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Master Thesis

Scoliose idiopathique de l’enfant : une maladie d’origine vestibulaire ?

Abstract : Introduction: idiopathie scoliosis in children is a frequent disease (3-4% of world population), with potentially heavy somatopsychic repercussions for the child (surgery, chronic respiratory failure, pain, depression…) and major Public Health cost for our societies (repeated consultation, radiological examinations, surgery, equipment (brace)…). Knowing the cause of this disease would eventually improve early detection, optimize its treatment, and thus reduce its impact and cost. Several hypotheses exist alongside attempting to explain this disease, but so far none are currently validated. One recent study showed for the first time in the animal a causality link between inner ear and scoliosis : in Xenopus tadpoles (aquatic frog specie), surgical destruction of one inner ear at some stage of development systematically induced scoliosis in adult Xenopus. This is explained by the existence of vestibulospinal pathways: posterior labyrinth can induce stimulation or inhibition of paraspinal muscles, thus causing a distortion in all respects similar to spinal deformities observed in humans during scoliosis. This vestibular asymmetry is not compensated in the absence of proprioceptive information (no land walking), and becomes final when ossification of the growth cartilages. If this hypothesis was to verify in humans, it would be logical to find remains of vestibular asymmetry among children with idiopathic scoliosis. Material and method: objectives of our study were to verify whether children with idiopathic scoliosis showed vestibular asymmetry even if it had been compensated in life (children with scoliosis do not have vertigo), and whether this asymmetry is significantly more common than in the general infant population, but also to check whether there were relationships between type of vestibular abnormalityand importance of scoliosis or scalability. Therefore we performed in children between 6 and 18 years after clinical ENT examination, vestibular explorations (caloric tests, saccular and utricle otolith evoked myogenical potentials (Vestibular EMP). To interpret our results, we have calculated a standard (which did not exist so far) for child’s PEO from a healthy control group. Our study was a prospective study conducted from 2011 to 2015. Results: our study is the first to propose a standard for the interpretation of VEMP in childhood. A utricule VEMP could be defined as abnormal if the ratio of asymmetry is greater than 41, while a saccular VEMP would be abnormal if the ratio of asymmetry is greater than 47. The present study shows a rate never observed of vestibular abnormalities in children with scoliosis (71% of the 31 children studied), while only 16% of 43 healthy children have a vestibular asymmetry (p < 0.001). We did not find any correlation between the type of vestibular disease and the importance or progression of scoliosis. Conclusion: after setting a standard for VEMP in children (asymmetry ratio below 41 for the bladderwort and 47 for saccular), we observed a vestibular asymmetry rate in children with scoliosis significantly higher than in healthy children (71% vs 16%, p <0.001). Discussion: vestibular abnormalities therefore do not appear to 100% of idiopathic scoliosis but this can be explained by several reasons: a sensitivity of paraclinical tests used less than 100% : we may be observed false negatives. Secondly, VEMP allow only calculate an asymmetry ratio and not an overall deficit in absolute value of the vestibular system. In our case, anomaly is embryonic. Vestibular compensation is performed during growth of the child, some patients may compensate faster than others: we may study only remains of the initial vestibular abnormalities. Thirdly, we have not tested the entire vestibular system: we lack a complete high frequency analysis of the function of all semicircular canals. Idiopathic scoliosis may not be all related to vestibular abnormalities. We believe that in reality there are many anomalies in the embryonic central nervous system affecting the spinal posture which could induce scoliosis. Vestibular system would probably not be an example of a possible cause of idiopathic scoliosis. The provided work in this thesis calls other studies to support the causal link between vestibular abnormalities and infant scoliosis, particularly in studying malformations and scoliosis of scoliosis operated, with larger numbers but also prospective therapeutic studies randomized controlled, student vestibular rehabilitation effect on scoliosis, and finally the development of a vestibular screening test (neonatal or infant) to identify children at risk of developing scoliosis.
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Master Thesis
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Submitted on : Thursday, November 19, 2015 - 3:48:26 PM
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François Rubin. Scoliose idiopathique de l’enfant : une maladie d’origine vestibulaire ?. Médecine humaine et pathologie. 2015. ⟨dumas-01231175⟩

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