A Longitudinal Study of Growth Velocity and Development of Secondary Gender Characteristics Versus Onset of Idiopathic Scoliosis

School of Medicine, University of Zagreb, Department of Orthopedic Surgery, Salata, Yugoslavia.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 10/1991; 270(270):278-82. DOI: 10.1097/00003086-199109000-00036
Source: PubMed


This study focused on evaluating the impact of the adolescent growth spurt on the onset of idiopathic scoliosis. A total of 698 students (362 girls and 336 boys aged nine to 12 years) were followed for three years to study their growth in the pubertal period and changes in spinal status. Every six months measurements were taken of body height and the development of secondary gender characteristics was recorded. The onset of the adolescent growth spurt could thus be detected in each child. When children with and without scoliosis were compared, it became evident that scoliotic children grew faster. Girls whose scoliosis developed from a previously normal body posture showed a peak height velocity (PHV) of 8.1 cm per year, whereas girls with a normal body posture throughout the pubertal stage had a PHV of 7.1 cm per year. The most rapid growth spurt was observed in Stages 2 and 3 of breast and pubic hair development. Simultaneously, the most frequent spinal status changes occurred in Stages 2 and 3 of sexual maturity; they were twice as frequent as in Stage 1 and four times as frequent as in Stages 4 and 5. Students in whom scoliosis developed in puberty during the adolescent growth spurt grew faster than their peers who did not develop scoliosis, which need not imply that they will eventually be taller after growth is completed.

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    • "According to Wang et al. [9] and Stokes and Aronsson [8], disc and vertebral body wedging could play an important role in the progression of adolescent idiopathic scoliosis since it usually increases during the rapid growth period in the adolescence [31], [32]. There is a dearth of studies on 3D vertebral wedging and these are limited by cadaver-based measurements whereas nearly all the clinical studies used mostly postero-frontal plane radiography measurements. "
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    ABSTRACT: Vertebral wedging is associated with spinal deformity progression in adolescent idiopathic scoliosis. Reporting frontal and sagittal wedging separately could be misleading since these are projected values of a single three-dimensional deformation of the vertebral body. The objectives of this study were to determine if three-dimensional vertebral body wedging is present in mild scoliosis and if there are a preferential vertebral level, position and plane of deformation with increasing scoliotic severity. Twenty-seven adolescent idiopathic scoliotic girls with mild to moderate Cobb angles (10° to 50°) participated in this study. All subjects had at least one set of bi-planar radiographs taken with the EOS® X-ray imaging system prior to any treatment. Subjects were divided into two groups, separating the mild (under 20°) from the moderate (20° and over) spinal scoliotic deformities. Wedging was calculated in three different geometric planes with respect to the smallest edge of the vertebral body. Factorial analyses of variance revealed a main effect for the scoliosis severity but no main effect of vertebral Levels (apex and each of the three vertebrae above and below it) (F = 1.78, p = 0.101). Main effects of vertebral Positions (apex and above or below it) (F = 4.20, p = 0.015) and wedging Planes (F = 34.36, p<0.001) were also noted. Post-hoc analysis demonstrated a greater wedging in the inferior group of vertebrae (3.6°) than the superior group (2.9°, p = 0.019) and a significantly greater wedging (p≤0.03) along the sagittal plane (4.3°). Vertebral wedging was present in mild scoliosis and increased as the scoliosis progressed. The greater wedging of the inferior group of vertebrae could be important in estimating the most distal vertebral segment to be restrained by bracing or to be fused in surgery. Largest vertebral body wedging values obtained in the sagittal plane support the claim that scoliosis could be initiated through a hypokyphosis.
    Full-text · Article · Aug 2013 · PLoS ONE
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    • "Body parts that are more distal will have their pubertal growth spurt earlier in adolescence. Furthermore, it is known that the sequence of growth spurts of different length measurements is similar in individual children, regardless of being an "early" or "late" maturer[4,20]. Therefore different body length growth velocities can be useful in predicting peak growth velocity of total height. "
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    ABSTRACT: Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis.The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient. This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity. Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic scoliosis. This study will determine the value of many maturity indicators and will be useful as well for other clinicians treating children with disorders of growth. Since not all clinicians have access to the presented new 3D X-ray system or have the time to make EMG's, for example, all indicators will be correlated to the timing of the peak growth velocity of total body height and curve progression in idiopathic scoliosis. Therefore each clinician can chose which indicators can be used best in their practice. NTR2048.
    Full-text · Article · May 2010 · BMC Musculoskeletal Disorders
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    • "Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional anomaly of the spine which involves lateral deviations on the frontal plane, misalignment on the sagittal plane, and spinal torsion. Asymmetric growth of the vertebrae was implicated as one possible etiologic factor in the pathogenesis of adolescent idiopathic scoliosis because the development and progression of scoliosis usually occurred during the rapid adolescent growth spurts [1-3]. Some research even reported that differential growth rates between the right and left side of the vertebrae could generate asymmetric growth and wedging of the vertebrae which may play an important role in the progression of the curve [4-8]. "
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    ABSTRACT: Asymmetrical growth of the vertebrae has been implicated as one possible etiologic factor in the pathogenesis of adolescent idiopathic scoliosis. The longitudinal vertebral growth derives from the endochondral ossification of the vertebral growth plate. In the present study, the growth plates from the convex and concave side of the vertebrae were characterized by the method of histology and immunohistochemistry to evaluate the growth activity, cell proliferation, and apoptosis. Normal zoned architectures were observed in the convex side of the growth plate and disorganized architectures in the concave side. The histological grades were significantly different between the convex and the concave side of the growth plate in the apex vertebrae (P < 0.05). The histological difference was also found significant statistically between end vertebrae and apex vertebrae in the concave side of vertebral growth plates (P < 0.05). The proliferative potential indexes and apoptosis indexes of chondrocytes in the proliferative and hypertrophic zone in the convex side were significantly higher than that in the concave side in the apex vertebral growth plate (P < 0.05). There was a significant difference of the proliferative potential index (proliferating cell nuclear antigen, PCNA index) between convex side and concave side at the upper end vertebra (P < 0.05). The difference of the proliferative potential index and apoptosis index were found significant statistically in the concave side of the vertebral growth plate between end vertebrae and apex vertebrae (P < 0.05). The same result was also found for the apoptosis index (terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate biotin nick end labeling assay, TUNEL index) in the convex side of vertebral growth plate between end vertebrae and apex vertebrae (P < 0.05). Some correlation were found between radiographic measurements and proliferation and apoptosis indexes. The difference in histological grades and cellular activity between the convex and concave side indicated that the bilateral growth plate of the vertebrae in AIS patients have different growth kinetics which may affect the curve progression.
    Full-text · Article · Nov 2007 · Journal of Orthopaedic Surgery and Research
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