The aetiology of adolescent idiopathic scoliosis: is sleep position the missing link? the nighttime perfect storm hypothesis

A review of the literature on adolescent idiopathic scoliosis (AIS) reveals that the cause remains unknown. Further, scientific investigation by researchers around the globe has determined that neither the nervous or endocrine systems, nor the muscular, connective, or osseous tissues are the primary causative factors which lead to the development of spinal curvatures as seen in AIS. This report will serve to introduce a new hypothetical model that we have termed, The Nighttime Perfect Storm Hypothesis. The model serves to explain why peripubescent children who have a particular genetic predisposition may be at heightened risk of developing a curvature in their spine if their body is habitually positioned while asleep in what we refer to as the Provocative Sleep Position (PSP). The concept of spinal stabilization is explored with respect to a landmark theoretical model by Panjabi in 1992. In the case of AIS, the childs spinal stabilization has gone completely awry. Through the lens of our hypothesis, this loss of stabilization is due to four interdependent components that may conspire and lead to the perfect storm. These components include 1) a genetic predisposition, 2) sleeping in the Provocative Sleep Position, 3) while in the REM stage of sleep, 4) during the childs peripubescent growth spurt. Included is a complete biomechanical analysis of the childs spine while lying in either the Prone or Lateral PSP, and how this may lead to the development of a thoracic or lumbar curvature, respectively. Finally, we propose a path forward that will make clear the need for subsequent scientific investigation to determine whether or not the The Nighttime Perfect Storm Hypothesis is a viable theory.