Etiology of adolescent idiopathic scoliosis: current trends and relevance to new treatment approaches
This book outlines knowledge and hypotheses of the causation of adolescent idiopathic scoliosis (AIS). It begins with Sevastik and Stokes addressing terminology. It includes the epidemiology and demography of adolescent idiopathic scoliosis, the role of genetic factors, hypothesis of causation, oste...
Gespeichert in:
| Format: | Buch |
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| Sprache: | English |
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Philadelphia
Hanley & Belfus
2000
|
| Schriftenreihe: | Spine
14,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Zusammenfassung: | This book outlines knowledge and hypotheses of the causation of adolescent idiopathic scoliosis (AIS). It begins with Sevastik and Stokes addressing terminology. It includes the epidemiology and demography of adolescent idiopathic scoliosis, the role of genetic factors, hypothesis of causation, osteopenia, Hueter-Votkmann effect, and the role of the intervertebral disc. It analyzes the structure and composition of the cartilage end plate and intervertebral disc, the significance of the sternum, the thoracospinal concept of etiopathogenesis of adolescent scoliosis, and the skeletal growth. |
| Beschreibung: | XVIII S., S. 299 - 520 Ill., graph. Darst. |
| ISBN: | 1560533331 |
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| 520 | 3 | |a This book outlines knowledge and hypotheses of the causation of adolescent idiopathic scoliosis (AIS). It begins with Sevastik and Stokes addressing terminology. It includes the epidemiology and demography of adolescent idiopathic scoliosis, the role of genetic factors, hypothesis of causation, osteopenia, Hueter-Votkmann effect, and the role of the intervertebral disc. It analyzes the structure and composition of the cartilage end plate and intervertebral disc, the significance of the sternum, the thoracospinal concept of etiopathogenesis of adolescent scoliosis, and the skeletal growth. | |
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| adam_text | SPINE: State of the Art Reviews
Vol. 14, No. 2,2000
Etiology of Adolescent Idiopathic Scoliosis:
Current Trends and Relevance to New Treatment Approaches
R. Geoffrey Burwell, BSc, MD, FRCS, Peter H. Dangerfield, MD,
Thomas G. Lowe, MD, and Joseph Y. Margulies, MD, PhD, Editors
CONTENTS
Preface xii
R. Geoffrey Burwell, Peter H. Dangerfield, Thomas G. Lowe, and Joseph Y. Margulies
Foreword xiv
Marc A. Asher
Introduction xvi
R. Geoffrey Burwell, Peter H. Dangerfield, Thomas G. Lowe, and Joseph Y. Margulies
Idiopathic Scoliosis: Terminology 299
John A. Sevastik and Ian A. F. Stokes
Research on the etiopathogenesis of the thoracospinal deformity called idiopathic scoliosis
(IS) demands vindication of existing classifications and terms, taking into consideration spe¬
cific characteristics of the various forms of this morbid condition. Scoliosis is a geometrical
property (lateral curvature) of the spine, whereas scoliosis deformity and in particular IS are
clinical conditions involving a complex set of spinal and thoracic asymmetries that change, es¬
pecially during growth. IS has been classified according to the age at onset, anatomical level(s)
of curve(s), and overall curve pattern and spinal flexibility. Although these groupings are used
to guide clinical management, they have not been significant in identifying the underlying
pathological processes. The overall spinal geometry, including the sagittal plane geometry and
the transverse plane rotations and asymmetry of the vertebrae and rib cage have been impli¬
cated in the etiopathogenesis. Standardized terminology and measurement techniques would
be helpful in establishing a common base of knowledge about this condition and its causes.
The Epidemiology and Demography of Adolescent Idiopathic Scoliosis 305
Thomas K. F. Taylor, Robert G. Cumming, Frank L. Jones,
Robert G. McCann, and Margaret Plunkett Cole
Adolescent idiopathic scoliosis (AIS) is a ubiquitous condition and there are no reports of its
absence in any population worldwide. Because there are no specific markers for the disorder,
epidemiological and demographic studies are more than somewhat flawed, with much con¬
fusing and contradictory data. The past efforts stem largely from ill fated school screening ex¬
ercises. In many investigations the criteria set down by the Scoliosis Research Society (SRS),
namely a Cobb angle of 10° or more with concomitant vertebral rotation, have not been as
rigorously applied as strict epidemiological methodology requires. The demography of AIS
has attracted less attention than prevalence rates and related phenomena. With the appropriate
investigative tools it is a rich field for further endeavors. Audit data from Australia and
Sweden suggest that AIS may be more common in the higher socioeconomic groups.
The Role of Genetic Factors in the Etiology of Idiopathic Scoliosis 313
Nancy H. Miller
The prevalence of idiopathic scoliosis among adolescents is 2 3%, with the most severe and
clinically significant curves occurring in 0.2 0.5% of the adolescent group. Idiopathic scolio¬
sis is known to aggregate within families; however, the pattern of inherited susceptibility is
iii
iv Contents
unclear. Multiple contradictory reports emphasize the importance of consistent diagnostic cri¬
teria and rigid methods of disease ascertainment in order to provide substantial evidence in
the support of a specific model of inherited susceptibility. The high prevalence of idiopathic
scoliosis in the general population and its clinical variability suggest that this disorder is com¬
plex in nature with a significant degree of genetic heterogeneity. The application of modern
genetic methodology to critically defined study populations will potentially result in the iden¬
tification of the genetic determinants of this disorder.
Adolescent Idiopathic Scoliosis: Hypotheses of Causation 319
R. Geoffrey Burwell and Peter H. Dangerfield
There is considerable evidence to support the concept that the pathomechanism by which pro¬
gressive scoliosis evolves is overgrowth of the anterior components of the spine relative to the
growth of its posterior components. The etiological factors that initiate such relative anterior
spinal overgrowth of idiopathic scoliosis are unknown and speculations include factors aris¬
ing in (1) the spine—immature vertebrae and/or discs, (2) the ribs, (3) other extraspinal tis¬
sues, including developmental neuromuscular asymmetry, or (4) the combination of several
tissues. When there is sustained eccentric loading of immature vertebrae by continuous
muscle action and gravity, these forces are likely to produce relative anterior spinal over¬
growth as a pathway of deformity (Hueter Volkmann law). Risk factors for adolescent idio¬
pathic scoliosis (AIS) include the sex of the child, residual skeletal growth and, for thoracic
curves, hypokyphosis, and possibly vertebral rotation and small lateral curves.
Biomechanical Factors in the Etiology of Idiopathic Scoliosis 335 f
V. James Raso
Biomechanical factors can affect spine alignment in many ways and are often highlighted in
the pathogenesis of idiopathic scoliosis. Mechanical properties of the tissues, alignment of the
spine, abnormal loading either through forces or displacements, or the way the spine is sup¬
ported may cause scoliosis to develop. These are static mechanisms, but spinal stability as a r
mechanical process involves continuous realignment of the spine based on position sensing
on a local scale, i.e., at the vertebral level, and on a global level involving the head and trunk as
well as the spine. This dynamic process might also lead to the development of scoliosis in the
presence of normal material behavior and research along this path has only recently begun.
Osteopenia 339 t
Jack Chun Yiu Cheng [
Low bone mineral density (BMD) was found in 54% of patients with adolescent idiopathic j
scoliosis (AIS). In the past 6 years we have performed a series of related studies on AIS pa
tients and found that the low BMD is not transient but a persistent phenomenon, as confirmed
by longitudinal follow up study. The low and symmetric areal BMD (aBMD) measured with f
bone densitometry and volumetric BMD (vBMD) measured with peripheral quantitative com *
puted tomography in bilateral proximal femora and distal tibiae points to the fact that the low
BMD is primary rather than secondary to the spinal deformity. Bone biopsies and histomor
phometric studies support the fact that the lower BMD in AIS is a generalized systemic os¬
teopenia. The mechanically weakened spinal column and the associated abnormal skeletal
growth may play a role in the etiology and pathogenesis of the spinal deformity during the ^
rapid growing peripubertal period in susceptible osteopenic AIS patients.
Hueter Volkmann Effect 349
Ian A. F. Stokes
The factors responsible for progression of scoliosis deformity both before and after the cessa¬
tion of growth are poorly understood, making it difficult to manage these deformities. C
Progressive angular deformities of bones are commonly thought to be controlled by the
Hueter Volkmann law that states that growth in physes is retarded by increased mechanical
compression, and accelerated by reduced loading in comparison with normal values.
Although it is well established that mechanical environment influences skeletal growth, the
relationship has not been quantified in terms of the response to loading magnitude and dura i
tion. Ultimately, combining a knowledge of spinal loading asymmetry and of the sensitivity r
of spinal growth to load would allow us to quantify how to control the mechanical contribu¬
tion to scoliosis progression during growth.
r
Contents v
The Role of the Intervertebral Disc in Adolescent Idiopathic Scoliosis 359
Thomas K. F. Taylor and James Melrose
The understanding of the process of growth, development, maturation, function and degeneration
of the disc has provided an ever increasing scientific basis for the management of adolescent id¬
iopathic scoliosis (AIS). Interactions between collagen(s) and aggrecans are central to normal
disc function. The subsequent adverse effects on adjacent discs of the introduction of a rigid
segment into a previously mobile lumbar spine indicate that as many mobile discs as possible
should be preserved in spinal fusion for AIS. Experimental and clinical evidence emphasizes the
need for meticulous surgical technique to restore normal or near normal spinal alignment in the
remaining mobile segments. It is to be acknowledged, even by spinal surgeons, that spinal
fusion runs counter to the most basic orthopedic dictum—the preservation of function.
Structure and Composition of the Cartilage End Plate and
Intervertebral Disc in Scoliosis 371
Sally Roberts, Bruce Caterson, and Jill P. G. Urban
The role of the cartilage end plate and intervertebral disc in the etiology of scoliosis is unclear.
What is clear, however, is that wedging of the intervertebral disc contributes significantly to the
curvature and hence deformity of the scoliotic spine. The cartilage end plates act as growth plates
in humans and so contribute to the growth of the spine and to the nutrition of the intervertebral
disc. Calcification of the cartilage end plate in scoliosis would affect both functions and thus
could be of key importance in the progression and development of the disorder. In this chapter
we review current knowledge of the properties of these two tissues, how they change in scolio¬
sis and suggest how these changes might be important to the etiopathogenesis of scoliosis.
The Significance of the Sternum: The Buttress of the Thoracic Spine 383
Alan D. H. Gardner
The sternum is often ignored when considering the dynamics of the trunk wall in relation to the
genesis of adolescent idiopathic scoliosis (AIS) and its surgical correction. The sternum acts
as an important anterior buttress of the spine and has been termed a fourth column of the
spine. The sternum probably limits the severity of a developing AIS by acting as a fused ante¬
rior segment. The sternum exerts its effect on the spine via the upper six ribs that act as mod¬
erately firm connecting struts, although in the immature spine this connection is much more
plastic. Unfortunately, the immature trunk, with its greater growth potential, will often develop
a progressive rib deformity in spite of a secure spinal fusion. The sternum is probably helpful
in resisting this tendency, but any subsequent attempt to correct the deformity will also be re¬
sisted. Modern segmental instrumentation is relatively efficient at frontal plane correction and
can also produce some vertebral derotation; however, at 1 year most of this denotation is lost
because of persisting deforming forces exerted by the stemally constrained upper six ribs, re¬
sulting in recurrence of the rib hump; in contrast, the lower six ribs, not being constrained by
the sternum, move with the spine at correction, producing a useful improvement in surface
shape with restoration of the waistline. This chapter indicates that it is futile to expect signifi¬
cant correction of the rib hump by vertebral derotation alone. There must be disconnection of
the convex upper ribs from the sternum and if the rib hump is significant, costoplasty is the
procedure of choice as it also provides additional bone to aid spinal fusion.
The Thoracospinal Concept of the Etiopathogenesis of Idiopathic Scoliosis 391
John A. Sevastik
The causation of the thoracospinal deformity of idiopathic scoliosis (IS) is still unknown and
this calls for new research approaches. This article reports a series of clinical and experimental
studies that together provide strong support for the thoracospinal theory of idiopathic scoliosis.
According to this new theory, increased vascularization of the left anterior thorax stimulates
the longitudinal growth of the corresponding ribs. Then, the thoracic spine, predisposed to
rotate to the right, is translated and further rotated to the right. The thoracospinal theory, better
than any other hypothesis, explains the triggering mechanism of the most common form of
adolescent idiopathic scoliosis (AIS). It explains the vertebral rotation to the right, the de¬
creased kyphosis and its association with adolescent girls. The results suggest that dysfunction
of the autonomic nervous system affecting the vascular supply to the costochondral junction
might be a factor in the etiology of IS. The experimental and clinical studies provide evidence
that mini operations on the ribs can be used for fine treatment of early progressive thoracic IS.
vi Contents
Skeletal Growth 401
Caroline J. Goldberg
The observed association between progression of deformity and growth rate in adolescent id
iopathic scoliosis has prompted investigations into the stature and endocrine status of these
children. Results have been conflicting, but the current consensus is that growth patterns and
hormone levels are essentially normal. The indications are that it is control of the timing of
the many developmental changes during adolescence that initiate the deformation, rather than
an intrinsic growth disorder in the traditional sense. Such control systems belong to the realm
of molecular biology and that is likely to be the most promising direction for future research.
Anthropometry 411
Ashley A. Cole, R. Geoffrey Burwell, Peter H. Dangerfield,
Theodoros B. Grivas, John K. Webb, and Alan Moulton
Research into the anthropometry of adolescent idiopathic scoliosis (AIS) is largely cross sec¬
tional with some longitudinal growth studies. Controversies have arisen because (1) the vari¬
ables of curve severity, type, side and age at diagnosis have not been separated in the I
sampling, (2) an insufficient number of skeletal components have been evaluated, and (3)
whether or not height loss has been corrected mathematically for the presence of a lateral
spinal curve. New findings are presented from an anthropometric study of 20 components in
66 preoperative AIS girls with right thoracic curves. Compared with healthy girls the findings
reveal (1) a large extrathoracic skeleton relative to the thorax, (2) a decreased AP and normal
lateral chest diameter, (3) upper limb length asymmetry with the longer arm on the convexity
of the curve, (4) no significant lower limb length asymmetry, and (5) skeletal disproportions.
Possible pathomechanisms of the scoliosis deformity are outlined.
Lower Limb Length Inequality and Scoliosis 423
Augusto Manganiello
Diagnostic imaging enables us to demonstrate that, during growth, lower limb length inequality
can lead to pelvic tilt and consequently various scoliotic deviations. These are differentiated by
the site at which the compensatory counterdeviation of the spine starts and by load distributions.
Curves that are initially of mild degree, nonstructural and mobile may subsequently, according
to the load distributions, diminish, remain stationary or progress and become structural. The
scoliosis is the fixing of a scoliotic attitude destined to suffer the deforming action of the asym¬
metric loading both at the level of the curves and, above all, at the lumbosacral level.
The Role of Melatonin and Growth Factors in the Etiology of
Idiopathic Scoliosis 431
Kent A. Reinker
Many of the classic features of AIS point to growth as a factor in its etiology. Melatonin has
also been implicated in the etiology of idiopathic scoliosis and its effects may not be entirely
separate from the growth hormone axis. Growth hormone and melatonin tend to have a recip¬
rocal relationship and the presence of one can influence the production of the other.
Melatonin has recently been shown to independently induce the production of IGF 1, and
therefore may have the capacity to affect growth in a manner independent of growth hormone.
Based upon the available data today, it would seem likely that melatonin is a possible sec¬
ondary player in the development of idiopathic scoliosis. There is no evidence that patients
with idiopathic scoliosis have an inability to form melatonin. Thus, if melatonin lack is a
factor in the production of scoliosis, it must be due to an alteration in the governance of its
synthesis, with either direct or indirect consequences upon growth mechanisms.
Skeletal Muscle and Platelet Abnormalities in Adolescent Idiopathic Scoliosis ... 441
Thomas G. Lowe
Muscle abnormalities noted in idiopathic scoliosis are more likely to be secondary changes
rather than primary etiologic factors. Certainly, many of the muscle changes found in paraver
tebral muscle were found in other muscles, but to a lesser degree. These changes suggest the
possibility of a muscle defect, but are most likely related to asymmetrical muscle loading re¬
sulting from the deformity. The importance of the research of platelet abnormalities in pa¬
tients with adolescent idiopathic scoliosis is the fact that a generalized cellular defect may be
Contents vii
present as opposed to an abnormality that may be secondary to the spinal deformity, as sug¬
gested by changes found in paravertebral muscle. A small percentage of thrombocytes in pa¬
tients with idiopathic scoliosis are larger than normal. Likewise, calmodulin levels have been
noted to be significantly higher in skeletally immature patients with adolescent idiopathic
scoliosis in a small group of patients. These changes in platelet morphology and physiology
suggest a cell membrane defect in patients with idiopathic scoliosis. Further studies are nec¬
essary to substantiate the abnormalities that may be genetically mediated.
Ligaments and Muscles in Adolescent Idiopathic Scoliosis 447
Keith M. Bagnall
r Recent research into the association between ligaments and muscles and the development of
scoliosis has focused on understanding an emerging concept of a neurological feedback
mechanism in which proprioceptive information from the ligaments directs reflex muscle ac¬
tivity to maintain intervertebral relationships at a local spinal level, as well as overall spine
morphology through a central mechanism in the brain stem. This research is not in isolation
• as this concept is being examined in association with many joints and there is much general
I evidence accumulating to support the concept. The approach being taken with scoliosis is one
in which a theory of etiology is being developed in conjunction with experimental support
and that is intended to be used to identify patients with adolescent idiopathic scoliosis (AIS)
whose cause can be attributed to a deficiency in this area.
Neural Mechanisms in the Etiology of Idiopathic Scoliosis 459
Michael Edgar
The debate over whether there might or might not be a neurological basis for idiopathic scol¬
iosis (IS) has been rekindled. Using the new techniques of imaging and EMG recording,
recent studies have demonstrated a high incidence of syrinx and Chiari I malformation associ¬
ated with abnormal somatosensory evoked potentials in IS patients. The whole question of
neurological dysfunction in idiopathic scoliosis has moved to a center stage position and now
needs to be carefully considered. This article reviews the subject matter anatomically, starting
with nerve root pathology and working through the spinal cord to the higher centers of the
brain, each zone being considered as a potential for scoliosis etiology. In conclusion, a neural
mechanism in idiopathic scoliosis etiology, be it a brain or spinal cord growth and maturation
problem or cerebral effect of developmental asymmetry, may be only one aspect of a multi
factorial etiology. This may involve growth, genetic, or hormonal factors, two or more of
which may be required to trigger scoliosis development.
Postural Control 469
John Bradley Williamson
Postural control in patients with adolescent idiopathic scoliosis can be considered on several
levels. Proprioception, muscle spindle function, and muscle action are involved. Differences
between scoliotics and normal subjects have been demonstrated in each of these functions.
Most differences have been demonstrated in the appendicular musculoskeletal system, and
the same changes may not exist in the control of spinal equilibrium. The quintessential
dilemma facing scoliosis researchers is to know that an abnormality has a causal relationship
¦ with the deformity, rather than resulting from it. This problem has not yet been addressed—
; and will only be addressed by longitudinal studies of patients with early scoliosis. No study has
• yet demonstrated a causal relationship between scoliosis and a disorder of postural control.
j The Brain Stem and Adolescent Idiopathic Scoliosis: A Hypothesis 477
I Thomas K. F. Taylor
The growing vertebral column is extraordinarily sensitive and responsive to the most subtle
alterations in neuromuscular control. This article considers several important questions: Does
AIS result from disordered brain stem function where there is as yet no detectable neurologi¬
cal abnormality? Further, does AIS resulting from occult brain stem dysfunction possibly lie
at one end of a spectrum wherein myelomeningocele with hydrocephalus, cerebellar ectopia,
syringomyelia and distal cord tethering lie at the other extreme? If, in due course, the hypoth¬
esis is proved to be correct, is it to be acknowledged that it relates only to the pathomechanics
of AIS, not the underlying cause. How a genetic message might be translated into brain stem
dysfunction would then be the basis for another entrancing hypothesis. To date, the brain stem
viii Contents
has surrendered few of its secrets to investigators, but until technology provides the means to
test the hypothesis, it should not be summarily cast aside.
Thoracic Scoliosis Accompanied by Restriction of Neck Flexion: A Distinct Type of
Adolescent Idiopathic Scoliosis in Males 483
Yizhar Floman
Twelve adolescent males with mild to moderate thoracic scoliosis and a striking limitation of
neck flexion accompanied by mild thoracic or neck pain are reported. The average neck flex¬
ion of these twelve individuals was 55% of the normal. The marked cervical flexion restric¬
tion in these adolescents was manifested by the inability to touch their chest wall with their
chin. No other anomalies were detected in these individuals. The twelve patients described in
this communication represent a distinct clinical entity of unknown etiology. It is postulated
that a short spinal cord may be the underlying cause for both thoracic scoliosis and limited
neck flexion. It remains to be determined if a similar developmental aberration may play a
role in other types of idiopathic scoliosis.
Finite Element Analysis for the Biomechanical Study of Scoliosis 489
Carl Eric Aubin
Finite element analysis has been used for many years to model and study the human trunk.
Biomechanical models are of practical interest because they provide the opportunity to simu¬
late an unlimited number of variables to investigate scoliosis biomechanics; they also make it
possible to predict the shape of the spine in response to a treatment. This chapter presents a
review of biomechanical modeling of the spine and trunk, with applications for the analysis of
scoliosis biomechanics and its treatment. Firstly, it introduces the principles of finite element
analysis, the types of models used to study spinal biomechanics and discusses their advan¬
tages and limitations in studying scoliosis biomechanics. Secondly, it reviews some pertinent
models and a few relevant state of the art applications. It concludes with a consideration of
future prospects and expected developments in this area.
Deforming Factors in Idiopathic Scoliosis: A Mathematical Tool 505
Joseph Y. Margulies, Roy L Adler, Alan D. Kalvin, Marco Martens, Michael Shub,
Charles P. Tresser, and Chai Wah Wu
A plan to incorporate data from imaging scanners into a mathematical tool for studying idio¬
pathic scoliosis is presented. The tool will be capable of constructing a 3 D representation of
the patient s spine, rendering the spine in neutral position and through the full normal and
pathological range of motion, as well as incorporating growth and 3 D progress of the defor¬
mity over time within the building blocks of the spine and of reducing deformities on the
screen. The latter function can indicate the existence of a primary deforming factor(s).
Success of this project will lead to the ability to identify various deforming factors and isolate
groups with these factors within the idiopathic scoliosis patient population, e.g., calculating
the overgrowth of the anterior column, locating a growth asymmetry in the pedicles with initi¬
ation of rotation, local changes in disc stiffness, or other entities not yet discerned. The model
will also enable prediction of deterioration by calculating the different local growth rates and
the changes in ranges of motion and location in space, which may lead to the possibility of
early arrest of deformity. Planning for the optimal surgical correction in an existing deformity
will be facilitated by the option to insert small local changes in the geometry of the spine in
order to obtain good balance.
Experimental Scoliosis 511
John A. Sevastik
Numerous experimental models have been devised for the induction of scoliosis in
quadrupedal and, in some cases, bipedal animals. These models have been developed from
clinical observations or pathophysiological concepts in attempts to correlate the experimen¬
tally induced scoliotic deformity with the etiology, pathogenesis and pathomechanisms of id¬
iopathic scoliosis (IS) in man. In several papers the findings are poorly documented and
inconclusive and the conclusions are sometimes contradictory and questionable.
Index .,..„„,.,.„ ,.,...;..... 519
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| genre | (DE-588)4143413-4 Aufsatzsammlung gnd-content |
| genre_facet | Aufsatzsammlung |
| id | DE-604.BV013205500 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T18:40:46Z |
| institution | BVB |
| isbn | 1560533331 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-008996418 |
| oclc_num | 44572323 |
| open_access_boolean | |
| owner | DE-19 DE-BY-UBM DE-12 |
| owner_facet | DE-19 DE-BY-UBM DE-12 |
| physical | XVIII S., S. 299 - 520 Ill., graph. Darst. |
| publishDate | 2000 |
| publishDateSearch | 2000 |
| publishDateSort | 2000 |
| publisher | Hanley & Belfus |
| record_format | marc |
| series | Spine |
| series2 | Spine |
| spelling | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches eds.: R. Geoffrey Burwell ... Philadelphia Hanley & Belfus 2000 XVIII S., S. 299 - 520 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Spine 14,2 This book outlines knowledge and hypotheses of the causation of adolescent idiopathic scoliosis (AIS). It begins with Sevastik and Stokes addressing terminology. It includes the epidemiology and demography of adolescent idiopathic scoliosis, the role of genetic factors, hypothesis of causation, osteopenia, Hueter-Votkmann effect, and the role of the intervertebral disc. It analyzes the structure and composition of the cartilage end plate and intervertebral disc, the significance of the sternum, the thoracospinal concept of etiopathogenesis of adolescent scoliosis, and the skeletal growth. Scoliosis Scoliosis Adolescent Scoliosis etiology Scoliosis therapy Idiopathische Skoliose (DE-588)4311093-9 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Idiopathische Skoliose (DE-588)4311093-9 s DE-604 Burwell, Richard G. 1928- Sonstige (DE-588)172490251 oth Spine 14,2 (DE-604)BV000700970 14,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008996418&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches Spine Scoliosis Scoliosis Adolescent Scoliosis etiology Scoliosis therapy Idiopathische Skoliose (DE-588)4311093-9 gnd |
| subject_GND | (DE-588)4311093-9 (DE-588)4143413-4 |
| title | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches |
| title_auth | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches |
| title_exact_search | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches |
| title_full | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches eds.: R. Geoffrey Burwell ... |
| title_fullStr | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches eds.: R. Geoffrey Burwell ... |
| title_full_unstemmed | Etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches eds.: R. Geoffrey Burwell ... |
| title_short | Etiology of adolescent idiopathic scoliosis |
| title_sort | etiology of adolescent idiopathic scoliosis current trends and relevance to new treatment approaches |
| title_sub | current trends and relevance to new treatment approaches |
| topic | Scoliosis Scoliosis Adolescent Scoliosis etiology Scoliosis therapy Idiopathische Skoliose (DE-588)4311093-9 gnd |
| topic_facet | Scoliosis Scoliosis Adolescent Scoliosis etiology Scoliosis therapy Idiopathische Skoliose Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008996418&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000700970 |
| work_keys_str_mv | AT burwellrichardg etiologyofadolescentidiopathicscoliosiscurrenttrendsandrelevancetonewtreatmentapproaches |