Rob C. Brink, Jelle F. Homans, Tom P. C. Schlösser, Marijn van Stralen, Koen L. Vincken, Lin Shi, Winnie C. W. Chu, Max A. Viergever, René M. Castelein, Jack C. Y. Cheng

December 2019, Volume 28, Issue 12, pp 3044 - 3052 Original Article Read Full Article 10.1007/s00586-019-06138-3

First Online: 11 September 2019

CT-based study of vertebral and intravertebral rotation in right thoracic adolescent idiopathic scoliosis


To define the longitudinal rotation axis around which individual vertebrae rotate, and to establish the various extra- and intravertebral rotation patterns in thoracic adolescent idiopathic scoliosis (AIS) patients, for better understanding of the 3D development of the rotational deformity.


Seventy high-resolution CT scans from an existing database of thoracic AIS patients (Cobb angle: 46°–109°) were included to determine the vertebral axial rotation, rotation radius, intravertebral axial rotation, and local mechanical torsion for each spinal level, using previously validated image processing techniques.


For all levels, the longitudinal rotation axis, from which the vertebrae rotate away from the midline, was localized posterior to the spine. The axis became closer to the spine at the apex: apex, r = 11.5 ± 5.1 cm versus two levels above (radius = 15.8 ± 8.5 cm; p < 0.001) and beneath (radius = 14.2 ± 8.2 cm; p < 0.001). The vertebral axial rotation, intravertebral axial rotation, and local mechanical torsion of the vertebral bodies were largest at the apex (21.9° ± 7.4°, 8.7° ± 13.5° and 3.0° ± 2.5°) and decreased toward the neutral, junctional zones (p < 0.001).


In AIS, the vertebrae rotate away around an axis that is localized posterior to the spine. The distance between this axis and the spine is minimal at the apex and increases gradually to the neutral zones. The vertebral axial rotation is accompanied by smaller amounts of intravertebral rotation and local mechanical torsion, which increases toward the apical region. The altered morphology and alignment are important for a better understanding of the 3D pathoanatomical development of AIS and better therapeutic planning for bracing and surgical intervention.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

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