ID 111239
Author
Nagamachi, Akihiro Tokushima University
Goda, Yuichiro Tokushima University
Morimoto, Masatoshi Tokushima University
Mineta, Kazuaki Tokushima University
Kimura, Tetsuya Tokushima University
Nitta, Akihiro Tokushima University
Higuchi, Tadahiro Tokushima University
Hama, Shingo Tokushima University
Jha, Subash C. Tokushima University
Takahashi, Rui Tokushima University
Fukuta, Shoji Tokushima University
Keywords
Spondylolysis
spondylolisthesis
growth plate
adolescents
children
Content Type
Journal Article
Description
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI ; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate.We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Journal Title
The Journal of Medical Investigation
ISSN
13496867
13431420
NCID
AA11166929
AA12022913
Publisher
Faculty of Medicine Tokushima University
Volume
62
Issue
1-2
Start Page
11
End Page
18
Sort Key
11
Published Date
2015-02
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
Publisher
departments
Medical Sciences
University Hospital