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PATTERNS OF EXTRA-SPINAL LEFT-RIGHT SKELETAL ASYMMETRIES IN ADOLESCENT GIRLS WITH LOWER SPINE SCOLIOSIS: I. RELATIVE LENGTHENING OF THE ILIUM ON THE CURVE CONCAVITY – REAL INCREASE OR INNOMINATE ROTATION/ TORSION EFFECT?

¹ The Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham, UK , ² Department of Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK (Supported by AO).

Patterns of extra-spinal skeletal length asymmetry have been reported for upper limbs [1] and ribcage [2] of patients with upper spine adolescent idiopathic scoliosis. This paper reports a third pattern in the ilia. Seventy of 108 consecutive adolescent patients referred from routine scoliosis school screening during 1996–1999 had lower spine scoliosis – lumbar (LS), thoracolumbar (TLS), or pelvic tilt scoliosis (PTS). Radiologic bi-iliac and hip tilt angles were both measurable in 60 subjects: LS 18, TLS 31, and PTS 11 (girls 44, boys 16, mean age 14.6 years). Cobb angle (CA), apical vertebral rotation (AVR) and apical vertebral translation from the T1-S1 line (AVT) were measured on standing full spine radiographs (mean Cobb angle 14 degrees, range 4–38 degrees, 33 left, 27 right curves). Bi-iliac tilt angle (BITA) and hip tilt angle (HTA) were measured trigonometrically and iliac height asymmetry calculated as BITA minus HTA (corrected BITA=CBITA) and directly as iliac height asymmetry. Iliac height is relatively taller on the concavity of these curves (p<0.001). CBITA is associated with Cobb angle, AVR and AVT (each p<0.001).

Conclusion: The relatively taller concave ilium may be 1) real from primary skeletal changes or asymmetric muscle traction on iliac apophyses [3], or 2) apparent from rotation/torsion at the sacro-iliac joint(s).

Correspondence should be addressed to Jeremy C T Fairbank at The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX7 7LD, UK