Asymmetric mechanical stress on both sides of the spine – Based on human functional chiral asymmetry – May constitute the underlying Pathomechanism of adolescent idiopathic scoliosis (AIS)

• AIS is a major burden, mainly in adolescents. It shows consistent patterns like female predominance and progression during growth. • AIS has a multifactorial etiology, involving genes, endocrine, metabolic factors, and biomechanics, though incompletely understood. • We propose intrinsic functional chiral asymmetry as a key cause, where asymmetric spinal stress initiates scoliosis. • Therapies addressing this biomechanical asymmetry, based on functional asymmetry, may offer a new treatment for scoliosis. The pathogenesis of adolescent idiopathic scoliosis (AIS) remains inadequately understood. We propose that the onset of AIS may be linked to biomechanical stress asymmetries along the spinal column, arising from inherent functional chiral asymmetries in human body, potentially serving as the underlying basis for scoliosis development. The resulting disparities in biomechanical loading between the two sides of the spine under these chiral configurations may account for the occurrence of both left- and right-convex curve patterns observed in AIS.