The etiology of adolescent idiopathic scoliosis is currently the unified academic concept that it is the result of a combination of multiple factors such as the nervous system, endocrine system, musculoskeletal system, and genetic abnormalities. But this result has never been convincing to me because the characteristics of scoliosis are too distinct, and it can only be the result of 1-2 factors. With so many systemic abnormalities, there would not be such distinct disease characteristics as scoliosis. What are its distinctive features?

1. Females are more common, with a ratio of 10:1 between females and males
Elizabeth Taylor was born in the suburbs of Hampton Gardens, England. She suffered from scoliosis and underwent self rehabilitation treatment.



2. Right chest curvature and left waist curvature are more common
Regardless of age, gender, and severity, right thoracic curvature and left lumbar curvature are the characteristics of most idiopathic scoliosis.



3. Everything is normal before puberty, onset after puberty, and no further progress after puberty
With the arrival of the second growth peak of human beings, the incidence of scoliosis increases, and the angle will also progress, but it is interesting that the first growth peak is not accompanied by scoliosis.



4. In patients with scoliosis, the anterior vertebral body of the spine grows faster than the posterior one
Anatomical studies on scoliosis and recent MR studies have shown that the anterior height of the vertebral body in patients with scoliosis is significantly higher than that of the normal control, indicating that the anterior growth rate of the vertebral body is too fast. However, the reason is unknown. This image is reproduced from a study by the Hong Kong Polytechnic University, which used MRI examination to confirm that the anterior part of the vertebral body in patients with scoliosis does indeed grow faster.



5. 25% of dancers and 36% of rhythmic gymnasts suffer from illness
Aubrey is an American ballet dancer who danced at the age of 3. At the age of 15, she discovered scoliosis and underwent non fusion anterior tethering surgery for scoliosis. After the surgery, she continued to dance with scoliosis.



6. Most patients with scoliosis may experience a flat back deformity in the sagittal plane (reduced thoracic kyphosis)
Observing the X-ray on the right side from a lateral perspective reveals a typical flat back deformity, but what is interesting is that some young men may experience an increase in thoracic kyphosis during puberty, with a tiger back and a bear waist. Chest kyphosis exceeding 70 ° requires treatment, known as Xiumen's disease. In fact, Xiumen's disease is likely to be a pathogenesis of scoliosis.



7. Only humans have scoliosis, while other terrestrial vertebrates do not have scoliosis
This is a fish found with scoliosis in the high selenium lake water of North Carolina. At the time, it was suspected that high selenium pollution caused scoliosis in the fish, which also broke the common knowledge that scoliosis only occurs in humans.

As early as 2009, I proposed that scoliosis is like a spring constrained by a rope, which can cause rotational distortion in three-dimensional space, and called this theory the spring three-dimensional spiral theory. Spinal scoliosis is the result of physiological curvature of the human spine rotating to other planes in the coronal plane (scoliosis), and there may also be a reduction in thoracic kyphosis (flat back) in the sagittal plane. At the same time, we propose that the ligaments around the spine, rather than the spinal cord, are the ropes that bind the spine- The result of the effects of two factors, with so many systemic abnormalities, would not have the distinctive characteristics of a disease like scoliosis. What are its distinctive features?

Spinal scoliosis is like a spring constrained by a rope, which causes rotational distortion in three-dimensional space. We refer to this theory as the spring three-dimensional spiral theory.        
Cheng Y, Shi Y, Xu B, Yang Z. The uncoupled antagonist and posterior spinal ligament tension (UAPLT) - An improvement to three dimensional spring model of adult idiopathic syndrome (AIS) pathogenesis Med Hypotheses 2021 Jul; 152:110616. doi: 10.1016/j.mehy.2021.110616                  
                   
According to this theory, it can basically explain the characteristics of all idiopathic scoliosis:               
1. Right chest curvature and left waist curvature are more common: normal individuals have a certain degree of right chest curvature (less than 10 °) and rotation; The opposite is true for people with mirrored hearts, indicating that the direction of curvature of scoliosis may be related to the position of the heart. At the moment when the spring is about to deform, the tiny heart gravity may determine the direction of scoliosis.                    
                   
2、Before puberty, everything is normal, and after puberty, it occurs: After puberty, humans secrete many hormones, the most representative of which is not only sex hormones, but also a hormone called relaxin3. RLN3 is an ancestral hormone that can cause extensive relaxation of ligaments, indirectly leading to tightening of the ligaments around the spine.                    
                   
                   
                   
We found a significant increase in serum RLN3 levels in patients with scoliosis in 2022         
3、More commonly seen in women, the female spine is like a more flexible spring, which is more prone to bending after being pulled. At the same time, estrogen enhances the secretion of RLN3 in the hypothalamus through the gonadotropin-releasing hormone axis.                    
                   
4、Dance and rhythmic gymnastics athletes both artificially stretch the anterior ligaments of the spine, indirectly leading to a relatively stronger pulling effect of the ligaments around the spine, resulting in a much higher incidence of scoliosis.                 
                   
                     
                   
5、Patients with scoliosis may experience sagittal plane flat back deformity: Scoliosis is the result of physiological curvature of the human spine rotating to other planes in the coronal plane (scoliosis), and sagittal plane may also appear (reduced thoracic kyphosis, flat back). Scoliosis is the result of physiological curvature of the human spine rotating to other planes in the coronal plane (scoliosis), and sagittal plane may also appear (reduced thoracic kyphosis, flat back).                    
                   
     

                    

                   
6、In patients with scoliosis, the front of the vertebral body grows faster than the back: after being restrained by a rope, according to Hueter Volkmann's law, the bone grows slower under compressive stress, grows faster under tensile stress, and the front of the vertebral body begins to grow too quickly.                    
                   
7、Only humans experience scoliosis: Spinal scoliosis is the cost of upright walking, and the most stable mechanical state of the upright spine is the three-dimensional spiral state. However, under normal circumstances, it is restricted by the muscles and ligaments on both sides and maintains physiological curvature in the sagittal plane. Once the ligament pulling effect is enhanced (rope pulling spring), the spine will return to its most stable state, which is the three-dimensional spiral state of the spring.                    
                   
In summary, scoliosis is like a stretched spring, it is not caused by poor posture, asymmetrical muscles on both sides, or a single shoulder backpack. With the support of the three-dimensional spiral theory of scoliosis, it provides us with important indications for prevention and treatment: it is possible to correct some mild scoliosis through specific muscle training and ligament release