Lumbar Spine In Children Research Articles

Union of defects in the pars interarticularis of the lumbar spine in children and adolescents. The radiological outcome after conservative treatment.

Lumbar spondylolysis can heal with conservative treatment, but few attempts have been made to identify factors which may affect union of the defects in the pars. We have evaluated, retrospectively, the effects of prognostic variables on bony union of pars defects in 134 young patients less than 18 years of age with 239 defects of the pars who had been treated conservatively. All patients were evaluated by CT scans when first seen and more than six months later at follow-up. The results showed that the spinal level and the stage of the defects were the predominant factors. The site of the defects in the pars, the presence or development of spondylolisthesis, the condition of the contralateral pars, the degree of lumbar lordosis and the degree of lumbar inclination all significantly affected union.

Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil.

To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD. Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained. The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm2 v 1.060 +/- 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal. The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.

Bone Mineral Density of the Lumbar Spine in Children and Adolescents With Celiac Disease on a Gluten‐Free Diet in São Paulo, Brazil

ABSTRACTBackgroundTo compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD.MethodsThirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten‐free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x‐ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained.ResultsThe mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 ± 10.5 kg v 55.3 ± 10.5 kg, P = 0.037; height: 153.0 ± 11.0 cm v 167 ± 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 ± 0.116 g/cm2v 1.060 ± 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple‐regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten‐free diet after 2 years of age was higher than that of children with CD (P &lt; 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal.ConclusionsThe BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.

The relationship between tight hamstrings and lumbar hypolordosis in children with cerebral palsy.

Retrospective clinical and radiographic review. To assess the influence of tight hamstrings on the sagittal alignment of the thoracic and lumbar spine in children with cerebral palsy. It is postulated that tight hamstrings may produce a hypolordosis of the lumbar spine. The abnormal sagittal contour of the spine may lead to increased stresses in the lumbar spine and subsequent pain and disability. This is of special concern in children with cerebral palsy who often have shortened spastic hamstring muscles. Twenty-one patients were evaluated, with a mean age of 9.4 years. Standing and sitting lateral spine films were obtained and the lumbar lordosis and thoracic kyphosis were measured using the Cobb method. The popliteal angle was measured to assess hamstring tightness, such that a large popliteal angle indicates tight hamstrings. We found a statistically significant correlation between the sitting lumbar curve and popliteal angle (Pearson correlation value -0.77, P < 0.01). As the popliteal angle increased, the amount of lumbar lordosis decreased. This correlation was less significant when the patient was standing (Pearson correlation value -0.59). This study demonstrates that there is a correlation between tight hamstrings, as measured by the popliteal angle, and decreasing lumbar lordosis, especially when sitting.

Treatment of injuries of the thoracic and lumbar spine in children

Traumatic injuries of the thoracic and lumbar spine are rare in children and differ in pathomorphology, healing process and prognosis from those in adults. Before growth arrest the vertebral epiphysis has an important role in pathomorphology and prognosis; therefore, treatment should recognize the age-dependent potential for growth and remodelling. This study demonstrates the different anatomic and pathomorphologic characteristics of traumatic spinal injuries in 40 children. Additionally, prognosis and the various forms of treatment are discussed in the context of the recent literature. In total we observed 85 % compression-type injuries and 15 % distraction- and rotation-type injuries. Vertebral body fractures were treated conservatively and segmental disruptions by fusion. Long-term follow-up was performed on average 8 years after the accident in 26 patients clinically and in 21 patients radiologically. Most patients had no physical complaints or clinical symptoms. Additionally, the radiographs did not demonstrate any post-traumatic defects. In summary, spinal injuries up to the age of 12 without initial neurologic symptoms have a favorable prognosis.

Fixation after fractures of the sternum and lumbar spine in children and adolescents: G. Möllemhoff, M. Walz, and G. Muhr. Chirurg 64:948–952, 1993

Fixation after fractures of the sternum and lumbar spine in children and adolescents: G. Möllemhoff, M. Walz, and G. Muhr. Chirurg 64:948–952, 1993

Lap-belt injuries of the lumbar spine in children: a pitfall in CT diagnosis.

A retrospective review of 365 consecutive CT studies in children assessed for intraabdominal trauma yielded five children in whom lap-belt-associated injuries of the lumbar spine were missed on CT. Facet subluxation and anterior dislocation of the third lumbar vertebra were present in four patients and multiple compression fractures were present in one. Clinical presentations included acute abdominal symptoms; two had acute back pain, and three experienced delayed onset of back pain. Although the injuries to the spine were visible retrospectively on anteroposterior radiographs, the findings were subtle and their extent was best appreciated on lateral lumbar spine views. Five of 365 patients with blunt abdominal trauma were identified as having sustained midlumbar spinal injury that was clearly visible only on a lateral radiograph of the spine.

Compression fractures of the thoracic and lumbar spine in children

The case histories of 82 children with compression fractures of the spine were analyzed.

Compression fractures of the thoracic and lumbar spine in children

The age-related evolution of the spine in combination with the physiological characteristics of a growing organism determines the specificity of the clinical and radiological picture and the treatment of uncomplicated spinal fractures in childhood.

Radionuclide bone imaging in spondylolysis of the lumbar spine in children.

Bone scintigraphy and radiography were performed in seven children with back pain. Six of the children with radiographic evidence of a pars interarticularis defect also had abnormal scintigrams. Increased uptake of the bone imaging agent occurred at six of the ten sites of radiographic pars interarticularis defects, implying increased bone metabolic activity. However, the location of scintigraphic abnormalities did not correspond to the location of radiographic abnormalities in several cases. Possible explanations for the discordant findings are: (a) normal bone metabolism at the site of an old spondylolysis and (b) radiographically inapparent stress fractures. Measurements of absorbed radiation dose indicate that plain radiography, including oblique views where appropriate, has a lower absorbed radiation dose than scintigraphy or tomography and should be performed prior to these studies.