A new look at the etiopathogenesis of adolescent idiopathic scoliosis

¹ Unit of Trauma and Orthopaedics, Health Care Institution, Olesno, Poland
² Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
Correspondence: Maciej Brzęczek, Unit of Trauma and Orthopaedics, Health Care Institution, Klonowa 1, 46-300 Olesno, e-mail: maciekbrzeczek@o2.pl

Pediatr Med Rodz 2016, 12 (2), p. 134–140
DOI: 10.15557/PiMR.2016.0012
ABSTRACT

Adolescent idiopathic scoliosis is the most common form of spinal deformity in children. The aetiology of the condition has not been elucidated. Currently, the multifactorial theory seems to be the most probable. Certain authors propose that melatonin should be considered as a causative factor of adolescent idiopathic scoliosis. Their assumption is supported by a range of research studies conducted on animal models with removed pineal gland, which induced scoliosis. Melatonin has been proven to exert direct and indirect effects on the development of the skeletal system. The role of calmodulin or osteoprotegerin seems equally important. In patients with this condition, the levels of platelet calmodulin and calmodulin in the specimens of the paraspinal muscles on the convex side of the curve have been shown to rise. Osteoprotegerin, in turn, modifies osteoclastic and osteoblastic differentiation. These substances have a direct influence on the cellular calcium and phosphate metabolism and can be potentially responsible for spinal deformity in adolescents. The role of oestrogens is being investigated. Moreover, the role of growth factors or thrombospondins still remains obscure. Additionally, molecular tests have revealed a number of genes that can predispose to adolescent idiopathic scoliosis. It still needs to be determined which of the musculoskeletal disorders occur first in the development of scoliosis and which are secondary to the deformity. The identification of the aetiological factor and factors responsible for scoliosis progression determines the manner of treatment.

Keywords: idiopathic scoliosis, aetiology, melatonin, calmodulin, osteoprotegerin