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Figure 5 | Scoliosis

Figure 5

From: Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy

Figure 5

In the autonomic nervous system of normal adolescent girls, the leptin-hypothalamic-sympathetic nervous system (LHS)-driven mechanism (red) supplements bilaterally the blood-borne hormonal contribution (lowest oblique arrow) to trunk width growth at the pelvis, chest and shoulders (yellow box) with little or no sympathetic nervous system (SNS)-induced effect in the limbs (upper arms, forearm-with-hands, tibiae and feet) [46, 117–119]. In the preoperative AIS girls, the LHS concept suggests that the GH/IGF axis (upper arrow labeled GH/IGF) and possibly estrogen [122], causes exaggeration of the SNS-induced vertebral/rib length asymmetry with both GH/IGF and sympathoactivation contributing to scoliosis curve progression (Figure 6) in an inverse pathogenetic relationship. The LHS concept suggests that both putative mechanisms, GH/IGF and SNS, provide therapeutic potential for progressive AIS in girls (GPs = growth plates, see Endocrine and Therapeutic Implications).

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Scoliosis and Spinal Disorders

ISSN: 2397-1789

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