Traditionally, scoliosis has been scrutinised primarily through the lens of orthopaedic and musculoskeletal medicine. However, recent advances in neuroscience have begun to elucidate the neurological underpinnings of this condition, offering a novel perspective on its etiology and progression. Moreover, the interplay between scoliosis and biological aging presents an intriguing dimension meriting further exploration.
The Neurological Basis of Scoliosis
Scoliosis, a multifaceted spinal disorder characterised by an abnormal lateral curvature of the spine, affects millions globally.
The genesis of scoliosis is inherently multifactorial, encompassing genetic, biomechanical, and neuromuscular components.
Emerging research underscores significant neurological factors that may contribute to the development and progression of scoliosis. A pivotal area of interest is the role of the central nervous system (CNS) in maintaining postural equilibrium and spinal alignment.
The CNS, comprising the brain and spinal cord, is integral to processing sensory information and coordinating motor output to sustain posture and balance. In individuals with scoliosis, disruptions in the neural pathways regulating these functions have been implicated. Studies have demonstrated that aberrant proprioception—the body’s ability to perceive its own position in space—may be a contributory factor. Such disruptions can precipitate improper spinal alignment and asymmetrical muscle activation, exacerbating spinal curvature.
Neuroimaging studies have revealed both structural and functional anomalies in the brains of individuals with scoliosis. These anomalies are often localised in regions associated with motor control and sensory processing, such as the cerebellum and somatosensory cortex. The cerebellum, which is crucial for motor coordination, has been found to exhibit abnormalities in size and activity levels in scoliosis patients. This suggests that cerebellar dysfunction may play a contributory role in the motor control deficits observed in scoliosis.
Scoliosis and Biological Aging
Biological aging, characterised by the progressive decline in physiological function and increased susceptibility to diseases, intersects intriguingly with scoliosis.
The degenerative changes associated with aging, such as sarcopenia (loss of muscle mass), osteopenia/osteoporosis (decreased bone density), and intervertebral disc degeneration, can exacerbate scoliosis or precipitate its late-onset variant, known as degenerative scoliosis.
As individuals age, the cumulative impact of biomechanical stressors on spinal structures can lead to the progression of scoliosis. Degenerative alterations in the spine, including facet joint arthritis and disc herniation, can destabilise the spinal column and contribute to worsening curvature. Furthermore, the aging process impairs the body’s capacity to repair and regenerate damaged tissues, complicating the management of scoliosis in older adults.
The relationship between scoliosis and biological aging is bidirectional. Aging exacerbates scoliosis, but scoliosis can also accelerate the aging process. Chronic pain and physical limitations associated with scoliosis often result in decreased physical activity, which in turn can expedite muscle atrophy and bone density loss. This creates a vicious cycle wherein scoliosis and aging synergistically deteriorate the individual’s overall health.
Current Treatments and Clinical Trials for Scoliosis
The management of scoliosis encompasses a range of treatments, including medications, surgical interventions, and ongoing clinical trials aimed at improving outcomes. Medications play a limited role and are primarily used to manage pain and inflammation associated with the condition.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to alleviate discomfort, although they do not address the curvature itself. In certain cases, muscle relaxants and opioids may be used to manage severe pain, but these are generally not recommended for long-term use due to their potential for dependence and side effects.
Surgical intervention is often considered for severe cases of scoliosis, particularly when the curvature exceeds 45-50 degrees and is progressive. The most common surgical procedure is spinal fusion, which involves the fusion of two or more vertebrae to prevent further curvature. Advanced techniques such as thoracoscopic surgery, which is less invasive, and the use of instrumentation like rods, screws, and hooks, have improved surgical outcomes and reduced recovery times.
Another innovative approach is vertebral body tethering (VBT), a less invasive procedure suitable for growing children that uses a flexible cord to correct the spine while allowing continued growth.
Clinical trials are actively exploring new treatments and interventions for scoliosis. One area of research focuses on the use of neuromodulation techniques, such as transcranial magnetic stimulation (TMS) and spinal cord stimulation (SCS), to correct neural pathway dysfunctions associated with scoliosis.
Additionally, regenerative medicine approaches, including stem cell therapy and gene therapy, are being investigated for their potential to repair and regenerate damaged spinal tissues. Pharmacological advancements are also underway, with trials examining the efficacy of novel compounds that target the molecular pathways involved in bone growth and remodelling.
Bisphosphonates, traditionally used for osteoporosis, are being explored for their potential to strengthen vertebrae and slow the progression of scoliosis. Another drug, melatonin, has shown promise in animal models by potentially influencing bone growth and spinal development. Research is also looking into the role of hormones such as growth hormone and leptin, which may have indirect effects on spinal curvature through their influence on growth and metabolism.
The integration of these emerging therapies with traditional treatments holds promise for more effective management of scoliosis.
The combination of surgical innovations, neuromodulation, and regenerative medicine represents a comprehensive approach that addresses both the structural and neurological aspects of scoliosis.
Ongoing research and clinical trials are essential for translating these advancements into clinical practice, ultimately improving patient outcomes and quality of life.
The Future of Scoliosis Research
An Integrative Approach
Elucidating the neurological basis of scoliosis and its interplay with biological aging opens new avenues for research and therapeutic intervention.
Neuromodulation techniques, advancements in regenerative medicine, including stem cell therapy and tissue engineering, offer potential for mitigating the degenerative changes associated with aging and scoliosis.
An integrative approach, amalgamating insights from neuroscience, orthopaedics, and geriatrics, is crucial for developing comprehensive treatment strategies. By addressing the neurological and aging-related aspects of scoliosis, healthcare providers can optimize management and improve the quality of life for affected individuals.
The neuroscientific exploration of scoliosis offers profound insights into its etiology and progression, while its connection to biological aging underscores the condition’s complexity. Continued interdisciplinary research is imperative for unravelling the intricacies of scoliosis and fostering innovative treatments that address both its neurological and aging-related dimensions.
Referencias
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About the author
Niharika Singh
I completed my Bachelor’s in Zoology (Honours) at Scottish Church College, University of Calcutta, graduating with distinction in 2019.
My interest in Neuroscience grew during my studies, particularly in adult neurogenesis and the fate specification of neural stem cells, which inspired me to explore therapeutic applications for nervous system disorders.
I received a fellowship to pursue a Master’s in Neuroscience at the School of Studies in Neuroscience, Gwalior, where I conducted my dissertation at IIT Madras, modeling the dynamics of the basal ganglia in Parkinson’s disease using computational neuroscience.
In 2022, I was awarded the UKRI Southwest Biosciences Doctoral Scholarship for a PhD at Cardiff University, focusing on the role of Zeb1 in astrocyte specification across development and adulthood. My research combines computational bioinformatics, stem cell biology, and developmental neuroscience.
Currently, I am undertaking a Professional Internship for PhD students at EpiDisease S.L. in Valencia, where I am investigating epigenetic modifications in patients with PICS, linking these findings to biological aging and disease progression.
After completing my PhD in 2026, I aim to pursue a postdoctoral position studying astrocytes in relation to glioblastoma.
Contact Niharika at:
singhn27@cardiff.ac.uk
