Articles: spine-growth-development.
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Comparative Study
Long-term three-dimensional changes of the spine after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis.
This is a prospective study comparing the short- and long-term three-dimensional (3D) changes in shape, length and balance of the spine after spinal instrumentation and fusion in a group of adolescents with idiopathic scoliosis. The objective of the study was to evaluate the stability over time of the postoperative changes of the spine after instrumentation with multi rod, hook and screw instrumentation systems. Thirty adolescents (average age: 14.5+/-1.6 years) undergoing surgery by a posterior approach had computerized 3D reconstructions of the spine done at an average of 3 days preoperatively (stage I), and 2 months (stage II) and 2,5 years (stage III) after surgery, using a digital multi-planar radiographic technique. ⋯ Slight changes were noted in apical vertebral rotation, in thoracic kyphosis and in lumbar lordosis. Spinal length and height were significantly increased at stage II, but at long-term follow-up spinal length continued to increase while spinal height remained similar. These results indicate that although a significant 3D correction can be obtained after posterior instrumentation and fusion, a significant loss of correction and an increase in spinal length occur in the years following surgery, suggesting that a crankshaft phenomenon may be an important factor altering the long-term 3D correction after posterior instrumentation of the spine for idiopathic scoliosis.
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We studied vertebral growth after thoracic or lumbar fractures in 52 children followed up from the time of fracture until skeletal maturity. We identified pure anterior compression in 32, combined anterior and lateral compression in 11, and total vertical compression in nine. Six patients had no treatment, 42 had a conservative treatment, and four were operated on. ⋯ Prolonged conservative treatment was not effective in children with a Risser sign of 3. The evolution of lateral compression seems to be related to the initial injury rather than to treatment. Vertical compression injuries were positively influenced by a conservative treatment when the Risser sign was < or = 2.
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This experimental study was designed to test the hypothesis that posterior spinal fusion and internal fixation, using a stiff transpedicular construct, would withstand additional anterior column growth without the need for an anterior procedure and would prevent the development of deformity secondary to asymmetric growth of the anterior column in the immature canine model. ⋯ The present study confirmed that in immature canines anterior column growth continues after posterior fusion without instrumentation. The magnitude of this growth, combined with a posterior tether, is sufficient to cause significant lordosis. The results are the first to document that a stiff posterior spinal instrumentation system is sufficient to overpower the residual anterior growth centers, even in the presence of a posterior tether (fusion mass). This technique creates a mechanical epiphysiodesis evidenced by arresting vertebral body length, narrowing disc space, and preventing lordosis, thus thwarting the deformity-producing mechanism without an additional anterior procedure.
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J Bone Joint Surg Am · May 1994
Comparative StudyThe effect of age on the change in deformity after radical resection and anterior arthrodesis for tuberculosis of the spine.
We compared the long-term changes in spinal deformity after a radical operation for tuberculosis of the spine in thirty-three children who were ten years old or younger at the time of the operation with those of seventy-one adult patients who were at least eighteen years old at the time of the operation. The spinal deformity was measured with use of the angles of kyphosis and deformity as assessed on lateral spinal radiographs made preoperatively and postoperatively at six months, one year, and five years and at the most recent follow-up evaluation (at a mean of fifteen years). We detected no significant difference in the mean angles of kyphosis and deformity between the children and the adults postoperatively at any follow-up evaluation; thus, we found that growth of the posterior portion of the spine does not contribute to the progression of deformity after a radical anterior procedure. ⋯ However, there were no such differences in the correction of the deformity between the adults and the children who had tuberculosis of the thoracolumbar or the lumbar spine. Our findings clearly show that a short anterior spinal arthrodesis done at an early age was not associated with progression of deformity during growth and development in our patients. The longitudinal pattern of changes in deformity was similar in the children and the adults, and there was no evidence of disproportionate posterior spinal growth contributing to the progression of deformity after anterior spinal arthrodesis.(ABSTRACT TRUNCATED AT 250 WORDS)