Rationale: Despite several decades of research, the exact etiology of adolescent idiopathic scoliosis (AIS) remains unclear. In AIS, spine curvature begins with and progresses during the adolescent growth spurt. Previous studies are only performed on populations with already established scoliosis and normal spinal growth (of bone and IVD tissue) during adolescence has also not been defined. Growth pattern differences may exist between scoliotic and nonscoliotic subjects. Previous studies support the hypothesis that AIS is a spinal deformity that starts with decompensation in the IVD and is linked to sagittal spinal alignment. However, to understand its cause and pathogenic mechanism, the changes to the adolescent spine must be assessed longitudinally during the growth period coinciding with the period prior to and during the onset of AIS. Ideally this should include a cohort who do and do not develop AIS and their assessment must be minimally harmful, without radiation exposure. Certain populations are at increased risk for scoliosis development (i.e. girls with family members with scoliosis and 22q11.2DS patients). New imaging modalities (boneMRI, 3D spinal ultrasound) allow for non-radiographic monitoring of spinal growth.
Objective: The primary objectives is: To longitudinally evaluate the substantial differences in anatomical changes in the spine during adolescent growth in girls, at increased risk for scoliosis development, and in adolescent 22q11.2DS patients, that do and do not develop AIS. The secondary objectives are: * To develop spine specific (IVD/endplates) maturity assessment grading. * To implement radiation-free imaging methods for spinal monitoring in adolescent patients at risk for scoliosis development. * To create a longitudinal dataset for patient specific spinal biomechanical assessment. Study design: Prospective observational cohort study Study population: 60 adolescent girls (8-10 years old) at increased risk for idiopathic scoliosis development (an older sibling or parent diagnosed with idiopathic scoliosis) (Cohort-1) and 60 adolescent girls and boys with 22q11.2DS with increased risk for idiopathic-like scoliosis development (Cohort-2). Intervention: none Main study parameters/endpoints: Spinal MR imaging of the thoracic and lumbar spine will be performed at 5 time points between 8 or 9 and 15 or 16 for girls and boys respectively to evaluate possible changes in the 3D anatomy of the spine. The main study parameter will be the longitudinal changes in segmental axial rotation on boneMRI of the thoracolumbar spine in subjects that do and do not develop AIS. Secondary endpoints: Changes in bone and intervertebral disc morphology, lateral shift of the nucleus pulposus. These will be correlated to assessments of growth, skeletal maturity and spinal alignment.
Study Type
OBSERVATIONAL
Enrollment
120
Longitudinal MRI examination of the thoracic and lumbar spine (T2, T2w, sCT)
3D ultrasound of the spine
At one timepoint, a Hand radiograph is taken for digital skeletal maturity assessment
UMC Utrecht
Utrecht, Netherlands
RECRUITINGSpinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Girls: Baseline
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Girls: 11year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Girls: 12year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Girls: 13year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Girls: 15year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Boys: Baseline
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Boys: 12year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Boys: 13year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Boys: 14year
Spinal MR Imaging of the thoracic and lumbar spine
MRI images
Time frame: Boys: 16year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Girls: Baseline
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Girls: 11year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Girls: 12year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Girls: 13year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Girls: 15year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Boys: Baseline
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Boys: 12year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Boys: 13year
A-P ratio vertebrae and disc
Ratio anterior and posterior height
Time frame: Boys: 14year
A-P ratio vertebrae
Ratio anterior and posterior height
Time frame: Boys: 16year
Left-right ratio
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Ratio left and right height
Time frame: Girls: Baseline
Left-right ratio
Ratio left and right height
Time frame: Girls: 11year
Left-right ratio
Ratio left and right height
Time frame: Girls: 12year
Left-right ratio
Ratio left and right height
Time frame: Girls: 13year
Left-right ratio
Ratio left and right height
Time frame: Girls: 15year
Left-right ratio
Ratio left and right height
Time frame: Boys: Baseline
Left-right ratio
Ratio left and right height
Time frame: Boys: 12year
Left-right ratio
Ratio left and right height
Time frame: Boys: 13year
Left-right ratio
Ratio left and right height
Time frame: Boys: 14year
Left-right ratio
Ratio left and right height
Time frame: Boys: 16year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Girls: Baseline
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Girls: 11year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Girls: 12year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Girls: 13year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Girls: 15year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Boys: Baseline
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Boys: 12year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Boys: 13year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Boys: 14year
Torsion
Difference in axial rotation between 2 subsequent endplates
Time frame: Boys: 16year
Volumes disc
Volumes disc
Time frame: Girls: Baseline
Volumes disc
Volumes disc
Time frame: Girls: 11year
Volumes disc
Volumes disc
Time frame: Girls: 12year
Volumes disc
Volumes disc
Time frame: Girls: 13year
Volumes disc
Volumes disc
Time frame: Girls: 15year
Volumes disc
Volumes disc
Time frame: Boys: Baseline
Volumes disc
Volumes disc
Time frame: Boys: 12year
Volumes disc
Volumes disc
Time frame: Boys: 13year
Volumes disc
Volumes disc
Time frame: Boys: 14year
Volumes disc
Volumes disc
Time frame: Boys: 16year
Volumes vertebrae
Volumes vertebrae
Time frame: Girls: Baseline
Volumes vertebrae
Volumes vertebrae
Time frame: Girls: 11year
Volumes vertebrae
Volumes vertebrae
Time frame: Girls: 12year
Volumes vertebrae
Volumes vertebrae
Time frame: Girls: 13year
Volumes vertebrae
Volumes vertebrae
Time frame: Girls: 15year
Volumes vertebrae
Volumes vertebrae
Time frame: Boys: Baseline
Volumes vertebrae
Volumes vertebrae
Time frame: Boys: 12year
Volumes vertebrae
Volumes vertebrae
Time frame: Boys: 13year
Volumes vertebrae
Volumes vertebrae
Time frame: Boys: 14year
Volumes vertebrae
Volumes vertebrae
Time frame: Boys: 16year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Girls: Baseline
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Girls: 11year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Girls: 12year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Girls: 13year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Girls: 15year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Boys: Baseline
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Boys: 12year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Boys: 13year
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Boys: 14y
Shift nucleus pulposis
Position of nucleus pulposus in discus
Time frame: Boys: 16year
Changes in spinal alignment during growth
Scan for changes over growth
Time frame: Girls: Baseline-15years, Boys: Baseline-15years
Spine specific maturity assessment grading
See if it is possible to create a spine specific maturity assessment
Time frame: Girls: Baseline-15years, Boys: Baseline-15years