UT TENSIO SIC VIS: NEW AND REVISITED ASPECTS IN (DE)FORMATION OF THE GROWING SPINE.

Abstract

Background: Unclear aetiology in scoliotic and kyphotic deformities of the spine are responsible for uncertainty in treatment options. To clarify aetiology a constant reference to what normal growth and optimal construction of the entire spine should be at the end of growth is lacking.

Examination of sitting children and consequent testing of muscular tightness can be useful in understanding the different disturbances of growth that keep the spine apparently away from an optimal configuration and thereby optimal function. Prolonged sitting of children exists only 200 years or less.

Goal:

• - Better understanding of the role of the central nervous system, especially the cord and roots in proper and improper growth of the human spine.

• - Clarifying that lordosis and good function at the tho-racolumbar junction at the end of growth can be a condition sine qua non for normal configuration and function of the spine in adult life.

Methods:

• - Present obvious important and consistent clinical observations in children in sitting and supine position with early and advanced adolescent deformities, both kyphotic and scoliotic by photographic studies and video fragments.

• - Present results of own study in which a lordotic force give significant correction of all curves in Adolescent Idiopathic Scoliosis.

• - Revisit the, for the greater part unknown, experimental work on growth and deformation of the spine by Milan Roth in German and Czech literature to disclose a tension-based balancing system between central cord and the osseous and discoligamentary spine (uncoupled neuro-osseous growth).

• - Relate these clinical and experimental findings with common knowledge about adolescent spinal deformities and mechanical laws on tensile and compressive forces in structures.

Results: We discovered by alteration of our brace-configuration that applying lordotic forces exclusively on the thoracolumbar spine gives excellent correction of kyphotic and scoliotic deformities progressing in adolescence. In a study of 32 patients with double curves > 25° all scoliotic curves significantly (p< 0,001) reduced by correcting with a forced lordotic fulcrum.

Extended clinical examination of children with proven or suspected spinal deformities revealed a complex of consistent findings in different sitting positions and functional tests in supine and standing positions.

Discussion: By looking for scientific support for these phenomena in (bio-)mechanical literature the work of Milan Roth was disclosed in his complete width. His embryologic studies, (neuro) anatomical and radiological findings with their explanations, alongside interesting cadaver-, mechanical- and neuro-anatomical experiments and models can bring his concept of neuro-spinal relationship in growth and misgrowth back to orthopaedic daylight. Even Nicoladoni saw a century ago that a cascade of structural alterations take place around the “core”-unit of the spine: the boundaries of the central canal to let it stay on its place and in the shortest configuration possible in scoliosis, by suspected tensile and compressive forces.

Anatomical and biomechanical consequences of keeping the spine upright in standing, but more important in the sitting positions seems to fit. Children do sit for prolonged periods only in the last one or two centuries!

It can be shown that the presence of these tension related clinical signs are easily leading to high compressive forces with deformation of the ventral parts in the TL-junction while sitting In literature evidence of torsion facilitating anatomical features can be found to clarify why some spines deform in scoliosis an not in pure kyphosis

Conclusions: By recognising positive effects of creating lordosis at the thoracolumbar junction of the spine and consistent clinical findings in early deformations scientific support was found by early experimental work of Roth. With a leading role of the central nervous system in growth of the spine of standing and sitting vertebrates by steering a tension based system, deformation can be understood as adaptations. Consequences for preventive measures and therapeutic strategies in deformities seems inevitable.