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Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis

There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limi...

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Autores principales: Park, Yulhyun, Ko, Jin Young, Jang, Joon Young, Lee, Seungeun, Beom, Jaewon, Ryu, Ju Seok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413345/
https://www.ncbi.nlm.nih.gov/pubmed/34475442
http://dx.doi.org/10.1038/s41598-021-96882-8
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author Park, Yulhyun
Ko, Jin Young
Jang, Joon Young
Lee, Seungeun
Beom, Jaewon
Ryu, Ju Seok
author_facet Park, Yulhyun
Ko, Jin Young
Jang, Joon Young
Lee, Seungeun
Beom, Jaewon
Ryu, Ju Seok
author_sort Park, Yulhyun
collection PubMed
description There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P < 0.005). In the DM type, the mean RMS EMG amplitudes of ES(T7) and ES(L3) where the apex was located were significantly higher at the convex side than those of the concave side (P < 0.005, effect size (Cohen’s d) for ES(T7)/ES(L3): 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the ES(T12) concave side and Mu(L3) and ES(L3) concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P < 0.008, effect size (Cohen’s d) for ES(T12)/Mu(L3)/ES(L3): 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P < 0.05). Different patterns of asymmetry of paraspinal muscles and structural variables were described based on the curvature of the spine. L type showed that EMG activity was asymmetric in the paraspinalis muscles where the apex was located and that structural asymmetry, such as coronal imbalance was significantly greater than other types. DM type showed similar paraspinalis asymmetry pattern to the ST type but there was no structural asymmetry in DM and ST types. TL type has the features of both thoracic and lumbar origins. Understanding these could contribute to the management in correcting scoliosis.
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spelling pubmed-84133452021-09-07 Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis Park, Yulhyun Ko, Jin Young Jang, Joon Young Lee, Seungeun Beom, Jaewon Ryu, Ju Seok Sci Rep Article There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P < 0.005). In the DM type, the mean RMS EMG amplitudes of ES(T7) and ES(L3) where the apex was located were significantly higher at the convex side than those of the concave side (P < 0.005, effect size (Cohen’s d) for ES(T7)/ES(L3): 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the ES(T12) concave side and Mu(L3) and ES(L3) concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P < 0.008, effect size (Cohen’s d) for ES(T12)/Mu(L3)/ES(L3): 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P < 0.05). Different patterns of asymmetry of paraspinal muscles and structural variables were described based on the curvature of the spine. L type showed that EMG activity was asymmetric in the paraspinalis muscles where the apex was located and that structural asymmetry, such as coronal imbalance was significantly greater than other types. DM type showed similar paraspinalis asymmetry pattern to the ST type but there was no structural asymmetry in DM and ST types. TL type has the features of both thoracic and lumbar origins. Understanding these could contribute to the management in correcting scoliosis. Nature Publishing Group UK 2021-09-02 /pmc/articles/PMC8413345/ /pubmed/34475442 http://dx.doi.org/10.1038/s41598-021-96882-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Park, Yulhyun
Ko, Jin Young
Jang, Joon Young
Lee, Seungeun
Beom, Jaewon
Ryu, Ju Seok
Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title_full Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title_fullStr Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title_full_unstemmed Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title_short Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
title_sort asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413345/
https://www.ncbi.nlm.nih.gov/pubmed/34475442
http://dx.doi.org/10.1038/s41598-021-96882-8
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