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Could early spinal imaging help predict scoliosis?

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New research could one day help clinicians predict and even prevent adolescent idiopathic scoliosis, an abnormal curvature of the spine that appears in late childhood or adolescence.

The study, published in the journal Nature Scientific Reports, shows how certain patterns of spinal curvature in younger children may be likely to develop into scoliosis by adolescence.

“This was the first study to quantitatively explain how variation in spinal patterns may lead to the spinal deformities seen in scoliosis, and may eventually guide us to early interventions for children at risk,” said researcher Saba Pasha, PhD, director of Orthopaedic Engineering and 3D Musculoskeletal Imaging at Children’s Hospital of Philadelphia (CHOP).

Although paediatric scoliosis may be caused by certain diseases, in most cases the cause is unknown. Researchers have found evidence of genetic influences, but the underlying mechanisms of the spinal instability in scoliosis are poorly understood, CHOP explained.

In the new study, Pasha used computer simulations to investigate how elastic rods, modelling children’s spines, change shape in response to mechanical loading. The research was based on spinal X-rays of 129 adolescents with or without scoliosis.

Under simulated mechanical force, S-shaped 2D patterns in the model deformed into the 3D patterns seen in scoliosis patients with the same sagittal curve. The rods in the model representing the sagittal curves of patients without scoliosis did not twist into a 3D scoliosis-like deformation.

This provides strong evidence that the shape of a person’s sagittal profile can be a leading cause of scoliosis, Pasha said.

Further research is necessary to determine whether imaging studies can identify young patients at risk of developing scoliosis during their teenage years.

The current treatment for patients with severe scoliosis is spinal bracing, with surgery in some cases. However, it may be possible that wearing a brace at a younger age may prevent scoliosis from developing, Pasha suggested.