Neuro-sensory approach
What we do know
Over the past 20 years, researchers have identified abnormal functioning of the vestibular system and morphological alterations in the central nervous system in patients with scoliosis.
These observations have led to the hypothesis that idiopathic scoliosis has a neurological origin, in which altered proprioceptive circuits play a decisive role.
What we ignore
There are many indications of a neurological/vestibular cause. But where exactly does it occur?
Are these neuronal or proprioceptive alterations the cause or effect of scoliosis and trunk deformation?
How does proprioception induce spinal deformity?
What advances were made thanks to the research supported by the Fondation Cotrel?
In Lille, Dr. Dominique Rousié uses an MRI technique that enables in vivo mapping of the microstructure and organization of brain tissue. His work has highlighted two fundamental points.
- No macroscopic alterations are present in patients with scoliosis.
- Alterations in the microstructure of the white matter are present: fibers are less numerous and show a myelination deficit in the corpus callosum and in the corticospinal bundle, at the level of the bridge (brainstem). Abnormal sensory and motor integration at the level of the bridge would thus be associated with the development of idiopathic scoliosis.
At Laval University (Canada), Prof. Martin Simoneau is analyzing the sensory-motor mechanisms that may play a role in the genesis and evolution of idiopathic scoliosis. He has identified asymmetry in descending (corticospinal) pathways in patients with idiopathic scoliosis.
Prof. Christine Assaiante (CNRS, Marseille) has shown differences in frontal cortex connectivity between scoliosis patients and healthy controls. It would appear that children with scoliosis may show a comparative delay in maturation.
At the Weizmann Institute of Science, Revohot (Israel), Prof. Elazar Zelzer and his team have highlighted the role of trunk proprioception. Using an animal model (mutant mice with sensory neuron deficiency), they have investigated the central role of trunk proprioception and shown that deletion of a key mechanoreceptor in trunk proprioception (muscle bundles) induces severe scoliosis in mice. A second project involves the study of a protein, PIEZO 2, involved in mechano-transduction.
Patients with idiopathic scoliosis see themselves as straighter than they really are: they suffer from dysmorphophobia. Rehabilitation goals in the management of adolescents with idiopathic scoliosis have been modified. Ablation of this gene again results in scoliosis in an animal model.
In Villeneuve d’Ascq, Dr. Jean-François Catanzariti worked on the evaluation of the sense of verticality and concluded that people with scoliosis have a distorted representation of it. Patients have an erroneous knowledge of the shape of their back, and have difficulty aligning their trunk with the vertical. The origin of this anomaly could be related to the perception of the force of gravity and trunk proprioception, opening the door to studies focusing on trunk proprioception in humans.
Impact for the patient : A better understanding of what he “feels
A patient suffering from idiopathic scoliosis aligns his trunk – and therefore his spine – with a distorted vertical. He sees himself as straighter than he really is: he suffers from dysmorphophobia.
As a result of these discoveries, rehabilitation goals in the management of adolescents suffering from idiopathic scoliosis have been modified.
If patients are to follow the proposed treatments (intensive re-education, corrective corset), they need to understand what they’re suffering from.
Re-educators start by making the patient aware of the deformity in a variety of ways. This involves working in front of a mirror and capturing a video of the patient’s back, so that the deformity can be seen live on the computer screen.
He then uses touch, coupled with explanations based on his X-ray.
Once the teenager is aware of his deformity, he will learn to correct it by aligning his trunk vertically. These techniques are carried out by specialized occupational and physical therapists.
Over the past 20 years, researchers have identified abnormal functioning of the vestibular system and morphological alterations in the central nervous system in patients with scoliosis.
These observations have led to the hypothesis that idiopathic scoliosis has a neurological origin, in which altered proprioceptive circuits play a decisive role.
There are many indications of a neurological/vestibular cause. But where exactly does it occur?
Are these neuronal or proprioceptive alterations the cause or effect of scoliosis and trunk deformation?
How does proprioception induce spinal deformity?
In Lille, Dr. Dominique Rousié uses an MRI technique that enables in vivo mapping of the microstructure and organization of brain tissue. His work has highlighted two fundamental points.
- No macroscopic alterations are present in patients with scoliosis.
- Alterations in the microstructure of the white matter are present: fibers are less numerous and show a myelination deficit in the corpus callosum and in the corticospinal bundle, at the level of the bridge (brainstem). Abnormal sensory and motor integration at the level of the bridge would thus be associated with the development of idiopathic scoliosis.
At Laval University (Canada), Prof. Martin Simoneau is analyzing the sensory-motor mechanisms that may play a role in the genesis and evolution of idiopathic scoliosis. He has identified asymmetry in descending (corticospinal) pathways in patients with idiopathic scoliosis.
Prof. Christine Assaiante (CNRS, Marseille) has shown differences in frontal cortex connectivity between scoliosis patients and healthy controls. It would appear that children with scoliosis may show a comparative delay in maturation.
At the Weizmann Institute of Science, Revohot (Israel), Prof. Elazar Zelzer and his team have highlighted the role of trunk proprioception. Using an animal model (mutant mice with sensory neuron deficiency), they have investigated the central role of trunk proprioception and shown that deletion of a key mechanoreceptor in trunk proprioception (muscle bundles) induces severe scoliosis in mice. A second project involves the study of a protein, PIEZO 2, involved in mechano-transduction.
Patients with idiopathic scoliosis see themselves as straighter than they really are: they suffer from dysmorphophobia. Rehabilitation goals in the management of adolescents with idiopathic scoliosis have been modified. Ablation of this gene again results in scoliosis in an animal model.
In Villeneuve d’Ascq, Dr. Jean-François Catanzariti worked on the evaluation of the sense of verticality and concluded that people with scoliosis have a distorted representation of it. Patients have an erroneous knowledge of the shape of their back, and have difficulty aligning their trunk with the vertical. The origin of this anomaly could be related to the perception of the force of gravity and trunk proprioception, opening the door to studies focusing on trunk proprioception in humans.
A patient suffering from idiopathic scoliosis aligns his trunk – and therefore his spine – with a distorted vertical. He sees himself as straighter than he really is: he suffers from dysmorphophobia.
As a result of these discoveries, rehabilitation goals in the management of adolescents suffering from idiopathic scoliosis have been modified.
If patients are to follow the proposed treatments (intensive re-education, corrective corset), they need to understand what they’re suffering from.
Re-educators start by making the patient aware of the deformity in a variety of ways. This involves working in front of a mirror and capturing a video of the patient’s back, so that the deformity can be seen live on the computer screen.
He then uses touch, coupled with explanations based on his X-ray.
Once the teenager is aware of his deformity, he will learn to correct it by aligning his trunk vertically. These techniques are carried out by specialized occupational and physical therapists.
Les chercheurs et leurs travaux
Dr Kariman Abelin Genevois
Lauréate 2024
Dr Christine Assaiante
Lauréate 2004, 2010, 2015
Pr Robert Carlier
Lauréat 2015
Dr Jean-François Catanzariti
Lauréat 2017
Pr Jack Cheng
Lauréat 2001, 2005, 2010
Dr Winnie Chu
Lauréate 2023
Dr Rocio Garcia
Lauréat 2023
Dr Marie-Line Pissonnier
Lauréat 2015
Dr Dominique Rousié
Lauréate 2003, 2007, 2013, 2017
Pr Martin Simoneau
Lauréat 2001, 2010, 2017
Pr Elazar Zelzer
Lauréat 2018, 2023
