Pathogenesis of Idiopathic Scoliosis

28 A clear understanding of the pathogenesis of idiopathic scoliosis is essential to appreciating its clinical behavior. Although epidemiological surveys have shown an enormous number of children with minor coronal-plane deformities of the spine, only a relatively small number show evidence of progressive idiopathic scoliosis, which means that other factors must be superimposed to make a deformity idiopathic and progressive. The environment of growth is clearly important, as with other progressive skeletal deformities. The prevalence rate of minor curves in boys is about half that for each age in girls, and the difference is progressively more obvious the greater the size of the curve. Boys are therefore in some way protected from idiopathic scoliosis, but their spines are going to be subjected to much the same neuromuscular, metabolic, and endocrine processes during growth as those of girls. On a commonsense basis it would seem unlikely that pointing the finger of suspicion, for instance, at the paravertebral musculature, brain, eyes, ears, spinal cord, nerve roots, muscles, collagen, and even platelets would not be a profitable line of research into the cause of idiopathic scoliosis. Notwithstanding, this path has largely been the focus of research activity in the etiology of idiopathic scoliosis over the past half century.