Modi Hitesh N, Suh Seung-Woo, Yang Jae-Hyuk, Hong Jae-Young, Venkatesh Kp, Muzaffar Nasir
Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Korea.
J Orthop Surg Res. 2010 Nov 4;5:80. doi: 10.1186/1749-799X-5-80.
Child with mild scoliosis is always a subject of interest for most orthopaedic surgeons regarding progression. Literature described Hueter-Volkmann theory regarding disc and vertebral wedging, and muscular imbalance for the progression of adolescent idiopathic scoliosis. However, many authors reported spontaneous resolution of curves also without any reason for that and the rate of resolution reported is almost 25%. Purpose of this study was to question the role of paraspinal muscle tuning/balancing mechanism, especially in patients with idiopathic scoliosis with early mild curve, for spontaneous regression or progression as well as changing pattern of curves.
An observational study of serial radiograms in 169 idiopathic scoliosis children (with minimum follow-up one year) was carried. All children with Cobb angle < 25° and who were diagnosed for the first time were selected. As a sign of immaturity at the time of diagnosis, all children had Risser sign 0. No treatment was given to entire study group. Children were divided in three groups at final follow-up: Group A, B and C as children with regression, no change and progression of their curves, respectively. Additionally changes in the pattern of curve were also noted.
Average age was 9.2 years at first visit and 10.11 years at final follow-up with an average follow-up of 21 months. 32.5% (55/169), 41.4% (70/169) and 26% (44/169) children exhibited regression, no change and progression in their curves, respectively. 46.1% of children (78/169) showed changing pattern of their curves during the follow-up visits before it settled down to final curve. Comparing final fate of curve with side of curve and number of curves it did not show any relationship (p > 0.05) in our study population.
Possible reason for changing patterns could be better explained by the tuning/balancing mechanism of spinal column that makes an effort to balance the spine and result into spontaneous regression or prevent further progression of curve. If this which we called as "tuning/balancing mechanism" fails, curve will ultimately progress.
轻度脊柱侧弯患儿的病情进展一直是大多数骨科医生关注的焦点。文献中描述了休特尔 - 福尔克曼理论，该理论涉及椎间盘和椎体楔形变以及青少年特发性脊柱侧弯进展中的肌肉失衡。然而，许多作者也报道了侧弯曲线会自发消退，且未给出任何原因，报道的消退率约为25%。本研究的目的是探讨椎旁肌调整/平衡机制的作用，特别是在早期轻度侧弯的特发性脊柱侧弯患者中，其对侧弯自发消退或进展以及侧弯曲线变化模式的影响。
对169例特发性脊柱侧弯儿童（至少随访一年）的系列X线片进行了观察性研究。选取所有首次诊断时Cobb角<25°的儿童。作为诊断时不成熟的标志，所有儿童的Risser征均为0级。整个研究组均未接受治疗。在最终随访时，将儿童分为三组：A组、B组和C组，分别为侧弯曲线消退、无变化和进展的儿童。此外，还记录了侧弯曲线模式的变化。
首次就诊时的平均年龄为9.2岁，最终随访时为10.11岁，平均随访21个月。分别有32.5%（55/169）、41.4%（70/169）和26%（44/169）的儿童侧弯曲线出现消退、无变化和进展。46.1%的儿童（78/169）在随访期间侧弯曲线模式发生变化，直至最终稳定。在我们的研究人群中，将侧弯曲线的最终转归与侧弯方向和侧弯数量进行比较，未发现任何相关性（p>0.05）。
脊柱的调整/平衡机制可能是侧弯曲线模式变化的更好解释，该机制努力平衡脊柱，导致侧弯自发消退或防止其进一步进展。如果我们所说的“调整/平衡机制”失效，侧弯最终将会进展。
