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Dimeglio A, Canavese F. The immature spine: growth and idiopathic scoliosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:22. [PMID: 32055613 PMCID: PMC6995907 DOI: 10.21037/atm.2019.11.134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/29/2022]
Abstract
Untreated progressive scoliosis can have negative effects on the growing spine as asymmetrical forces will act on the growth plates of the vertebral column (>130 growth plates). Spinal growth can be considered as a mixture of hierarchy, synchronization, and harmony: the slightest error can lead to a complex malformation; it is also a very dynamic process although it does not progress linearly: periods of acceleration are followed by periods of deceleration. Remaining growth is a determining factor for the worsening of idiopathic scoliosis (IS): the younger is the child, the higher is the risk of progression, and the more severe will be the disease. After birth, growth of the spine is not linear, and three periods can be identified: (I) between birth and age 5 years; (II) between age 5 and 10 years of age; (III) between age 10 and skeletal maturity. Spine and thoracic cage growth are correlated, although their growth is not synchronous. Timely control of the spinal deformity and its correction are mandatory to restore-as soon as possible-the harmony and the hierarchy of growth between the different growth plates. If action is delayed, the abnormal growth and the subsequent anatomical modifications will lead to a progressive, evolutive, and irreversible clinical picture. This article aims to provide a comprehensive review of how spinal deformities can affect the normal spine and thoracic cage growth.
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Affiliation(s)
- Alain Dimeglio
- Pediatric Orthopedic Department, Clinique St. Roch, Montpellier, France
| | - Federico Canavese
- Pediatric Surgery Department, University Hospital Estaing, Clermont-Ferrand, France
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Canavese F, Dimeglio A, Barbetta D, Pereira B, Fabbro S, Bassini F, Canavese B. Effect of thoracic arthrodesis in prepubertal New Zealand white rabbits on cardio-pulmonary function. Indian J Orthop 2014; 48:184-92. [PMID: 24741141 PMCID: PMC3977375 DOI: 10.4103/0019-5413.128763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This experimental study was aimed at evaluating the type of cardiac and pulmonary involvement, in relation to changes of the thoracic spine and cage in prepubertal rabbits with nondeformed spine following dorsal arthrodesis. The hypothesis was that T1-T12 arthrodesis modified thoracic dimensions, but would not modify cardiopulmonary function once skeletal maturity was reached. MATERIALS AND METHODS The study was conducted in 16 female New Zealand White (NZW) rabbits. Nine rabbits were subjected to T1-T12 dorsal arthrodesis while seven were sham-operated. Echocardiographic images were obtained at 12 months after surgery and parameters for 2-dimensional and M-mode echocardiographic variables were assessed. One week before echocardiographic examination, blood samples were withdrawn from the animals' central artery of the left ear to obtain blood gas values. One week after echocardiographic assessment, a thoracic CT scan was performed under general anesthesia. Chest depth (CD) and width (CW), thoracic kyphosis (ThK) and sternal length (StL) were measured; thoracic index (ThI), expressed as CD/CW ratio. All subjects were euthanized after the CT scan. Heart and lungs were subsequently removed to measure weight and volume. RESULTS The values for 2-dimensional and M-mode echocardiographic variables were found to be uniformly and significantly higher, compared to those reported in anesthetized rabbits. CD, ThK, and StL were considerably lower in operated rabbits, as compared to the ones that were sham-operated. Similarly, the ThI was lower in operated rabbits than in sham-operated ones. CONCLUSION Irregularities in thoracic cage growth resulting from thoracic spine arthrodesis did not alter blood and echocardiographic parameters in NZW rabbits.
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Affiliation(s)
- Federico Canavese
- Department of Pediatric Surgery, Universitys Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
- Faculty of Medicine, University of Auvergne, 28 place Henri-Dunant BP 38 63001 Clermont-Ferrand, France
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, 2 Rue de l’Ecole de Medecine, 34000 Montpellier, France
| | - Davide Barbetta
- Department of Life Sciences, University of Trieste, Animal Facility, Via Valerio 28, 34127 Trieste, Italy
| | - Bruno Pereira
- Department of Research and Innovation (CRCI), Biostatistic Unit, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - Sergio Fabbro
- Veterinary Clinic, Via Campos 192, 33030 Maiano (UD), Italy
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Canavese F, Dimeglio A. Normal and abnormal spine and thoracic cage development. World J Orthop 2013; 4:167-174. [PMID: 24147251 PMCID: PMC3801235 DOI: 10.5312/wjo.v4.i4.167] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/14/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive early-onset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension (cor pulmonale), which characterize thoracic insufficiency syndrome (TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations (e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases (e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth.
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Canavese F, Dimeglio A, Stebel M, Galeotti M, Canavese B, Cavalli F. Thoracic cage plasticity in prepubertal New Zealand white rabbits submitted to T1-T12 dorsal arthrodesis: computed tomography evaluation, echocardiographic assessment and cardio-pulmonary measurements. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1101-12. [PMID: 23307193 PMCID: PMC3657050 DOI: 10.1007/s00586-012-2644-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 01/02/2023]
Abstract
PURPOSE We aimed to describe the morphological changes in the thoracic cage and spinal column induced in New Zealand White (NZW) prepubertal rabbits subjected to dorsal arthrodesis and observed at skeletal maturity by computed tomography (CT) scans. This was done to evaluate the plasticity of the thoracic cage of rabbits with non-deformed spine, by highlighting its modifications after spinal arthrodesis. Emogas data analysis, echocardiographic assessment and cardio-pulmonary measurements completed the evaluation. METHODS Surgery was performed in 16 female rabbits, 6 weeks old. Nine were subjected to T1-T12 dorsal arthrodesis, while seven were sham-operated. Surgery involved the implant of two C-shaped stainless steel bars and heterologous bone graft. CT scans were performed before surgery, 2, 6 and 12 months after surgery. One week after the last CT scan, echocardiographic and emogas evaluations were performed. RESULTS Chest depth (8%), thoracic kyphosis (ThK) (23%), dorsal and ventral length of the thoracic spine (11%) and sternal length (7%) were significantly reduced in operated compared to sham-operated rabbits. Mean values ± standard deviation (SD) of PaCO2, PaO2 and sO2 were not significantly different. Mean values ± SD of echocardiographic measurements were not significantly different between the two groups of rabbits, except for thickness of the interventricular septum in systole, contractile capacity of the left ventricle and ejection fraction. CONCLUSIONS T1-T12 dorsal arthrodesis in prepubertal NZW rabbits with non-deformed spine induced changes of the thoracic cage morphology. However, those changes are source of cardio-pulmonary complications not severe enough to reproduce a clinical picture comparable to thoracic insufficiency syndrome in humans.
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Affiliation(s)
- Federico Canavese
- Service de Chirurgie Infantile, Centre Hospitalière Universitaire Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
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Dimeglio A, Canavese F. The growing spine: how spinal deformities influence normal spine and thoracic cage growth. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:64-70. [PMID: 21874626 PMCID: PMC3252439 DOI: 10.1007/s00586-011-1983-3] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 06/03/2011] [Accepted: 08/14/2011] [Indexed: 01/11/2023]
Abstract
PURPOSE This article aims to provide an overview of how spinal deformities can alter normal spine and thoracic cage growth. METHODS Some of the data presented in this article are gathered from studies performed in 1980 and 1990, and their applicability to populations of different ethnicity, geography or developmental stage has not yet been elucidated. In the present article, older concepts have been integrated with newer scientific data available to give the reader the basis for a better understanding of both normal and abnormal spine and thoracic cage growth. RESULTS A thorough analysis of different parameters, such as weight, standing and sitting height, body mass index, thoracic perimeter, arm span, T1-S1 spinal segment length, and respiratory function, help the surgeon to choose the best treatment modality. Respiratory problems can develop after a precocious vertebral arthrodesis or as a consequence of pre-existing severe vertebral deformities and can vary in patterns and timing, according to the existing degree of deformity. The varying extent of an experimental arthrodesis also affects differently both growth and thoracopulmonary function. CONCLUSIONS Growth is a succession of acceleration and deceleration phases and a perfect knowledge of normal growth parameters is mandatory to understand the pathologic modifications induced on a growing spine by an early onset spinal deformity. The challenges associated with the growing spine for the surgeon include preservation of the thoracic spine, thoracic cage, and lung growth without reducing spinal motion.
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Affiliation(s)
- Alain Dimeglio
- Université de Montpellier Faculté de Médecine, 2, Rue de l’Ecole de Médecine, 34000 Montpellier, France
| | - Federico Canavese
- Service de Chirurgie Infantile, Centre Hospitalier Universitaire Estaing, 1 Place Lucie Aubrac, 63003 Clermont Ferrand, France
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Current world literature. Curr Opin Pediatr 2010; 22:117-26. [PMID: 20068414 DOI: 10.1097/mop.0b013e32833539b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Canavese F, Dimeglio A, D'Amato C, Volpatti D, Granier M, Stebel M, Cavalli F, Canavese B. Dorsal arthrodesis in prepubertal New Zealand white rabbits followed to skeletal maturity: Effect on thoracic dimensions, spine growth and neural elements. Indian J Orthop 2010; 44:14-22. [PMID: 20165672 PMCID: PMC2822414 DOI: 10.4103/0019-5413.57280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several studies have shown that severe spinal deformity and early arthrodesis can adversely affect the development of the spine and thorax by changing their shape and reducing their normal function. This article analyzes the consequences of posterior fusion on the growth of spine, thorax and neural elements in New Zealand white rabbits and compares with similar human data. MATERIALS AND METHODS The first section of the article analyzes the consequences of T1-T6 dorsal arthrodesis on the growth of the spine, sternum, thorax volume and neural elements in 12 prepubertal female New Zealand white rabbits, through a study of CT scans and histology specimens. The second part, evaluates thoracic dimensions in 21 children with spinal arthrodesis for treatment of deformity performed prior to nine years of age. RESULTS Dorsal arthrodesis in prepubertal rabbits changes thoracic growth patterns. In operated rabbits thoracic depth grows more slowly than thoracic width. The sternum as well as length of thoracic vertebral bodies in the spinal segment T1-T6 show reduced growth. Children undergoing spinal arthrodesis before nine years of age were noted to have shortened height, short trunk and disproportionate body habitus at skeletal maturity. Observed spine height and chest dimension values were reduced compared to the expected norms. The ratio between chest width and chest depth was below normal values. CONCLUSIONS The first part of the study shows that thoracic dorsal arthrodesis in prepubertal New Zealand white rabbit influences thoracic, spine growth and affects the shape of pseudo unipolar neurons of the dorsal root ganglia. The second part demonstrates that children treated before nine years of age have significantly reduced spine height and thoracic dimensions. The thorax becomes elliptical as chest depth grows less than chest width. Both experimental and clinical findings contribute to explain reduced chest growth and subsequent thoracic growth disturbance in patients treated with early arthrodesis.
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Affiliation(s)
- Federico Canavese
- Service de Chirurgie Orthopédique Pédiatrique – CHU Hôpital Lapeyronie, 371, Avenue du Doyen G. Giraud 34295 Montpellier, France,Department of Pediatric Orthopedic Surgery – Shriners Hospital – 3101 SW Sam Jackson Park Road, Portland, OR 97225 USA,Address for correspondence: Dr. Federico Canavese, Department of Pediatric Orthopedic Surgery, Shriners Hospital, 3101 SW Sam Jackson Park Road, Portland, OR 97225, USA. E-mail:
| | - Alain Dimeglio
- Service de Chirurgie Orthopédique Pédiatrique – CHU Hôpital Lapeyronie, 371, Avenue du Doyen G. Giraud 34295 Montpellier, France
| | - Charles D'Amato
- Department of Pediatric Orthopedic Surgery – Shriners Hospital – 3101 SW Sam Jackson Park Road, Portland, OR 97225 USA
| | - Donatella Volpatti
- Dipartimento di Scienze Animali – Università di Udine, Via delle Scienze, 206 – 30100 Udine, Italy
| | - Marie Granier
- Departement d'Anesthesie et Reanimation A – CHU Montpellier – 371, Avenue du Doyen G. Giraud 34295 Montpellier, France
| | - Marco Stebel
- CSPA, Settore Stabulario Sperimentazione Animale – Università di Trieste, Via Valerio, 28 – 34127 Trieste, Italy
| | - Fabio Cavalli
- Dipartimento di Diagnostica per Immagini, Struttura Complessa di Radiodiagnostica, Ospedale Maggiore, Piazza Ospedale, 1 – 34000 Trieste, Italy
| | - Bartolomeo Canavese
- Dipartimento di Scienze Animali – Università di Udine, Via delle Scienze, 206 – 30100 Udine, Italy
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