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A new concept for the etiopathogenesis of the thoracospinal deformity of idiopathic scoliosis: summary of an electronic focus group debate of the IBSE

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Abstract.

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis, and treatment is pragmatic and unrelated to such knowledge. As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate of extant knowledge on important topics. This has been designated as an on-line Delphi discussion, and has proven very successful. The text for this EFG was written by Professor Sevastik and drawn from the extensive research carried out by himself and his co-workers. The thoracospinal concept of etiopathogenesis applies only to girls with right thoracic adolescent idiopathic scoliosis (Rcx-T-AIS-F). According to this concept, increased longitudinal growth of the left periapical ribs triggers the thoracic curve simultaneously in the three cardinal planes. The concept does not deal with factors involved in curve progression. Sevastik advocates mini-invasive operations on the ribs as a treatment for early progressive thoracic curves. Areas of controversy include whether or not there is overgrowth of the left periapical ribs in Rcx-T-AIS-F, and the question of whether there should be a clinical trial of mini-invasive operations on the ribs.

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Author information

Authors and Affiliations

  1. Karolinska Institute, Stockholm, Sweden

    J. Sevastik

  2. The Centre for Spinal Studies and Surgery, NG7 2UH, Nottingham, UK

    R. G. Burwell

  3. Faculty of Medicine, University of Liverpool, Liverpool, UK

    P. H. Dangerfield

Authors
  1. J. Sevastik
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  2. R. G. Burwell
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  3. P. H. Dangerfield
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Corresponding author

Correspondence to R. G. Burwell.

Additional information

This paper provides an edited summary of the first electronic focus group (EFG) of the International Federated Body on Scoliosis Etiology (IBSE). In it, the extensive research of Professor Sevastik and his colleagues on the thoracospinal theory of right thoracic adolescent idiopathic scoliosis in girls was debated via e-mail by IBSE members during the period November 2000 to March 2001. The summary (Comments, Questions and Answers 1–14) was circulated by e-mail to IBSE members on 4 April 2001. Comment 15 was subsequently received on 3 June 2002. Ideas presented in this summary are personal opinion and are not necessarily shared by all those within IBSE

Appendix

Appendix

International Federated Body on Scoliosis Etiology: mission, organization, membership, origins and mandate

Mission

The aim of the International Federated Body on Scoliosis Etiology (IBSE) is to widen the understanding of scoliosis etiology into other fields of science by bringing together experts in various fields of biological and engineering science. It provides a forum for a wider debate about scoliosis etiology and the presentation and encouragement of scoliosis research. The goal is the prevention of idiopathic scoliosis.

In the 9 years of its existence, the IBSE has promoted research on the etiology of idiopathic scoliosis in collaboration with other individuals and bodies. This has resulted in a conference (the Tenth Philip Zorab Scoliosis Symposium, Oxford, 30 March – 1 April 1998), a book (Etiology of Adolescent Idiopathic Scoliosis, Current Trends and Relevance to New Treatment Approaches, edited by RG Burwell, PH Dangerfield, TG Lowe, JY Margulies – Spine: State of the Art Reviews 2000;14), a CD-ROM bibliography of over 3500 references (available from Dr. Dangerfield), three electronic focus group debates (a summary of the first of which is published here), and the establishment of a website (www.liv.ac.uk/FacultyMedicine/ibse/). In addition, as a direct outgrowth of this collaboration, a Current Concepts Review was published in the American issue of the Journal of Bone and Joint Surgery (Lowe et al. 2000).

Organization

IBSE is not affiliated to any society and is an ad hoc body. It has two Trustees and eleven Co-ordinators. The Trustees are Mr. M.A. Edgar MChir FRCS and Mr. A.D.H. Gardner FRCS. The Co-ordinators are Professor R.G. Burwell MD FRCS, Dr. P.H. Dangerfield MD, Dr. K.M. Bagnall PhD, Dr. T.G. Lowe MD, Dr T.B. Grivas MD, Dr. N.H. Miller MD, Mr. V.J. Raso MASc, Professor J.A. Sevastik MD PhD, Dr. I.A.F. Stokes PhD, Professor T.K.F. Taylor D Phil FRCS and Professor D. Uyttendaele MD. The late Dr. S. Willner MD PhD was a Co-ordinator. Professor Burwell and Dr. Dangerfield facilitate the activities of IBSE. Currently there are 124 members in 26 countries. The initial members were contacted by mail in the first Postal Meeting of IBSE, dated 14 December 1994. The Tenth IBSE Meeting was e-mailed to IBSE members on September 26 2000 and comments invited. All contacts and exchange of views are by e-mail. Funding of IBSE was by the Scoliosis Research Society (1995–1997) and subsequently the British Scoliosis Research Foundation, for which we are grateful.

Membership

To date, the IBSE membership has been established mainly by invitation. The 11th Postal Meeting of IBSE contains the current list of members with qualifications, affiliations, postal addresses, telephone/fax numbers, e-mail addresses and research interests. Membership is open to all scoliosis surgeons and scientists as well as surgeons and scientists in other fields who are interested in the etiology of idiopathic scoliosis, who can join by sending their details electronically to Dr. Dangerfield (spine92@liverpool.ac.uk). There is no membership fee. New members will be informed by e-mail of the current activities of IBSE.

Origins and mandate

In 1993, in a paper that appeared in the British edition of the Journal of Bone and Joint Surgery (Orthopaedic Proceedings, vol 76 Supplement I, 12; 1994), presenting a concept for the etiology of idiopathic scoliosis, Burwell and Dangerfield called for a Task Force to hasten the possible finding of new treatments based on some knowledge of causation of idiopathic scoliosis. A letter was subsequently received by Professor Burwell from Dr. Dale E. Rowe MD, Chairman of the Prevalence Committee of the Scoliosis Research Society, requesting "thoughts...on the etiology and any ways in which the Scoliosis Research Society can further research in this matter." During the following year, the possibility of encouraging more etiologic research was discussed further at scientific meetings and among scoliosis surgeons and scientists. A formal proposal for the creation of an International Federated Body on Scoliosis Etiology (IBSE) was developed, put to and approved by each of the British Scoliosis Society Executive, the British Scoliosis Research Foundation (BSRF), the European Spinal Deformities Society Executive, the International Research Society of Spinal Deformities, through its first President Dr. Morey Moreland MD, and the Board of Directors of the Scoliosis Research Society (SRS). The then President of the SRS, Dr. Edgar G. Dawson MD, on behalf of the Board of Directors, gave approval for the initial funding for IBSE "with Drs. Dale Rowe, Thomas Haher and Richard Brown to serve as ad hoc committee to work with you on this project." Subsequently, during the Presidency of Marc Asher (1996–1997), the SRS established an ad hoc Etiology Committee (Chairman Dr. Thomas G. Lowe MD), four members of which are also Co-ordinators or a Trustee of IBSE (Dr. T.G. Lowe MD, Mr. M.A. Edgar M Chir FRCS, Dr. N.H. Miller MD, Mr. V.J. Raso MASc).

An earlier draft of this account of IBSE was written by R.G. Burwell and P.H. Dangerfield and sent by e-mail to all IBSE members for comment, and those comments have been incorporated in this text.

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Sevastik, J., Burwell, R.G. & Dangerfield, P.H. A new concept for the etiopathogenesis of the thoracospinal deformity of idiopathic scoliosis: summary of an electronic focus group debate of the IBSE. Eur Spine J 12, 440–450 (2003). https://doi.org/10.1007/s00586-002-0489-4

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