Vertebral Rounding Deformity in Pediatric Spondylolisthesis Occurs Due to Deficient of Endochondral Ossification of the Growth Plate

Higashino, Kosaku; Sairyo, Koichi; Sakamaki, Tadanori; Komatsubara, Shinji; Yukata, Kiminori; Hibino, Naohito; Kosaka, Hirofumi; Sakai, Toshinori; Katoh, Shinsuke; Sendo, Toshiaki; Yasui, Natsuo

doi:10.1097/brs.0b013e31815b981f

Cited by 19 publications

(4 citation statements)

References 20 publications

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“…These patients do not need to refrain from sporting activities, but the treating surgeon should always be aware of the possibility of a progressive slip. [7][8][9] Recent studies have shown that this occurs through the growth plate rather than the disc, [10][11][12][13][14][15][16][17] particularly in children, because it is principally a disorder of the growth plate. We have previously shown that in 80% of children with an immature skeleton and a spondylolysis the slip increases within two years.…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment of lumbar spondylolysis in childhood and adolescence

Sairyo

Sakai

Yasui

2009

The Journal of Bone and Joint Surgery. British volume

112

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It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.

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Section: Discussionmentioning

confidence: 99%

Conservative treatment of lumbar spondylolysis in childhood and adolescence

Sairyo

Sakai

Yasui

2009

The Journal of Bone and Joint Surgery. British volume

112

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“…Tartrate-resistant acid phosphatase (TRAP) staining was performed as reported previously. [18] The height of the growth plate and the cell size were measured using ImageJ software.…”

Section: Methodsmentioning

confidence: 99%

Hypertrophic Chondrocytes in the Rabbit Growth Plate Can Proliferate and Differentiate into Osteogenic Cells when Capillary Invasion Is Interposed by a Membrane Filter

et al. 2014

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The fate of hypertrophic chondrocytes during endochondral ossification remains controversial. It has long been thought that the calcified cartilage is invaded by blood vessels and that new bone is deposited on the surface of the eroded cartilage by newly arrived cells. The present study was designed to determine whether hypertrophic chondrocytes were destined to die or could survive to participate in new bone formation. In a rabbit experiment, a membrane filter with a pore size of 1 µm was inserted in the middle of the hypertrophic zone of the distal growth plate of ulna. In 33 of 37 animals, vascular invasion was successfully interposed by the membrane filter. During 8 days, the cartilage growth plate was enlarged, making the thickness 3-fold greater than that of the nonoperated control side. Histological examination demonstrated that the hypertrophic zone was exclusively elongated. At the terminal end of the growth plate, hypertrophic chondrocytes extruded from their territorial matrix into the open cavity on the surface of the membrane filter. The progenies of hypertrophic chondrocytes (PHCs) were PCNA positive and caspase-3 negative. In situ hybridization studies demonstrated that PHCs did not express cartilage matrix proteins anymore but expressed bone matrix proteins. Immunohistochemical studies also demonstrated that the new matrix produced by PHCs contained type I collagen, osteonectin, and osteocalcin. Based on these results, we concluded that hypertrophic chondrocytes switched into bone-forming cells after vascular invasion was interposed in the normal growth plate.

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“…Sairyo et al (26) radiographically examined 46 athletes under 18 years of age with spondylolysis at L5 and revealed that the deformity occurred secondary to the slippage. Higashino et al (27) histologically analyzed the anterior corner of the deformed vertebra, and concluded that deficient endochondral ossification of the growth plate in the anterior upper corner of the vertebra could be the pathomechanism of the rounding deformity of the sacrum. And they assumed that the repetitive overstresses at the anterior corner of the vertebral body might be the crucial factor that led to dysfunction of the ossification mechanism of the growth plate.…”

Section: Discussionmentioning

confidence: 99%

The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: Technical note

et al. 2017

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: Presently, lumbar spondylolisthesis did not have the indication of direct repair surgery because of the difficulty to reduce the slippage. In this report, we presented a case and described a minimally invasive direct repair surgery to reduce and repair the pars interarticularis defects of lumbar spondylolisthesis. First, curettage and removal of the synovium of the pars interarticularis and decompression of nerve root are conducted. Next, cancellous bone is harvested from the iliac crest. And then the Percutaneous Pedicle Screws are inserted bilaterally. A rod is bended and placed just caudal to the spinous process. We can make reposition of slipped vertebra and stabilize the loose lamina more firmly using a reduction tool and a rod pusher. Finally, bone grafts are implanted onto the pars defects. The Smiley face rod method is very useful to reduce the slippage and repair the pars defects in the lumbar spondylolisthesis especially in adolescent athletes.

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Vertebral Rounding Deformity in Pediatric Spondylolisthesis Occurs Due to Deficient of Endochondral Ossification of the Growth Plate

Abstract: Deficient endochondral ossification of the growth plate in the anterior upper corner of the vertebra could be the pathomechanism of the rounding deformity of the sacrum.

Cited by 19 publications

References 20 publications

Conservative treatment of lumbar spondylolysis in childhood and adolescence

Conservative treatment of lumbar spondylolysis in childhood and adolescence

Hypertrophic Chondrocytes in the Rabbit Growth Plate Can Proliferate and Differentiate into Osteogenic Cells when Capillary Invasion Is Interposed by a Membrane Filter

The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: Technical note

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