Spine In Children Research Articles

S1149 Magnetic Resonance Imaging of the Lumbosacral Spine in Children with Chronic Constipation and Functional Non-Retentive Fecal Incontinence: A Prospective Study

S1149 Magnetic Resonance Imaging of the Lumbosacral Spine in Children with Chronic Constipation and Functional Non-Retentive Fecal Incontinence: A Prospective Study

Infection and Tumors of the Spine in Children

Corresponding author: John P. Dormans, MD , Division of Orthopaedic Surgery, 2nd Floor, Wood Building, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399

Infection and Tumors of the Spine in Children

Corresponding author: John P. Dormans, MD , Division of Orthopaedic Surgery, 2nd Floor, Wood Building, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399

Long-term maintenance of cervical alignment after occipitocervical and atlantoaxial screw fixation in young children

Despite decades of surgical experience, the long-term consequences of occipitocervical (OC) and atlantoaxial (C1-2) fusions in children are unknown. The purpose of this study was to determine the long-term effects of these fusions on growth and alignment of the maturing cervical spine. A retrospective chart review was conducted for patients 6 years of age or younger (mean 4.7 years, range 1.7-6.8 years) who underwent OC or C1-2 fusion at the Primary Children's Medical Center at the University of Utah within the last 10 years. Immediate postoperative plain radiographs and computed tomography (CT) scans were compared with the most recent plain and dynamic radiographs to assess changes in spinal growth and alignment. Seventeen children met entry criteria for the study. All patients had fusion documented on follow-up radiography or CT scans. At a mean follow up of 28 months, there were no cases of sagittal malalignment (kyphotic or swan-neck deformity), subaxial instability (osteophyte formation or subluxation), or unintended fusion of adjacent levels. The lordotic curvature of the cervical spine increased from a mean of 15 degrees postoperatively to 27 degrees at follow up (p = 0.06). A mean of 34% of the vertical growth of the cervical spine occurred within the fusion segment. When data were analyzed pertaining to a subgroup of five patients who underwent follow-up periods for longer than 48 months (mean 50.2 months, range 48-54 months), similar results were seen. Preliminary follow-up results indicate that, compared with older children, children 6 years of age or younger undergoing OC or C1-2 fusion are not at an increased risk of spinal deformity or subaxial instability. Longer follow-up periods, during which measurements of the spinal canal are taken, will be necessary to determine precisely how children's spines grow and remodel after an upper cervical spine fusion.

Congenital and Developmental Deformities of the Spine in Children With Myelomeningocele

The treatment of spinal deformities in children with myelomeningocele poses a formidable task. Multiple medical comorbidities, such as insensate skin and chronic urinary tract infection, make care of the spine difficult. A thorough understanding of the natural history of these deformities is mandatory for appropriate treatment to be rendered. A team approach that includes physicians from multiple specialties provides the best care for these patients. The two most challenging problems are paralytic scoliosis and rigid lumbar kyphosis. The precise indications for surgical intervention are multifactorial, and the proposed benefits must be weighed against the potential risks. Newer spinal constructs now allow for fixation of the spine in areas previously difficult to instrument. Complications appear to be decreasing with improved understanding of the pathophysiology associated with myelomeningocele.

THE CLASSIC: Tuberculosis of the Spine in Children

THE CLASSIC: Tuberculosis of the Spine in Children

Tumors and Tumor-like Conditions of the Spine in Children

Tumors and tumor-like conditions of the spine, although rare, should be included in the differential diagnosis of infants and children with back pain. Skeletal pathology is more frequently the cause of back pain in children than in adults. Although most tumors and tumor-like conditions of the spine in children are benign, many require surgery. Children with malignant tumors of the spine (with the exception of leukemia and lymphoma) may require multimodality therapy, including surgery, to achieve long-term cure. Advances in imaging, surgical technique, surgical technology, and adjuvant therapy have led to improvements in diagnosis and treatment and, thus, outcomes. In many cases, however, early and accurate diagnosis is often possible based on only clinical history, physical examination, and plain radiographic imaging.

Modern Surgical Treatment of Primary Aneurysmal Bone Cyst of the Spine in Children and Adolescents

Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor-like condition. Treating children with spinal involvement poses special hazards due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability and balance after surgery. Twelve children with ABC treated between 1990 and 2002 at a tertiary pediatric musculoskeletal tumor center using modern surgical techniques and technology were retrospectively reviewed. A surgical technique using a four-step approach of intralesional curettage, high-speed bur, electrocautery, and bone grafting was found to have a significantly reduced rate of recurrence (0/8 cases) compared with traditional intralesional curettage and bone grafting (4/4 cases) (P < 0.002). Short-segment spinal fusion with instrumentation was also done in five cases immediately after excision of the ABC under the same anesthesia and was a nonsignificant marker for reduced rate of recurrence (P < 0.08), likely secondary to wide exposure. Overall, at last follow-up, all 12 patients were alive and well with no evidence of disease and no significant spinal deformity. The four-step approach to treatment of ABC of the spine with appropriate spinal instrumentation and fusion is recommended for successful treatment of this aggressive lesion.

Langerhans cell histiocytosis of the spine in children. Long-term follow-up.

Langerhans cell histiocytosis causes destructive lesions in a child's spine. Few large, long-term studies have evaluated the clinical and radiographic presentation, natural history, outcomes of modern treatment approaches, and maintenance of normal spinal growth and stability after the diagnosis of this disease in children. Twenty-six children with biopsy-proven Langerhans cell histiocytosis involving the spine were treated at our institution between 1970 and 2003. They had a total of forty-four involved vertebrae (twenty cervical, fourteen thoracic, and ten lumbar). Vertebral body collapse was measured on radiographs and classified as grade I (0% to 50% collapse) or grade II (51% to 100% collapse) and subclassified as A (symmetric collapse) or B (asymmetric collapse). Lesions of the posterior elements of the spine were classified as grade III. Twenty-three children were followed for two years or more (mean, 9.4 years), and the analyses of treatment and long-term outcomes were performed in that group of patients. There was a predominance of lesions in the cervical spine (p </= 0.02). Sixteen (62%) of the twenty-six children were found to have multifocal skeletal disease. Cervical and lumbar lesions were more commonly associated with multilevel spinal disease. The extent of the initial collapse seen radiographically was grade IA for twenty vertebrae, IB for three, IIA for ten, IIB for nine, and III for two. Grade-I lesions were more likely to be associated with symmetric collapse than were grade-II lesions. Spinal deformity developed in four children, and two later required spinal fusion. No relationship was observed between the grade of the initial collapse and the subsequent development of spinal deformity. Despite heterogeneous treatment, all patients were alive and well with resolution of all presenting signs and symptoms and no evidence of active disease at the time of the most recent follow-up. We found a particularly high prevalence of lesions in the cervical spine and a high prevalence of multiple skeletal lesions. In contrast to the classic finding of vertebra plana, we found that more severe lesions often led to asymmetric collapse; yet, asymmetric collapse was not found to be associated with the development of subsequent spinal deformity. The natural history of these lesions in the spine in the absence of systemic disease or spinal deformity is such that aggressive surgical management is usually not indicated; only follow-up is necessary to monitor recovery and spinal balance.

Imaging of the Cervical Spine in Children

Australasian RadiologyVolume 48, Issue 1 p. 103-103 Imaging of the Cervical Spine in Children Roger Davies, Search for more papers by this author Roger Davies, Search for more papers by this author First published: 19 March 2004 https://doi.org/10.1111/j.1440-1673.2004.01262.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume48, Issue1March 2004Pages 103-103 RelatedInformation

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.

Imaging of the Cervical Spine in Children

Imaging of the Cervical Spine in Children

Book Reviews

Book reviewed in this article:Paediatric Psychopharmacology: Combining Medical and Psychological InterventionsImaging of the Cervical Spine in Children By Leonard E SwischukConsent, Rights and Choices in Health Care for Children and Young People British Medical AssociationTumours of the Pediatric Central Nervous System Edited by Robert F Keating, James Tait Goodrich, and Roger J Packer

Imaging of the Cervical Spine in Children

Imaging of the Cervical Spine in Children

Imaging of the Cervical Spine in Children.

Imaging of the Cervical Spine in Children.

Tuberculosis of the Spine in Children

Tuberculosis of the Spine in Children

Profiles of the cervical, thoracic, and lumbosacral spine in children and adolescents with lumbosacral spondylolisthesis.

The sagittal and frontal profiles of the entire spine are poorly studied in lumbosacral spondylolisthesis. It was the purpose of this study to further investigate these profiles. Standing posterior-anterior and lateral radiographs in 24 children with lumbosacral spondylolisthesis were reviewed (18 isthmic, 6 congenital). Cervical lordosis, lumbar lordosis, thoracic kyphosis, sagittal vertebral axis, sacral inclination, slip magnitude, slip angle, and sagittal rotation were measured. Cobb magnitude, Risser sign, curve location, and direction were noted for those with scoliosis. Relationships between sagittal variables were explored (Pearson correlation). The average age of patients was 14.7 +/- 2.5 years, slip magnitude was 38 +/- 38%, slip angle was 5 +/- 31 degrees, sagittal rotation was -6 +/- 31 degrees, thoracic kyphosis was 29 +/- 16 degrees, cervical lordosis was -1 +/- 12 degrees, and lumbar lordosis was 62 +/- 22 degrees. Correlations were noted between thoracic kyphosis and sacral inclination, percent slip, slip angle, and sagittal rotation. Sacral inclination decreased as the slip increased. Scoliosis was present in 10 children, with an average curve of 19 +/- 6 degrees. Thoracic kyphosis was less in those with scoliosis (21 +/- 25 degrees versus 33 +/- 25 degrees, p = 0.033). In children with lumbosacral spondylolisthesis, the sacrum becomes more vertical as the slip worsens. As the sacrum becomes more vertical, the thoracic spine becomes more lordotic, which is likely an adaptive mechanism used by the body to maintain forward visual gaze.

Point of View: Primary Tumors of the Spine in Children

Point of View: Primary Tumors of the Spine in Children

Vertebral Growth After Thoracic or Lumbar Fracture of the Spine in Children

Summary: 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. In fractures with anterior compression <10°, no significant difference could be found between the group without treatment and the group with conservative treatment when the Risser sign was 0 or 1 at the time of injury. In such fractures with angles >10°, conservative treatment gave better results when the Risser sign at injury was ≤2. 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 ≤2.