Schlösser Tom P C, van der Heijden Geert J M G, Versteeg Anne L, Castelein René M
Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Social Dentistry, Academic Center for Dentistry Amsterdam, VU Amsterdam University and University of Amsterdam, Amsterdam, the Netherlands.
PLoS One. 2014 May 12;9(5):e97461. doi: 10.1371/journal.pone.0097461. eCollection 2014.
Despite more than a century of dedicated research, the etiology and pathogenesis of adolescent idiopathic scoliosis (AIS) remain unclear. By definition, 'idiopathic' implies an unknown cause. Nevertheless, many abnormalities concomitant to AIS have been described, often with the suggestion that these abnormalities are related to etio-pathogenesis. Insight in the concomitant abnormalities may assist in improving the understanding of the etiological pathways of AIS. We aimed to systematically review and synthesize available studies on abnormalities concomitant to AIS.
Original studies comparing untreated AIS patients with healthy adolescents on abnormalities other than the deformity of the spine were retrieved from PubMed and Embase. We followed PRISMA guidelines and to quantify the relationship between each abnormality and AIS we used a best-evidence-syntheses for relating risk-of-bias to consistency of effect sizes.
We identified 88 relevant citations, forty-seven carried high risk-of-bias and twenty studies did not report quantitative data in a sufficient manner. The remaining twenty-one publications failed to report data from before initiation of the deformity and blind assessments. These cross-sectional studies provided data on fourteen abnormalities concomitant to AIS. With our best-evidence-syntheses we were unable to find both strong evidence and a consistent pattern of occurrence for AIS and any of these abnormalities. From moderate risk-of-bias studies a relatively consistent pattern of occurrence for AIS and impaired gait control (4 studies; 155 subjects; Cohen's d = 1.00) and decreased bone mineral density (2 studies; 954 subjects; Cohen's d = -0.83) was found. For nine abnormalities a consistent pattern of occurrence with AIS was found, but the evidence for these was weak.
Based on the available literature, strong evidence is lacking for a consistent pattern of occurrence of AIS and any abnormality. The relevance for understanding the multifactorial etiology of AIS is very limited.
尽管经过了一个多世纪的专门研究，青少年特发性脊柱侧凸（AIS）的病因和发病机制仍不明确。从定义上讲，“特发性”意味着病因不明。然而，已经描述了许多与AIS相关的异常情况，并且常常暗示这些异常与病因发病机制有关。了解这些伴随的异常情况可能有助于增进对AIS病因途径的理解。我们旨在系统地回顾和综合关于AIS伴随异常情况的现有研究。
从PubMed和Embase数据库中检索将未经治疗的AIS患者与健康青少年在脊柱畸形以外的异常情况方面进行比较的原始研究。我们遵循PRISMA指南，并使用最佳证据综合法来量化每种异常情况与AIS之间的关系，即将偏倚风险与效应大小的一致性联系起来。
我们识别出88条相关引文，其中47条存在高偏倚风险，20项研究未充分报告定量数据。其余21篇出版物未报告畸形开始前的数据和盲法评估。这些横断面研究提供了与AIS相关的14种异常情况的数据。通过我们的最佳证据综合法，我们未能找到AIS与这些异常情况中的任何一种之间存在有力证据和一致发生模式的情况。从中度偏倚风险研究中发现，AIS与步态控制受损（4项研究；155名受试者；科恩d值 = 1.00）以及骨密度降低（2项研究；954名受试者；科恩d值 = -0.83）存在相对一致的发生模式。对于9种异常情况，发现了与AIS一致的发生模式，但支持这些情况的证据较弱。
基于现有文献，缺乏AIS与任何异常情况一致发生模式的有力证据。这对于理解AIS多因素病因的相关性非常有限。
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