Is There a ‘Single Cause’ for Scoliosis?

AIS, Adolescent Idiopathic Scoliosis, believed to affect 1-4% of the general population, but more likely closer to 10%, has no ‘cure’. That’s the ‘not so great’ news. There are many many theories, some more ‘evidenced based’ than others. (evidence based is the new ‘buzz word’ in the medical scientific community for results purported to be a solid finding, one worthy of being applied to humans, and technically reproducible). If something is not ‘evidence based’ than it is considered either quackery or unworthy of application. That would effectively rule out therapies such as homeopathy an effective alternative treatment for many conditions but not ‘scientifically’ proven in a laboratory. It ruled out chiropractic treatment for more than a century considered to be ‘Quackery’ by the medical establishment. This until it was proven as ‘evidence based’ but renamed ‘manual manipulation’.

Interestingly enough, current accepted treatment for AIS, standard physical therapy, bracing, and surgery have not been proven scientifically (evidence based) to be effective long term. To date, there have been no short, medium or long term Random Controlled Trials (RCTs) showing surgery to be a long term cure or resolution of AIS.

In fact there are purported to be many potential causes of scoliosis. I will discuss some of the current ones which should give one pause before making a radical decision to proceed with any scoliosis treatment that is permanent and irreversible.

One of the current hypothesis, or theories is that there are two causes of IS (idiopathic scoliosis). One is the ‘aetiology’ or initial cause, and the second is that which causes ‘curve progression’.

While we garner enough to know that scoliosis has a hereditary component, the genome or exact genetic links are still unknown, although enough genetic markers have shown a strong relationship between heredity and scoliosis development.

‘Epigenetics’ is another nuevo medical term which consists of information heritable during early cell division but not contained within the actual DNA itself. Epigenetics, evaluates factors concerned with how the environment relates to the process of a disease, how it may affect normal development and aging, especially the early years of life. For example we know that if pregnant mothers drink alcohol to excess during their pregnancy, it can negatively affect their offspring. We are talking about disorders that are not airborne or communicated via body fluids or sneezing but those factors that affect persons with scoliosis at the more elementary level.

Some of the mechanisms both biological and in daily human interactions and activities that may affect scoliosis outcomes along with the definite genome factor are: food and nutrition, physical activities and lifestyles, geographic location (AIS, adolescent idiopathic scoliosis is more prevalent in northern climates than southern ones), socio-economic status, the use of heated indoor swimming pools when very young due to chlorine exposure as an infant (believe it or not!) age of menarche (the age when a girl’s menstrual cycle starts), parents’ age at birth of a child can affect the child’s body balance resulting in scoliosis.

When I was a boy, the postmen carried their mail on one shoulder. Low and behold, many of them, including ours, developed thoracic scoliosis, after carrying those heavy mail bags for 25 years or more. Another prevalent ‘cause of scoliosis’ theory is that of imbalance in the intervertebral discs of the spine which leads to asymmetry in the loads or weights of the body which then sends neurological messages back to the spine which starts to curve as an adaption to this asymmetry. Included in this category is research suspecting the abnormal or asymmetrical growth of the spinal cord itself relative to the spinal column in which it is housed. That is to say, that there is a ‘normal’ sequence of the two (neuro -osseous) growing together but in the aetiopathogenesis they do not do this and grow at differing rates, which may contribute as ‘a’ cause but not the only cause of AIS.

Another potential cause is considered low BMI (body mass index). What this is inferring in laboratory testing is that adolescents that have less body mass have other related system issues that lend themselves to Adolescent Idiopathic Scoliosis.

We’ll discuss more of these theories of ‘What causes scoliosis’ in next month’s blog