Asymmetric otolith vestibulo-ocular responses in children with idiopathic scoliosis,☆☆,,★★

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Abstract

Objective: A suggested cause of idiopathic scoliosis (IS) in children is a disequilibrium in the vestibulospinal control of trunk muscles. We sought a correlation between otolith vestibular dysfunction and IS. Methods: A recently developed test for evaluation of otolith vestibular function (off-vertical axis rotation, OVAR) was applied to 30 children with IS, 12 control subjects, and 3 with congenital scoliosis as a result of spinal deformities. Results: Of the patients with IS, 67% had significantly greater values of directional preponderance on the OVAR test (a measure of otolith system imbalance) compared with control subjects. Patients with congenital scoliosis showed normal responses on the OVAR test. No correlation was found between the direction of the preponderance and the side of the spine imbalance, or between the directional preponderance and the curve magnitude. The rate of progression of the scoliosis was not significantly correlated with the amplitude of the directional preponderance. Conclusion: These results support the hypothesis that central otolith vestibular system disorders lead to a vestibulospinal system imbalance, and may be a factor in the cause of IS. (J Pediatr 1998;132:1028-32.)

Section snippets

Study Design

Three groups of children were studied: a group of 30 patients with IS, a control group of 12 children with normal posture and free from pathologic condition, and a third group of 3 children with a scoliosis caused by congenital vertebral deformities, such as hemivertebrae (data available from authors). All children had orthopedic, neurologic, and otorhinolaryngologic clinical examinations to exclude other possibly relevant pathologic conditions. In addition, all underwent pure-tone audiometry

Results

In 20 of the 30 patients with IS, the mean absolute values of otolith DP were greater than those of the entire group of control subjects (Fig. 3).

. Magnitude of DP of otolith VOR during OVAR in patients with IS (circles), control subjects (squares), and patients with congenital scoliosis (triangles). The absolute values of the DP measured during OVAR are plotted here for the horizontal versus the vertical component of eye movements. Twenty of the patients with IS have values greater than 0.95

Discussion

In this database, 66.7% of the patients with IS have otolith responses with greater asymmetry than matched control subjects. One possible explanation is that a peripheral dysfunction of the otolith receptors is a major factor in the cause of these cases of IS. A study in adult guinea pigs showed that selective experimental lesions of the otolith receptors induce deformations of the spine comparable in many ways to those observed in children with IS.7 Selective lesions of the otolith receptors

Acknowledgements

We thank Prof. Philippe Narcy (Chief of the Otorhinolaryngology Department at Robert Debré Hospital) and Prof. Georges-François Penneçot (Chief of the Department of Orthopedic Surgery at Robert Debré Hospital) for their contribution to the study. We also thank Dr. Sidney Wiener and Prof. Pierre Denise who provided helpful comments on the text.

References (20)

  • LS Weinstein

    Adolescent idiopathic scoliosis: prevalence and natural history

  • R Herman et al.

    Vestibular functioning in idiopathic scoliosis

    Orthop Trans

    (1979)
  • GM Jensen et al.

    Horizontal post-rotatory nystagmus response in female subjects with adolescent idiopathic scoliosis

    Phys Ther

    (1979)
  • T Sahlstrand et al.

    Vestibulospinal reflex activity in patients with adolescent idiopathic scoliosis: postural effects during caloric labyrinthine stimulation recorded by stabilometry

    Acta Orthop Scand

    (1979)
  • T Sahlstrand et al.

    A study of labyrinthine function in patients with adolescent idiopathic scoliosis: an electro-nystagmo-graphic study

    Acta Orthop Scand

    (1979)
  • T Sahlstrand et al.

    Postural effects on nystagmus response during caloric labyrinthine stimulation in patients with adolescent idiopathic scoliosis: an electro-nystagmo-graphic study

    Acta Orthop Scand

    (1979)
  • C De Waele et al.

    A radiological analysis of the postural syndromes following global and selective lesions in the guinea pig

    Exp Brain Res

    (1989)
  • B Cohen et al.

    Selective labyrinthine lesions and nystagmus induced by rotation about off vertical axes

  • C Darlot et al.

    Eye movements induced by off vertical axis rotation (OVAR) at small angles of tilt

    Exp Brain Res

    (1988)
  • JM Furman et al.

    Off vertical axis rotation: a test of the otolith-ocular reflex

    Ann Otol Rhinol Laryngol

    (1992)
There are more references available in the full text version of this article.

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    Because the lateral vestibulospinal tract controls axial muscles, alteration in the brainstem during body growth (i.e., preadolescent and adolescent period) may translate in abnormal trunk activation and cause permanent spine deformities. Consequently, during the last decades, several authors have suggested that scoliosis onset may be related to impairment of the vestibular system because of its contribution to regulation of axial muscles tone e.g. [5,11–13]. Nonetheless, no study has addressed whether direct vestibular stimulation would lead to abnormal motor response in patients with AIS compared to controls.

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From the Otorhinolaryngology Department and the Department of Orthopedic Surgery, Hôpital Robert Debré, Paris, France.

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Supported by the CNES, INSERM, Fondation pour la Recherche Médicale, Fondation de France, and The Reuter Fondation.

Reprint requests: Sylvette R. Wiener-Vacher, MD, Hôpital Robert Debré, Département d'ORL, 48 bld Sérurier, 75019 Paris, France.

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