Pathogenesis of idiopathic scoliosis: a review.
Idiopathic scoliosis is a three-dimensional deformation of the spine. As its name suggests, its pathogenesis remains poorly understood. Enhanced comprehension of its pathogenesis would be likely to improve current therapeutic results. While the hereditary and genetic origin of scoliosis appears unassailable and several chromosomes are known to be involved in transmission, the role assumed by each individual chromosome remains uncertain, and the mechanisms leading to the expression of scoliosis have yet to be determined. Even though a large number of pathogenetic hypotheses have been put forward and numerous studies carried out, none of these hypotheses have won unanimous approval, and the controversy remains persistent.


OBJECTIVE
The objective of this paper is to identify the existing hypotheses and to group them within large-scale etiological categories.


METHODS
We examined the Pubmed and Goggle databases using as keywords "idiopathic scoliosis" and "pathogenesis". The search was limited to articles in English and French.


RESULTS
The vicious cycle hypothesis is markedly preponderant. However, no existing pathogenetic model adequately accounts for the formation of scolioses.


CONCLUSIONS
We are proposing four main pathogenetic mechanisms: asymmetric bone growth dysregulation, susceptibility of bones to deformation, abnormal passive spinal system maintenance and disturbed active spinal system maintenance.
Service de MPR, unité de médecine orthopédique, hôpital Tastet-Girard, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. mathieu.de-seze@chu-bordeaux.fr
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D000293:Adolescent; D000818:Animals; D001696:Biomechanical Phenomena; D001846:Bone Development; D002147:Calmodulin / Q000502:physiology; D002648:Child; D004195:Disease Models, Animal; D018450:Disease Progression; D005260:Female; D020022:Genetic Predisposition to Disease; D006728:Hormones / Q000502:physiology; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology; D008297:Male; D008550:Melatonin / Q000502:physiology; D008954:Models, Biological; D011187:Posture; D011628:Puberty, Delayed; D012600:Scoliosis / Q000196:embryology / Q000209:etiology* / Q000235:genetics / Q000503:physiopathology; D013131:Spine / Q000254:growth & development; D016474:Weight-Bearing
D002147:Calmodulin; D006728:Hormones; D008550:Melatonin