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DOI: https://doi.org/10.31616/asj.2024.0299    [Online first]
Online first February 4, 2025.
Dystrophinopathy in the paravertebral muscle of adolescent idiopathic scoliosis: a prospective case-control study in China
Junyu Li1,2,3  , Danfeng Zheng4  , Zekun Li5  , Jiaxi Li5  , Zexi Yang1,2,3  , Xiang Zhang1,2,3  , Yingshuang Zhang6  , Miao Yu1,2,3 
1Orthopaedic Department, Peking University Third Hospital, Beijing, China
2Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
3Beijing Key Laboratory of Spinal Disease Research, Beijing, China
4Department of Pathology, School of Basic Medical Sciences, Peking University Third Hospital, Peking University Health Science Center, Beijing, China
5Peking University Health Science Center, Beijing, China
6Departmant of Neurology, Peking University Third Hospital, Peking University, Beijing, China
Correspondence:  Miao Yu, Tel: +86-82267368, Fax: +86-10-82267368, 
Email: miltonyupku@163.com
Received: 6 August 2024   • Revised: 9 November 2024   • Accepted: 11 November 2024
*Junyu Li and Danfeng Zheng contributed equally to this study as co-first authors.
Abstract
Study Design
A prospective case-control study.
Purpose
This prospective case-control study aimed to analyze the paravertebral muscle changes in patients with adolescent idiopathic scoliosis (AIS) and determine paravertebral myopathological changes associated with the clinical progression of AIS.
Overview of Literature
The incidence of AIS is significant globally and worsens before bone maturation, causing a serious effect. Many studies have investigated its causes—such as genetic, epigenetic, and hormonal factors—but more research remains warranted.
Methods
This study enrolled 40 patients with AIS, 20 patients with congenital scoliosis (CS), and 20 patients with spinal degenerative disease (SDD). All patients underwent open posterior surgery in our hospital, and a paravertebral muscle (multifidus muscle) biopsy was performed intraoperatively. This study included many indexes that describe muscle, especially dystrophin staining. The above pathological results were compared among the AIS, CS, and SDD groups. The correlation between the Cobb angle and Nash–Moe classification and the above pathological results was analyzed in patients with AIS.
Results
Significant reductions in the dystrophin staining of dystrophin-1 (p<0.001), dystrophin-2 (p<0.001), and dystrophin-3 (p<0.001) were observed in the AIS group than in the CS and SDD groups. The higher the Nash–Moe classification in the AIS group, the more significant the loss of dystrophin-2 (p=0.042) in the convex paraspinal muscles. Additionally, a significantly positive correlation was observed between the reductions of dystrophin-2 on the concave side of the AIS group and Cobb angle (p=0.011).
Conclusions
Dystrophin protein deficiency in the paraspinal muscles plays a crucial role in AIS formation and progression. The severity of scoliosis in patients with AIS is correlated with the extent of dystrophin loss in the paravertebral muscles. Therefore, dystrophin dysfunction may be relevant to AIS occurrence and development.
Key Words: Paraspinal muscles; Adolescent idiopathic scoliosis; Biopsy; Pathology; Dystrophinopathy


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