The role of the intervertebral disc in correction of scoliotic curves. A theoretical model of idiopathic scoliosis pathogenesis.
Wedging of the scoliotic inter-vertebral disc (IVD) was previously reported as a contributory factor for progression of idiopathic scoliotic (IS) curves. The present study introduces a theoretical model of IVD's role in IS pathogenesis and examines if, by reversing IVD wedging with conservative treatment (full- and night-time braces and exercises) or fusionless IS surgery with staples, we can correct the deformity of the immature spine. The proposed model implies the role of the diurnal variation and the asymmetric water distribution in the scoliotic IVD and the subsequent alteration of the mechanical environment of the adjacent vertebral growth plates. Modulation of the IVD by applying corrective forces on the scoliotic curve restores a close-to-normal force application on the vertebral growth plates through the Hueter-Volkmann principle and consequently prevents curve progression. The forces are now transmitted evenly to the growth plate and increase the rate of proliferation of chondrocytes at the corrected pressure side, the concave. Application of appropriately directed forces, ideally opposite to the apex of the deformity, likely leads to optimal correction. The wedging of the elastic IVD in the immature scoliotic spine could be reversed by application of corrective forces on it. Reversal of IVD wedging is thus amended into a "corrective", rather than "progressive", factor of the deformity. Through the proposed model, treatment of progressive IS with braces, exercises and fusionless surgery by anterior stapling could be effective.
Grivas
T B
TB
Scoliosis Clinic, Orthopaedic Department, Thriasio General Hospital, G. Genimata Avenue, Magula, 19600, Athens, Greece. grivastb@vodagone.net.gr
Vasiliadis
E S
ES
Rodopoulos
G
G
Bardakos
N
N
D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D008962:Models, Theoretical; D019637:Orthopedic Procedures / Q000295:instrumentation; D012600:Scoliosis / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion