ArticleJOR spine2026
Assessment of Vertebral Body Bone Quality in Adolescent Idiopathic Scoliosis (AIS) Using Micro-CT, qBEI, and Nanoindentation-A Case Study.
Article in JOR spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional spinal deformity, predominantly affecting females aged 10-16 years. Although no single etiological factor has been definitively identified, alterations in bone quality and biomechanical properties have been proposed as contributing factors to AIS development. Methods: We developed a surgical protocol to obtain trabecular bone biopsies from the apex vertebra during anterior corrective surgery for AIS. Multimodal analysis was performed on samples from eight AIS participants (14.8 ± 1.5 years), including microstructural assessment via micro-computed tomography (micro-CT), bone mineral density distribution (BMDD) via quantitative backscattered electron imaging (qBEI), and mechanical characterization via nanoindentation. Correlations with major curve angle, apical wedge angle, and Risser grade were investigated. Results: Mean trabecular bone volume fraction (BV/TV) was 0.146 ± 0.029, comparable to values reported in healthy populations. Mean trabecular thickness (Tb.Th) was 0.146 ± 0.011 mm, suggesting slightly thicker trabeculae than typically reported in healthy young cohorts. BMDD analysis revealed CaPeak values of 23.34 ± 1.02 wt% Ca, and greater CaWidth values (4.26 ± 0.33 wt% Ca) compared to healthy adolescent and adult reference data. CaPeak was significantly negatively correlated with apical wedge angle, indicating lower mineralization with increasing vertebral wedging. Nanoindentation showed a negative association between reduced modulus (13.37 ± 2.5 GPa) and apical wedge angle, with hardness values of 0.412 ± 0.079 GPa. Conclusions: These findings provide novel insights into vertebral trabecular bone alterations in AIS and their association with deformity severity. To our knowledge, this is the first study to integrate micro-CT, qBEI, and nanoindentation analyses in AIS vertebral biopsies, revealing structural, compositional, and mechanical differences that may contribute to the pathogenesis and progression of AIS.
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