affected. The HRQoL immediately after the end of conservative treatment of AIS is found to have been negatively affected. Because of limitations in study design, this finding does not necessarily implicate the conservative treatment itself, but highlights the importance of HRQoL measurement in assessing how AIS patients perceive the impact of their disease. [ABSTRACT FROM AUTHOR]

Adolescent Idiopathic Scoliosis (AIS) prevalence has been reported to be different in various geographic latitudes and demonstrates higher values in northern countries. A study on epidemiological reports from the literature was conducted to record the prevalence of AIS among the general population of boys and girls, aged 10-16 years old, in different geographic latitudes, in order to test the hypothesis that the prevalence of AIS among boys and girls is different in various geographic latitudes and to examine if there is a possible association between them. Seventeen peer-reviewed published papers reporting AIS prevalence in the general population of boys and girls from most geographic areas of the northern hemisphere were retrieved from the literature. The geographic latitude of each centre where a particular study was originated was documented. The statistical analysis included a linear regression forward modeling procedure of the AIS prevalence by latitude, weighted by sample size. According to the modelling of the data, a significant positive association between prevalence of AIS and latitude was found for girls (p<0.001), following a rather curvilinear trend, but not a significant positive association was found for boys (p<0.111). A positive association between prevalence of AIS and geographic latitude is reported only for girls in the present study. Prevalence of AIS in boys is not associated significantly with geographic latitude. This differing significant association implicates the possible role of environmental factors in the pathogenesis of AIS that may act in a different way between boys and girls. [ABSTRACT FROM AUTHOR]

Neurofibromatosis type 1 (NF1), which is the most common phacomatoses, is an autosomal dominant disorder characterized by clinical presentations in various tissues and organs, such as the skin, eyes and nervous and skeletal systems. The musculoskeletal implications of NF1 include a variety of deformities, including scoliosis, kyphoscoliosis, spondylolistheses, congenital bony bowing, pseudarthrosis and bone dysplasia. Scoliosis is the most common skeletal problem, affecting 10–30% of NF1 patients. Although the pathophysiology of spinal deformities has not been elucidated yet, defects in bone metabolism have been implicated in the progression of scoliotic curves. Measurements of Bone Mineral Density (BMD) in the lumbar spine by using dual energy absorptiometry (DXA) and quantitative computer tomography (QCT) have demonstrated a marked reduction in Z-score and osteoporosis. Additionally, serum bone metabolic markers, such as vitamin D, calcium, phosphorus, osteocalcin and alkaline phosphatase, have been found to be abnormal. Intraoperative and histological vertebral analysis confirmed that alterations of the trabecular microarchitecture are associated with inadequate bone turnover, indicating generalized bone metabolic defects. At the molecular level, loss of function of neurofibromin dysregulates Ras and Transforming Growth factor-β1 (TGF-β1) signaling and leads to altered osteoclastic proliferation, osteoblastic activity and collagen production. Correlation between clinical characteristics and molecular pathways may provide targets for novel therapeutic approaches in NF1. [ABSTRACT FROM AUTHOR]

Idiopathic scoliosis is a disorder of unknown etiology. Bone biopsies from idiopathic scoliosis patients revealed changes at cellular and molecular level. Osteocytic sclerostin is downregulated, and serum level of sclerostin is decreased. Osteocytes in idiopathic scoliosis appear to be less active with abnormal canaliculi network. Differentiation of osteoblasts to osteocytes is decelerated, while Wnt/β-catenin signaling pathway is overactivated and affects normal bone mineralization that leads to inferior mechanical properties of the bone, which becomes susceptible to asymmetrical forces and causes deformity of the spinal column. Targeting bone metabolism during growth by stimulating sclerostin secretion from osteocytes and restoring normal function of Wnt/β-catenin signaling pathway could, in theory, increase bone strength and prevent deterioration of the scoliotic deformity. [ABSTRACT FROM AUTHOR]

An abstract of the article "Braces for idiopathic scoliosis in adolescents. A cochrane review," by Stefano Negrini and colleagues is presented.