Assessing nasal airway resistance and symmetry: An approach to global perspective through computational fluid dynamics.

This study aimed to explore the variability in nasal airflow patterns among different sexes and populations using computational fluid dynamics (CFD). We focused on evaluating the universality and applicability of dimensionless parameters R (bilateral nasal resistance) and ϕ (nasal flow asymmetry), initially established in a Caucasian Spanish cohort, across a broader spectrum of human populations to assess normal breathing function in healthy airways. In this retrospective study, CT scans from Cambodia (20 males, 20 females), Russia (20 males, 18 females), and Spain (19 males, 19 females) were analyzed. A standardized CFD workflow was implemented to calculate R-ϕ parameters from these scans. Statistical analyses were conducted to assess and compare these parameters across different sexes and populations, emphasizing their distribution and variances. Our results indicated no significant sex-based differences in the R parameter across the populations. However, moderate sexual dimorphism in the ϕ parameter was observed in the Cambodian group. Notably, no geographical differences were found in either R or ϕ parameters, suggesting consistent nasal airflow characteristics across the diverse human groups studied. The study also emphasized the importance of using dimensionless variables to effectively analyze the relationships between form and function in nasal airflow. The observed consistency of R-ϕ parameters across various populations highlights their potential as reliable indicators in both medical practice and further CFD research, particularly in diverse human populations. Our findings suggest the potential applicability of dimensionless CFD parameters in analyzing nasal airflow, highlighting their utility across diverse demographic and geographic contexts. This research advances our understanding of nasal airflow dynamics and underscores the need for additional studies to validate these parameters in broader population cohorts. The approach of employing dimensionless parameters paves the way for future research that eliminates confounding size effects, enabling more accurate comparisons across different populations and sexes. The implications of this study are significant for the advancement of personalized medicine and the development of diagnostic tools that accommodate individual variations in nasal airflow.

Beyond skeletal studies: A computational analysis of nasal airway function in climate adaptation.

OBJECTIVES: Ecogeographic variation in human nasal anatomy has historically been analyzed on skeletal morphology and interpreted in the context of climatic adaptations to respiratory air-conditioning. Only a few studies have analyzed nasal soft tissue morphology, actively involved in air-conditioning physiology. MATERIALS AND METHODS: We used in vivo computer tomographic scans of (N = 146) adult individuals from Cambodia, Chile, Russia, and Spain. We conducted (N = 438) airflow simulations during inspiration using computational fluid dynamics to analyze the air-conditioning capacities of the nasal soft tissue in the inflow, functional, and outflow tract, under three different environmental conditions: cold-dry; hot-dry; and hot-humid. We performed statistical comparisons between populations and sexes. RESULTS: Subjects from hot-humid regions showed significantly lower air-conditioning capacities than subjects from colder regions in all the three conditions, specifically within the isthmus region in the inflow tract, and the anterior part of the internal functional tract. Posterior to the functional tract, no differences were detected. No differences between sexes were found in any of the tracts and under any of the conditions. DISCUSSION: Our statistical analyses support models of climatic adaptations of anterior nasal soft tissue morphology that fit with, and complement, previous research on dry skulls. However, our results challenge a morpho-functional model that attributes air-conditioning capacities exclusively to the functional tract located within the nasal cavity. Instead, our findings support studies that have suggested that both, the external nose and the intra-facial soft tissue airways contribute to efficiently warming and humidifying air during inspiration. This supports functional interpretations in modern midfacial variation and evolution.

How to make a digital reconstruction of the human ribcage.

Up to now, there have been no publication standardizing the digital reconstruction of the modern human ribcage from commingled costo-vertebral material. Consequently, we designed a validated protocol based on anatomical features observed in the literature and the CT scanned ribcages of 10 adult European individuals. After quantifying the shape of these ribcages using 3D geometric morphometrics, we split each vertebra and rib within their corresponding (semi)landmarks. Subsequently, individual bones + (semi)landmarks were imported to LhpFusionBox, commingled and 3D reconstructed. To validate the accuracy of the protocol, we first reconstructed a randomly chosen ribcage three times and then compared these reconstructions to the rest of the sample. Since these reconstructions were closer to their original counterpart than to the others, the remaining sample was reconstructed once. Next, we tested the intra-observer error during reconstructing using the Procrustes distances among the original ribcages and the reconstructions. We observed that first each ribcage reconstruction was clustered to its original counterpart and second there was a learning curve showing an improvement in the reconstruction process over time. Subsequently, we explored general size and shape differences among the original and reconstructed ribcages through a study of centroid size and a permutation test on the Procrustes distances (10,000 permutations), respectively. Specific shape differences between both groups were further examined through a principal component analysis in shape space. None of these analyses found statistical differences between the original and reconstructed ribcages (p > 0.05). Eventually, we extracted the mean shapes of the original ribcages and the reconstructions in order to visualize potential deviations caused by the anatomical considerations of the researcher. These results demonstrate that the protocol is accurate enough to be used when reconstructing a disarticulated human ribcage.

Covariation between the shape and mineralized tissues of the rib cross section in Homo sapiens, Pan troglodytes and Sts 14.

OBJECTIVES: Studying rib torsion is crucial for understanding the evolution of the hominid ribcage. Interestingly, there are variables of the rib cross section that could be associated with rib torsion and, consequently, with the morphology of the thorax. The aim of this research is to conduct a comparative study of the shape and mineralized tissues of the rib cross section in different hominids to test for significant differences and, if possible, associate them to different thoracic morphotypes. MATERIALS AND METHODS: The sample consists of the rib cross sections at the midshaft taken from 10 Homo sapiens and 10 Pan troglodytes adult individuals, as well as from A. africanus Sts 14. The shape of these rib cross sections was quantified using geometric morphometrics, while the mineralized tissues were evaluated using the compartmentalization index. Subsequently, covariation between both parameters was tested by a Spearman's ρ test, a permutation test and a linear regression. RESULTS: Generally, P. troglodytes individuals exhibit rib cross sections that are rounder and more mineralized compared to those of H. sapiens. However, the covariation between both parameters was only observed in typical ribs (levels 3-10). Although covariation was not found in the rib cross sections of Sts 14, their parameters are closer to P. troglodytes. DISCUSSION: On the one hand, the differences observed in the rib cross sections between H. sapiens and P. troglodytes might be related to different degrees of rib torsion and, consequently, to different thoracic 3D configurations. These findings can be functionally explained by considering their distinct modes of breathing and locomotion. On the other hand, although the rib cross sections belonging to Sts 14 are more similar to those of P. troglodytes, previous publications determined that their overall morphology is closer to modern humans. This discrepancy could reflect a diversity of post-cranial adaptations in Australopithecus.

How accurate are medical CT and micro-CT techniques compared to classical histology when addressing the growth of the internal rib parameters?

Rib internal anatomy and its cross-sectional morphology inform about important biomechanical or even evolutionary aspects. Classic histological studies require destructive techniques that are reprehensible depending on the case (e.g., fossils). In the last years, non-destructive CT-based methods are contributing to complementing previous knowledge without damaging the bone. Even though these methods have been proved to be useful to understand adult variation, we do not know whether these methods are useful to cover ontogenetic variation. This work compares classical histological methods with medical- and micro-CT to quantify the amount of mineral area at the rib midshaft (% Min. Ar.), a proxy for bone density. We compared cross-sections from an ontogenetic sample of 14 human first ribs ranging from perinates to adults using a) classical histology, b) HD (9-17 microns) and SD micro-CT (90 microns), and c) standard medical-CT (0.66 mm). We found that all the CT-based methods provide a larger % Min. Ar. compared to the histological techniques, but the HD micro-CT resolution is the only capable of producing results comparable to classical histology (p > 0.01), with the SD micro-CT and the medical-CT producing statistically larger results compared to classical histology (p < 0.01). In addition, it is important to state that the resolution of a standard medical-CT is not high enough to differentiate between mineral and non-mineral areas of the cross-sections for perinates and infants. These results could have important implications to avoid (when necessary) destructive techniques that are not appropriate in the case of highly valuable specimens such as fossils.

The aorta in humans and African great apes, and cardiac output and metabolic levels in human evolution.

Humans have a larger energy budget than great apes, allowing the combination of the metabolically expensive traits that define our life history. This budget is ultimately related to the cardiac output, the product of the blood pumped from the ventricle and the number of heart beats per minute, a measure of the blood available for the whole organism physiological activity. To show the relationship between cardiac output and energy expenditure in hominid evolution, we study a surrogate measure of cardiac output, the aortic root diameter, in humans and great apes. When compared to gorillas and chimpanzees, humans present an increased body mass adjusted aortic root diameter. We also use data from the literature to show that over the human lifespan, cardiac output and total energy expenditure follow almost identical trajectories, with a marked increase during the period of brain growth, and a plateau during most of the adult life. The limited variation of adjusted cardiac output with sex, age and physical activity supports the compensation model of energy expenditure in humans. Finally, we present a first study of cardiac output in the skeleton through the study of the aortic impression in the vertebral bodies of the spine. It is absent in great apes, and present in humans and Neanderthals, large-brained hominins with an extended life cycle. An increased adjusted cardiac output, underlying higher total energy expenditure, would have been a key process in human evolution.

Vitamin D and adolescent idiopathic scoliosis, should we stop the hype? A cross-sectional observational prospective study based on a geometric morphometrics approach.

PURPOSE: There is strong evidence supporting the presence of fluctuating asymmetry (FA) in Adolescents with Idiopathic Scoliosis (AIS). Additionally, recent research investigating the relationship between vitamin D and AIS found a relation between them. We hypothesize a negative correlation between FA and vitamin D. METHODS: We performed a surface scan of the torso of 53 AIS patients, a blood test to measure vitamin D and the radiographic Cobb angle. A correlation analysis between vitamin D and FA was carried out to test our hypothesis, and a regression of vitamin D on 3D shape was performed to observe shape differences between the vitamin D deficiency and insufficiency groups. RESULTS: There was no correlation between vitamin D and FA. We found a strong negative correlation between vitamin D and the Cobb angle only in the premenarche group (n = 7; r = - 0.92). Differences in shape were observed between the deficiency and insufficiency groups, and that differences were related to the width of the torso, but not the rotation or lateral flexion. CONCLUSIONS: Our results do not support the massive screening of vitamin D in AIS. Shape analysis revealed differences between the shape of the deficiency and insufficiency groups related to robustness. However, this finding had no relation with the scoliosis characteristics, it just reflected different body composition, and its importance should be explored in future.

Advancements in veterinary medicine: the use of Flowgy for nasal airflow simulation and surgical predictions in big felids (a case study in lions).

Flowgy is a semi-automated tool designed to simulate airflow across the nasal passage and detect airflow alterations in humans. In this study, we tested the use and accuracy of Flowgy in non-human vertebrates, using large felids as the study group. Understanding the dynamics of nasal airflow in large felids such as lions (Panthera leo) is crucial for their health and conservation. Therefore, we simulated airflow during inspiration through the nasal passage in three lions (Panthera leo), two of which were siblings (specimens ZPB_PL_002 and ZPB_PL_003), without breathing obstructions. However, one of the specimens (ZPB_PL_001) exhibited a slight obstruction in the nasal vestibule, which precluded the specimen from breathing efficiently. Computed tomography (CT) scans of each specimen were obtained to create detailed three-dimensional models of the nasal passage. These models were then imported into Flowgy to simulate the airflow dynamics. Virtual surgery was performed on ZPB_PL_001 to remove the obstruction and re-simulate the airflow. In parallel, we simulated the respiration of the two sibling specimens and performed an obstructive operation followed by an operation to remove the obstruction at the same level and under the same conditions as the original specimen (ZPB_PL_001). Thus, we obtained a pattern of precision for the operation by having two comparable replicas with the obstructed and operated specimens. The simulations revealed consistent airflow patterns in the healthy specimens, demonstrating the accuracy of Flowgy. The originally obstructed specimen and two artificially obstructed specimens showed a significant reduction in airflow through the right nostril, which was restored after virtual surgery. Postoperative simulation indicated an improvement of >100% in respiratory function. Additionally, the temperature and humidity profiles within the nostrils showed marked improvements after surgery. These findings underscore the potential of Flowgy in simulating nasal airflow and predicting the outcomes of surgical interventions in large felids. This could aid in the early detection of respiratory diseases and inform clinical decision-making, contributing to improved veterinary care and conservation efforts. However, further research is needed to validate these findings in other species and explore the potential of integrating Flowgy with other diagnostic and treatment tools in veterinary medicine.

The evolution, form and function of the human respiratory system.

This paper presents an updated view on the morphological and functional significance of the human respiratory system in the context of human evolutionary anatomy. While usually the respiratory system is treated either from a craniofacial perspective, mostly in the context of nasal evolution and air-conditioning, or from a postcranial perspective featuring on overall thoracic shape changes, here we pursue a holistic perspective on the form, function, integration, and evolutionary change of the entire organismal system in hominins. We first present a brief review of the most important morphological structures, their function, and its potential integration and interaction with the nasal cavity and thoracic skeleton. This is followed by an overview of the most important improvements in methods for the comparative study in recent humans and fossil hominins. We then overview and list a compendium of hominin fossil material currently available for the study. We propose four functional categories of hominin respiratory system configurations that differ potentially with respect to size, shape, biomechanics and/or bioenergetics. Finally, we discuss these and speculate on possible ways for future research into an anatomical system that, despite its under-investigated status, is central to the understanding of the form and functions of the hominin organism and its paleobiology.

Variation in human 3D trunk shape and its functional implications in hominin evolution.

This study investigates the contribution of external trunk morphology and posture to running performance in an evolutionary framework. It has been proposed that the evolution from primitive to derived features of torso shape involved changes from a mediolaterally wider into a narrower, and antero-posteriorly deeper into a shallower, more lightly built external trunk configuration, possibly in relation to habitat-related changes in locomotor and running behaviour. In this context we produced experimental data to address the hypothesis that medio-laterally narrow and antero-posteriorly shallow torso morphologies favour endurance running capacities. We used 3D geometric morphometrics to relate external 3D trunk shape of trained, young male volunteers (N = 27) to variation in running velocities during different workloads determined at 45-50%, 70% and 85% of heart rate reserve (HRR) and maximum velocity. Below 85% HRR no relationship existed between torso shape and running velocity. However, at 85% HRR and, more clearly, at maximum velocity, we found highly statistically significant relations between external torso shape and running performance. Among all trained subjects those with a relatively narrow, flat torso, a small thoracic kyphosis and a more pronounced lumbar lordosis achieved significantly higher running velocities. These results support the hypothesis that external trunk morphology relates to running performance. Low thoracic kyphosis with a flatter ribcage may affect positively respiratory biomechanics, while increased lordosis affects trunk posture and may be beneficial for lower limb biomechanics related to leg return. Assuming that running workload at 45-50% HRR occurs within aerobic metabolism, our results may imply that external torso shape is unrelated to the evolution of endurance running performance.

The earliest Pleistocene record of a large-bodied hominin from the Levant supports two out-of-Africa dispersal events.

The paucity of early Pleistocene hominin fossils in Eurasia hinders an in-depth discussion on their paleobiology and paleoecology. Here we report on the earliest large-bodied hominin remains from the Levantine corridor: a juvenile vertebra (UB 10749) from the early Pleistocene site of 'Ubeidiya, Israel, discovered during a reanalysis of the faunal remains. UB 10749 is a complete lower lumbar vertebral body, with morphological characteristics consistent with Homo sp. Our analysis indicates that UB-10749 was a 6- to 12-year-old child at death, displaying delayed ossification pattern compared with modern humans. Its predicted adult size is comparable to other early Pleistocene large-bodied hominins from Africa. Paleobiological differences between UB 10749 and other early Eurasian hominins supports at least two distinct out-of-Africa dispersal events. This observation corresponds with variants of lithic traditions (Oldowan; Acheulian) as well as various ecological niches across early Pleistocene sites in Eurasia.

Three-dimensional form and function of the nasal cavity and nasopharynx in humans and chimpanzees.

The facial differences between recent Pan troglodytes and Homo sapiens can be used as a proxy for the reduction of facial prognathism that happened during evolutionary transition between Australopithecines and early Homo. The projecting nasal morphology of Homo has been considered both a passive consequence of anatomical reorganization related to brain and integrated craniofacial evolution as well as an adaptation related to air-conditioning during physiological and behavioral shifts in human evolution. Yet, previous research suggested impaired air-conditioning in Homo challenging respiratory adaptations based on computational fluid dynamics (CFD) and airflow simulations. Here we improved CFD model at the inflow region and also carried out three-dimensional (3D) geometric morphometrics to address the hypothesis of impaired air-conditioning in humans and species differences in airway shape. With the new CFD model we simulated pressure, velocity, and temperature changes in airflow of six adult humans and six chimpanzees and analyzed 164 semi-landmarks of 10 humans and 10 chimpanzees for 3D size and shape comparisons. Our finding shows significantly different internal 3D nasal airways. Also, species means of pressure, velocity, and temperature differed statistically significantly. However, form-related differences in temperature exchanges seem subtle and may question adaptive disadvantages. We rather support a hypothesis of craniofacial changes in the Australopithecus-Homo transition that are related to brain evolution and craniofacial integration with facial and nasal modifications that contribute to maintain respiratory adaptations related to air conditioning.

Morphological correlates of distal fibular morphology with locomotion in great apes, humans, and Australopithecus afarensis.

OBJECTIVES: Recent studies highlighted the importance of the fibula to further our understanding of locomotor adaptations in fossil hominins. In this study, we present a three-dimensional geometric morphometric (3D-GM) investigation of the distal fibula in extant hominids and Australopithecus afarensis with the aim of pointing out morphological correlations to arboreal behavior. METHODS: Three-dimensional surface meshes of the distal fibula were obtained using computer tomography for 40 extant hominid specimens and laser scanner for five A. afarensis specimens. Distal fibula morphology was quantified positioning 11 fixed landmarks, 40 curve semilandmarks, and 20 surface landmarks on each specimen. A generalized Procrustes analysis (GPA) was carried out on all landmark coordinates followed by Procrustes ANOVA. Principal component analysis (PCA) was performed on the GPA-aligned shape coordinates. Kruskal-Wallis tests and Mann-Whitney test were performed on scores along PCs. RESULTS: Great apes are characterized by a shorter subcutaneous triangular surface (STS), more downward facing fibulotalar articular facets, more anteriorly facing lateral malleolus and wider/deeper malleolar fossa than humans. Within great apes, orangutans are characterized by more medially facing fibulotalar articular facets. Australopithecus afarensis shows a unique distal fibular morphology with several traits that are generally associated more to arboreality and less to bipedalism such as a short STS, a more anteriorly facing, laterally pointing malleolus and deeper and larger malleolar fossa. CONCLUSIONS: The distal fibula morphology is indicative of locomotor patterns within extant hominids. The 3D-GM method presented here can be successfully used to further our understanding of arboreal adaptations in fossil hominins.

Geometric Morphometrics of the human cervical vertebrae: sexual and population variations.

This study aims to carry out the first geometric morphometric analysis of the 3D size and shape of the full series of cervical vertebrae delving into variability related to sex and population background. For this reason, we analyzed the cervical vertebrae of both males and females belonging to Europeans, Africans, and Greenland Inuit. We 3D-scanned a total of 219 cervical vertebrae of males and females of three different modern human populations (European, African, and Inuit). A minimum of 72 landmarks and curve semilandmarks were positioned in each of the 3D vertebral models. Landmark configurations were analyzed following the standards of 3D Geometric Morphometrics to test for size and shape differences related to sex or population variation. Results show that male cervical vertebrae are consistently larger than in females while no regular shape differences are observed between males and females in any of the populations. Sex differences in cervical lordosis are thus not supported at the skeletal level of the 3D shape. On the other hand, there is no evidence for population-specific differences in size while shape does vary considerably, possibly also in relation to eco-geographic factors of overall trunk shape. Cervical vertebrae in cold-adapted Inuit were consistently shorter than in Europeans and Africans. The cervical spine may show a different pattern than the thoracic and lumbar spine, which might be related to stronger integration with the cranium, head mobility, and soft-tissue dependence. Our findings suggest that morpho-functional interpretations of the cervical spine based on vertebral skeletal morphology requires caution.

New fossils of Australopithecus sediba reveal a nearly complete lower back.

Adaptations of the lower back to bipedalism are frequently discussed but infrequently demonstrated in early fossil hominins. Newly discovered lumbar vertebrae contribute to a near-complete lower back of Malapa Hominin 2 (MH2), offering additional insights into posture and locomotion in Australopithecus sediba. We show that MH2 possessed a lower back consistent with lumbar lordosis and other adaptations to bipedalism, including an increase in the width of intervertebral articular facets from the upper to lower lumbar column ('pyramidal configuration'). These results contrast with some recent work on lordosis in fossil hominins, where MH2 was argued to demonstrate no appreciable lordosis ('hypolordosis') similar to Neandertals. Our three-dimensional geometric morphometric (3D GM) analyses show that MH2's nearly complete middle lumbar vertebra is human-like in overall shape but its vertebral body is somewhat intermediate in shape between modern humans and great apes. Additionally, it bears long, cranially and ventrally oriented costal (transverse) processes, implying powerful trunk musculature. We interpret this combination of features to indicate that A. sediba used its lower back in both bipedal and arboreal positional behaviors, as previously suggested based on multiple lines of evidence from other parts of the skeleton and reconstructed paleobiology of A. sediba.

One of the defining features of humans is our ability to walk comfortably on two legs. To achieve this, our skeletons have evolved certain physical characteristics. For example, the lower part of the human spine has a forward curve that supports an upright posture; whereas the lower backs of chimpanzees and other apes ­ which walk around on four limbs and spend much of their time in trees ­ lack this curvature. Studying the fossilized back bones of ancient human remains can help us to understand how we evolved these features, and whether our ancestors moved in a similar way. Australopithecus sediba was a close-relative of modern humans that lived about two million years ago. In 2008, fossils from an adult female were discovered at a cave site in South Africa called Malapa. However, the fossils of the lower back region were incomplete, so it was unclear whether the female ­ referred to as Malapa Hominin 2 (MH2) ­ had a forward-curving spine and other adaptations needed to walk on two legs. Here, Williams et al. report the discovery of new A. sediba fossils from Malapa. The new fossils are mainly bones from the lower back, and they fit together with the previously discovered MH2 fossils, providing a nearly complete lower spine. Analysis of the fossils suggested that MH2 would have had an upright posture and comfortably walked on two legs, and the curvature of their lower back was similar to modern females. However, other aspects of the bones' shape suggest that as well as walking, A. sediba probably spent a significant amount of time climbing in trees. The findings of Williams et al. provide new insights in to our evolutionary history, and ultimately, our place in the natural world around us. Our lower back is prone to injury and pain associated with posture, pregnancy and exercise (or lack thereof). Therefore, understanding how the lower back evolved may help us to learn how to prevent injuries and maintain a healthy back.

How can directional and fluctuating asymmetry help in the prognosis of scoliosis along the course of the condition?

Fluctuating asymmetry (FA) is an indicator of developmental instability referred to random deviations from mean asymmetry. That average asymmetry is the directional asymmetry (DA), which, in the particular case of adolescent idiopathic scoliosis (AIS), corresponds to a right thoracic and left lumbar curves. Investigating the presence of FA and DA in AIS has never been done, and it is a key element of the pathophysiology of the scoliotic condition. Thirty-six X-rays of patients with AIS were digitized and analysed using Geometric Morphometric analyses to test for both statistical effects. The individual FA score for each patient was calculated using Procrustes ANOVA and a methodology based on the components of shape was used to estimate the individual DA score. DA is a stronger effect than FA (2.12 to 1), as it has been found in other clinical conditions. The individual DA score, with an effect size of 0.58, is a better predictor of the Cobb angle than FA score. The methodology presented in this paper to estimate DA score is a valid approach in the study of asymmetries in AIS. FA should be correlated in future studies with environmental covariates to serve as a variable in the medical prognosis, while DA will serve as a good predictor of the Cobb angle during the course of the condition, avoiding the abuse of X-rays. This potential use of DA should be tested on 3D shape due to the three-dimensional clinical presentation of AIS.

The outline of the pubic symphyseal surface is sexually dimorphic and changes with age in humans.

The bony symphyseal surface is an important trait for age-at-death estimation from human skeletal remains. In this paper, we demonstrate for the first time that the outline of the human symphyseal surface is sexually dimorphic and that it changes with age. We present a geometric morphometric analysis based on a sample of 323 symphyseal pubic bones from males and females in the age range of 14 to 82 years. These bones were surface-scanned and the resulting surface models were measured along the ventral and dorsal borders of the symphyseal surface using two fixed and 36 curve semilandmarks. Our findings imply that age-related changes in the outline of the symphyseal surface differ between the sexes. According to our results, age explains 5% of total shape variation in females, but less than 1% in males. These findings for the outline, could potentially complement existing sex and age-at-death estimation methods based on other features of the bony pubic surface.

Geometric morphometrics of adolescent idiopathic scoliosis: a prospective observational study.

OBJECTIVE: Adolescent idiopathic scoliosis is the most prevalent type of scoliosis, and its consequences on the human torso have not been deeply studied. In spite of being a 3D condition, clinical management is circumscribed to 2D images among health-care professionals. GMM is a well-recognized tool in the study of 3D shape and symmetry. METHODS: Twenty-four subjects with AIS and 24 controls were subjected to surface scan. Digitization and shape data were extracted and submitted to GMM analysis. 3D shape and asymmetry were correlated with Cobb angle in subjects with X-ray availability. Comparisons of mean shapes were done between each group and its symmetric average shape and between each group at two states: initial and 6 months after. RESULTS: AIS and controls show similar areas of asymmetry, being significantly higher in quantity in AIS (PD = 0.045; PD 0.037; p < 0.001). Significant correlation was observed between Cobb angle and Procrustes asymmetry (r = 0.38; p = 0.01) as happened with 3D shape (r = 0.11; p < 0.001). No significant changes were observed in the 3D shape of both groups 6 months after (AIS, p = 0.51; control, p = 0.304). CONCLUSION: The greater asymmetry observed in AIS was expectable, but the similarity of areas of asymmetry in both groups made us suspect of directional asymmetry in the human torso that could explain the high prevalence of right scoliosis observed in nature. The shape of the torso and the asymmetry should be considered as variables to study in AIS due to its correlation with Cobb angle. Progression of the deformities was not observed in our study, maybe due to short-term follow-up.