Clinical detectable tension in the growing body: new and revisited signs in clinical examination in children with postural problems and spinal deformities. Restoration of lordosis on the thoracolumbar junction can correct sagittal and coronal plane deformity; a new (revisited) linked approach on the treatment and etiology of adolescent spinal deformities.
Unclear etiology in scoliotic and kyphotic deformities of the spine is responsible for uncertainty in treatment options. Normal all-day factors can be of importance. Newly developed or revisited clinical examination of sitting and supine children and consequent testing of neuro-muscular tightness shows to be useful in understanding the different spinal deformations and postural problems during growth and point to neuromuscular tension in growth. The goal is: -Better understanding of the role and individual characteristics of the central nervous system, especially the cord and roots in proper and improper growth of the human spine. -Clarifying that preservation of lordosis and good function at the thoracolumbar junction at the end of growth can be of value for normal configuration and function of the spine in adult life. -Present obvious important and consistent clinical observations in children in sitting and supine position with early and advanced adolescent deformities, by photographic studies and video fragments. Use of work on growth and deformation of the spine by Milan Roth on uncoupled neuro-osseous growth and other historical literature. -Relate these clinical findings and background literature with common knowledge about adolescent spinal deformities and mechanical laws on tensile and compressive forces in structures. Overview of relevant clinical tests in the growing child presented with deformities show possible correlation with the proposed internal balancing problem (uncoupled neuro-osseous growth) researched by Roth. Concomitant radiological and MRI signs are shown. Around 1900 most orthopaedic surgeons and anatomists saw relationship between the new habitude of children to sit for prolonged periods in schools and spinal deformities. A physiological explanation as adaptations needed by the total neuromuscular system ("the growing system") was widely postulated (Hueter-Volkmann principle) and subject in research but a concise theory was not achieved. By recognising positive effects of creating lordosis at the thoracolumbar junction of the spine and consistent clinical findings in early deformations scientific support was found by earlier experimental work of Roth. With a leading role of the central nervous system in growth of the spine of standing and sitting vertebrates by steering a tension based system, deformation can be understand as adaptations. Consequences for new preventive measures and therapeutic strategies in deformities seems possible.
van Loon
P J M
PJ
Department of orthopaedic surgery, Slingeland Hospital, Doetinchem, The Netherlands.
D001696:Biomechanical Phenomena; D002648:Child; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008141:Lordosis; D011187:Posture; D011859:Radiography; D012600:Scoliosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D013131:Spine / Q000473:pathology*