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A Comparative Analysis of the Metabolic and Coagulative Profiles in Patients with Idiopathic Scoliosis, Congenital Scoliosis and Healthy Controls: A Case-Control Study

  • Ahuja, Kaustubh (Department of Orthopaedics, All India Institute Of Medical Sciences) ;
  • Garg, Bhavuk (Department of Orthopaedics, All India Institute Of Medical Sciences) ;
  • Chowdhuri, Buddhadev (Department of Orthopaedics, All India Institute Of Medical Sciences) ;
  • Yadav, Raj Kumar (Department of Physiology, All India Institute Of Medical Sciences) ;
  • Chaturvedi, Pradeep Kumar (Department of Reproductive Medicine, All India Institute Of Medical Sciences Sciences)
  • Received : 2018.02.21
  • Accepted : 2018.05.02
  • Published : 2018.12.31

Abstract

Study Design: Single-center, observational, case-control study. Purpose: Comparison and analysis of the metabolic and coagulative profiles in patients with idiopathic scoliosis, patients with congenital scoliosis, and healthy controls. Overview of Literature: Serum melatonin deficiency has been a controversial topic in the etiopathogenesis of scoliosis. Low bone mineral density, low vitamin D3 levels, and high parathyroid hormone levels are common metabolic abnormalities associated with scoliosis that may be responsible for its pathogenesis. In addition to metabolic defects, several studies have shown coagulation defects that either persist from the preoperative period or occur during surgery and usually lead to more than the expected amount of blood loss in patients undergoing deformity correction for scoliosis. Methods: The study population (n=73) was classified into those having congenital scoliosis (n=31), those with idiopathic scoliosis (n=30), and healthy controls (n=12). After detailed clinicoradiological evaluation of all the subjects, 10-mL blood samples were collected, measured, and analyzed for various metabolic and coagulation parameters. Results: The mean serum melatonin levels in patients with idiopathic scoliosis were significantly lower than those in the healthy controls. Although the mean serum melatonin level in the congenital group was also low, the difference was not statistically significant. Serum alkaline phosphatase and parathyroid hormone levels were higher in the scoliosis groups, whereas the vitamin D level was lower. No differences were observed in the coagulation profiles of the different groups. Conclusions: Low serum melatonin levels associated with scoliosis can be a cause or an effect of scoliosis. Moreover, low bone mineral density, high bone turn over, and negative calcium balance appear to play an important role in the progression, if not the onset, of the deformity.

Keywords

References

  1. Batista R, Martins DE, Hayashi LF, Lazaretti-Castro M, Puertas EB, Wajchenberg M. Association between vitamin D serum levels and adolescent idiopathic scoliosis. Scoliosis 2014;9:O45. https://doi.org/10.1186/1748-7161-9-S1-O45
  2. Herring JA. Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children. 5th ed. Philadelphia (PA): Elsevier; 2014.
  3. Wynne-Davies R. Familial (idiopathic) scoliosis: a family survey. J Bone Joint Surg Br 1968;50:24-30.
  4. Robin GC, Cohen T. Familial scoliosis: a clinical report. J Bone Joint Surg Br 1975;57:146-8.
  5. Machida M, Murai I, Miyashita Y, Dubousset J, Yamada T, Kimura J. Pathogenesis of idiopathic scoliosis: experimental study in rats. Spine (Phila Pa 1976) 1999;24:1985-9. https://doi.org/10.1097/00007632-199910010-00004
  6. Michelsson JE. The development of spinal deformity in experimental scoliosis. Acta Orthop Scand Suppl 1965:Suppl 81:1-91.
  7. Machida M, Dubousset J, Imamura Y, Iwaya T, Yamada T, Kimura J. Role of melatonin deficiency in the development of scoliosis in pinealectomised chickens. J Bone Joint Surg Br 1995;77:134-8.
  8. Machida M, Dubousset J, Yamada T, Kimura J. Serum melatonin levels in adolescent idiopathic scoliosis prediction and prevention for curve progression: a prospective study. J Pineal Res 2009;46:344-8. https://doi.org/10.1111/j.1600-079X.2009.00669.x
  9. Bagnall KM, Raso VJ, Hill DL, et al. Melatonin levels in idiopathic scoliosis: diurnal and nocturnal serum melatonin levels in girls with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1996;21:1974-8. https://doi.org/10.1097/00007632-199609010-00006
  10. Fagan AB, Kennaway DJ, Sutherland AD. Total 24-hour melatonin secretion in adolescent idiopathic scoliosis: a case-control study. Spine (Phila Pa 1976) 1998;23:41-6. https://doi.org/10.1097/00007632-199801010-00009
  11. Balioglu MB, Aydin C, Kargin D, et al. Vitamin-D measurement in patients with adolescent idiopathic scoliosis. J Pediatr Orthop B 2017;26:48-52. https://doi.org/10.1097/BPB.0000000000000320
  12. Ryan KM, O'Brien K, Regan I, et al. The prevalence of abnormal preoperative coagulation tests in pediatric patients undergoing spinal surgery for scoliosis. Spine J 2015;15:1217-22. https://doi.org/10.1016/j.spinee.2013.07.460
  13. Bosch P, Kenkre TS, Londino JA, Cassara A, Yang C, Waters JH. Coagulation profile of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. J Bone Joint Surg Am 2016;98:e88. https://doi.org/10.2106/JBJS.16.00114
  14. Brenn BR, Theroux MC, Dabney KW, Miller F. Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976) 2004;29:E310-4. https://doi.org/10.1097/01.BRS.0000132513.88038.64
  15. Neuwelt EA, Mickey B, Lewy AJ. The importance of melatonin and tumor markers in pineal tumors. J Neural Transm Suppl 1986;21:397-413.
  16. Minneman KP, Wurtman RJ. The pharmacology of the pineal gland. Annu Rev Pharmacol Toxicol 1976;16:33-51. https://doi.org/10.1146/annurev.pa.16.040176.000341
  17. Thillard MJ. Vertebral column deformities following epiphysectomy in the chick. C R Hebd Seances Acad Sci 1959;248:1238-40.
  18. Machida M, Dubousset J, Imamura Y, Miyashita Y, Yamada T, Kimura J. Melatonin: a possible role in pathogenesis of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1996;21:1147-52. https://doi.org/10.1097/00007632-199605150-00005
  19. Machida M, Saito M, Dubousset J, Yamada T, Kimura J, Shibasaki K. Pathological mechanism of idiopathic scoliosis: experimental scoliosis in pinealectomized rats. Eur Spine J 2005;14:843-8. https://doi.org/10.1007/s00586-004-0806-1
  20. Deacon S, Arendt J. Posture influences melatonin concentrations in plasma and saliva in humans. Neurosci Lett 1994;167:191-4. https://doi.org/10.1016/0304-3940(94)91059-6
  21. Kamimura M, Uchiyama S, Takahara K, Hashidate H, Kawaguchi A, Nakagawa H. Urinary excretion of type I collagen cross-linked N-telopeptide and serum bone-specific alkaline phosphatase analysis to determine the correlation of age and back-pain related changes in elderly women. J Bone Miner Metab 2005;23:495-500. https://doi.org/10.1007/s00774-005-0634-3
  22. Mukaiyama K, Kamimura M, Uchiyama S, Ikegami S, Nakamura Y, Kato H. Elevation of serum alkaline phosphatase (ALP) level in postmenopausal women is caused by high bone turnover. Aging Clin Exp Res 2015;27:413-8. https://doi.org/10.1007/s40520-014-0296-x
  23. Matsuoka K, Park KA, Ito M, Ikeda K, Takeshita S. Osteoclast-derived complement component 3a stimulates osteoblast differentiation. J Bone Miner Res 2014;29:1522-30. https://doi.org/10.1002/jbmr.2187
  24. Murray DJ, Pennell BJ, Weinstein SL, Olson JD. Packed red cells in acute blood loss: dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg 1995;80:336-42.
  25. Horlocker TT, Nuttall GA, Dekutoski MB, Bryant SC. The accuracy of coagulation tests during spinal fusion and instrumentation. Anesth Analg 2001;93:33-8.
  26. Ho WK, Baccala M, Thom J, Eikelboom JW. High prevalence of abnormal preoperative coagulation tests in patients with adolescent idiopathic scoliosis. J Thromb Haemost 2005;3:1094-5. https://doi.org/10.1111/j.1538-7836.2005.01252.x
  27. Stanitski CL, Whittlesey G, Thompson I, Stanitski DF, Mohan A. Clotting parameters in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion and instrumentation. J Pediatr Orthop B 1998;7:132-4. https://doi.org/10.1097/01202412-199804000-00007