Idiopathic scoliosis. Mechanisms of development

Objective: One of the most complicated problems of Orthopaedics is the treatment of scoliosis. More than 90% of cases are attributable to Idiopathic deformation, the cause of which is unknown. We investigated the cause of pathogenesis of this disorder. Methods: At our institution more than 6900 patients aged 1-89 years have undergone inpatient and outpatient treatment in connection with spinal pain syndrome and different neurological disorders associated with idiopathic scoliosis. This study was undertaken between February 1996 and February 2010. All patients had a clinical, radiography and laboratory examinations. Results: The 29.6% of patients were aged 31-50 years old. 60% were men and 40% were women. While examining patients with scoliosis deformation, we noted symptoms of body asymmetry i.e. different volumes of the right and left halves of face body and limbs. These features were typical for all patients irrespective of sex, age, and ethnic origin. 83,2% of patients had underdevelopment of the left part of the body, and only 16,8% of the right side. Analysis of published work in anatomy, physiology, neurophysiology, vertebrology, done simultaneously with analysis of the clinical material, allowed us to make some conclusions. Conclusions: First asymmetrical structure of the human body is based on laws of nature and is linked with difference of sizes of brain’s hemispheres, particularly of the right and left gyrus centralis anterior which controls the muscle’s function and our movements. Second asymmetrical tension of Erector spinae muscles, leads to inclination of the pelvis on a side of weak muscles; thus initiating development of the lateral spine curves. Since such a situation is typical for all people, this deformation is known as functional scoliosis. Third, further development of the bodies of vertebrae, their arches, processes, intervertebral discs, ligaments, and other anatomical elements in position of the deviation leads to one sided underdevelopment of these structures. As a result the areas of instability appear in each segment of spine ( neck, chest, lumbar and sacral areas ). Fourth, the muscles in a growing body misbalance and on the ground of rotating movement, start rotatory dislocation of vertebrae in zones of instability in all parts of the spine. As a result torsion of the deformed wedge-shaped vertebrae leads to formation of the structural scoliosis. The rotation of the vertebrae, described above, does not depend on sex, age and ethnic origin of the patient and has a character of the natural development. Thus from our point of view, the term idiopathic scoliosis, must be changed to spinal muscle asymmetrical deformation of a reflex origin. Understanding of this rotation allowed us to establish an effective non-surgical method of treatment of scoliosis and spinal pain syndrome in patients of all ages.