Role of Intranatal cervical spine injury in the pathogenesis of idiopathic scoliosis: integration of neurological and biomechanical aspects. A review

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Abstract

Idiopathic scoliosis remains one of the most common and complex orthopedic disorders in children and adolescents. Despite recognition of the role of genetic, hormonal, and environmental factors, the initial trigger initiating spinal deformity at an early age remains a subject of debate. This review analyzes the international scientific data addressing intranatal cervical spine injury as a potential provoking factor in the development of idiopathic scoliosis in genetically predisposed individuals. A systematic analysis of publications indexed in PubMed, Google Scholar, eLibrary, and CyberLeninka from 2010 to 2024 was conducted, addressing the etiology of idiopathic scoliosis, with an emphasis on studies examining the association between complicated childbirth, cervical spine biomechanics, and the subsequent development of spinal deformity. This review summarizes and analyzes current evidence on the potential role of intranatal injury to the craniovertebral junction in the pathogenesis of idiopathic scoliosis, integrating neurological, biomechanical, and genetic aspects. It has been demonstrated that mechanical stress applied to the cervical spine during childbirth (including breech presentation, precipitous or prolonged labor, and the use of obstetric maneuvers) may result in microinjury to dural structures, brainstem ischemia, and dysfunction of reticulospinal pathways. These alterations may lead to asymmetrical muscle tone, which, in pubertal growth acceleration and genetic susceptibility, manifests as a persistent three-dimensional spinal deformity. An integrative model of the pathogenetic cascade is proposed to explain the latent period and subsequent progression of idiopathic scoliosis. Intranatal cervical spine injury represents a considerable, although not exclusive, trigger in the development of idiopathic scoliosis. A comprehensive approach incorporating perinatal history assessment, early genetic screening, and ultrasound monitoring of the craniovertebral region in at-risk children may serve as a basis for developing primary prevention strategies for idiopathic scoliosis.

About the authors

Marina E. Vinderlikh

Mari State University

Author for correspondence.
Email: vinderlikh@yandex.ru
ORCID iD: 0000-0002-9855-548X
SPIN-code: 9943-2150

MD, Cand. Sci. (Medicine)

Russian Federation, Yoshkar-Ola

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

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