title: Adolescent idiopathic scoliosis without limb weakness: a differential diagnosis of core myopathy?
abstract: BACKGROUND
  Core myopathies are a clinically and genetically heterogeneous group of congenital myopathies with the common defined histopathological feature of focally reduced oxidative activity on muscle biopsy. It has a low incidence, however, recent articles show broad clinical spectrum, suggesting that the real incidence should be considerably larger than previously described. Due to the important association between scoliosis and paravertebral muscle imbalance, numerous authors study, by biopsy of the spinal rotator muscles, potential changes that may elucidate the etiology of adolescent idiopathic scoliosis.
  
  
  METHODS
  Two patients have been followed at Spine Group of Department of Orthopedics at Federal University of São Paulo, with an initial diagnosis of idiopathic scoliosis. Both patients had clinical and radiological findings compatible with it. The patients authorized, through the Term of Consent, intraoperative biopsy of muscle multifidus from the apex of the thoracic curve on concave and convex sides. After muscle biopsy was performed a histopathological analysis. As regard to the histopathological features: in both patients were identified, the presence of core structures in extensive areas with reduced oxidative activity running along the muscle fiber.
  
  
  CONCLUSIONS
  All patients with 'idiopathic' scoliosis deserve a careful neurological evaluation, even if they have minimal muscle symptoms in the extremities. The frequent occurrence of scoliosis in patients with CORE Myopathies, supports the thesis that the change in the paravertebral muscle fiber must be the underlying pathogenic factor in scoliosis and may help us understand the onset and progression of curves in patients previously diagnosed with idiopathic scoliosis.
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. rafaelluciano@ig.com.br.
authors.forename: Rafael de Paiva
authors.initials: Rde P
authors.lastname: Luciano
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. ebpuertas@gmail.com.
authors.forename: Eduardo Barros
authors.initials: EB
authors.lastname: Puertas
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. eulalio@me.com.
authors.forename: Delio Eulalio
authors.initials: DE
authors.lastname: Martins
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. faloppa.dot@gmail.com.
authors.forename: Flavio
authors.initials: F
authors.lastname: Faloppa
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. ddelcurto@hotmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Del Curto
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. luciano.miller@uol.com.br.
authors.forename: Luciano Miller Reis
authors.initials: LM
authors.lastname: Rodrigues
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. benyschmidt@gmail.com.
authors.forename: Beny
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. acary.bulle@unifesp.br.
authors.forename: Acary Souza Bulle
authors.initials: AS
authors.lastname: de Oliveira
authors.affiliation: Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil. marcelow@einstein.br.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Wajchenberg
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018908:Muscle Weakness; D009135:Muscular Diseases / Q000150:complications / Q000175:diagnosis*; D012600:Scoliosis / Q000150:complications / Q000175:diagnosis*