Articles: spine-growth-development.
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Prospective study of the sagittal plane alignment of the spine and pelvis in the normal pediatric population. ⋯ Pelvic morphology, as measured by the pelvic incidence angle, tends to increase during childhood and adolescence before stabilizing into adulthood, most likely to maintain an adequate sagittal balance in view of the physiologic and morphologic changes occurring during growth. Pelvic tilt and lumbar lordosis, two position-dependent parameters, also react by increasing with age, most likely to avoid inadequate anterior displacement of the body center of gravity. Sacral slope is achieved with the standing posture and is not further significantly influenced by age. These results are important to establish baseline values for these measurements in the pediatric population, in view of the reported association between pelvic morphology and the development of various spinal disorders such as spondylolisthesis and scoliosis.
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A retrospective study of 19 consecutive cases (1991-2001) where 91 thoracic and lumbar pedicle screws were used in the treatment of various pediatric spinal disorders in 1- and 2-year-old children. ⋯ The results suggest that pedicle screw fixation can be performed safely in 1- and 2-year-old children without negative effects on vertebral growth. In various pediatric spinal disorders, transpedicular screw fixation is the only procedure that provides a secure anchorage in short-segment instrumentation.
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A retrospective follow-up study of spine geometry after posterior instrumentation and fusion for adolescent idiopathic scoliosis (AIS). ⋯ Spinal growth as indicated by an increase in spinal length can be measured in a significant proportion of adolescents with idiopathic scoliosis after posterior instrumentation and fusion. Some of these study participants will develop a crankshaft phenomenon but Cobb angle progression is not a reliable indicator of this complication, since it may occur without any detectable growth of the spine.
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Thirty-four patients with idiopathic scoliosis who underwent anterior spinal surgery as part of the correction of spinal deformity were studied prospectively. Superior and inferior endplates were harvested and examined histologically for evidence of residual growth activity. This was then correlated with Risser grades, chronologic age, and pubertal status. ⋯ The crankshaft phenomenon is reported to occur only in patients with Risser Grade 2 or less, particularly those with open triradiate cartilages. Our findings of significant endplate growth activity, even in patients with Risser Grade 4, make it unlikely that the crankshaft phenomenon is caused purely by longitudinal spinal growth.