Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/54291
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Type: Book chapter
Title: The posterior skeletal thorax: rib-vertebral angle and axial vertebral rotation asymmetries in adolescent idiopathic scoliosis
Author: Burwell, R.
Aujla, R.
Freeman, B.
Dangerfield, P.
Cole, A.
Kirby, A.
Polak, F.
Pratt, R.
Moulton, A.
Citation: Research into Spinal Deformities 6, 2008 / Dangerfield, P. (ed./s), pp.263-268
Publisher: IOS Press
Publisher Place: The Netherlands
Issue Date: 2008
Series/Report no.: Studies in Health Technology and Informatics ; 140
ISBN: 9781586038885
Statement of
Responsibility: 
R.G. Burwell, R.K. Aujla, B.J.C. Freeman, P.H. Dangerfield, A.A. Cole, A.S. Kirby, F.J. Polak, R.K. Pratt and A. Moulton
Abstract: The deformity of the ribcage in thoracic adolescent idiopathic scoliosis (AIS) is viewed by most as being secondary to the spinal deformity, though a few consider it primary or involved in curve aggravation. Those who consider it primary ascribe pathogenetic significance to rib-vertebra angle asymmetry. In thoracic AIS, supra-apical rib-vertebra angle differences (RVADs) are reported to be associated with the severity of the Cobb angle. In this paper we attempt to evaluate rib and spinal pathomechanisms in thoracic and thnoracolumbar AIS using spinal radiographs and real-time ultrasound. On the radiographs by costo-vertebral angle asymmetries (rib-vertebral angle differences RVADs, and rib-spinal angle differences RSADs), apical vertebral rotation (AV) and apical vertebral translation (AVT) were measured; and by ultrasound, spine-rib rotation differences (SRRDs) were estimated. RVADs are largest at two and three vertebral levels above the apex where they correlate significantly and positively with Cobb angle and AVT but not AVR. In right thoracic AIS, the cause(s) of the RVA asymmetries is unknown: it may result from trunk muscle imbalance, or from ribs adjusting passively within the constraint of the fourth column of the spine to increasing spinal curvature from whatever cause. Several possible mechanisms may drive axial vertebral rotation including, biplanar spinal asymmetry, relative anterior spinal overgrowth, dorsal shear forces in the presence of normal vertebral axial rotation, asymmetry of rib linear growth, trunk muscle imbalance causing rib-vertebra angle asymmetry weakening the spinal rotation-defending system of bipedal gait, and CNS mechanisms.
Keywords: Thorax; Skeleton; Spine; Lumbar Vertebrae; Thoracic Vertebrae; Ribs; Humans; Spinal Curvatures; Scoliosis; Disease Progression; Posture; Adolescent; Female; Male
RMID: 0020084233
DOI: 10.3233/978-1-58603-888-5-263
Appears in Collections:Orthopaedics and Trauma publications

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