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Loubeyre E, Terrier LM, Cognacq G, Aggad M, Francois P, Odent T, Amelot A. Surgical management of herniated intervertebral disc in children. Neurochirurgie 2024; 70:101593. [PMID: 39241927 DOI: 10.1016/j.neuchi.2024.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 08/24/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
STUDY DESIGN Retrospective literature review analysis OBJECTIVE: Analyze the risk factors, characteristics, outcome, and follow up of surgical management of disc herniation in children ≤15 years old (y.o) through a review of the literature. BACKGROUND Disc herniation is a rare disease in the pediatric population. While conservative treatment if very often tried, some cases require surgical treatment. METHODS A literature search was conducted using PubMed data base using the terms 'pediatric/children/adolescent disc herniation' and 'surgical management' as key words. Significant manuscripts i.e: case reports, case series, reviews were identified and analyzed. The exclusion criteria were: series and cases with patients >15 y.o, results non-individualizable and medical management. RESULTS 49 studies were identified, 28 were retained. 69 children <15 y.o were identified with a median age of 13 y.o (SD 1-15). The mean FU was 3.3 years. Trauma and repeated micro traumatism were identified as the main causes of disc herniation in this population. It is mostly a lumbar disease, with very anecdotic cases of thoracic or cervical herniation described. In the absence of neurological deficit, conservative treatment should be tried. Different types of surgery exist (open, endoscopic, tubular), with no difference in outcome or complications. The post-operative outcome was very satisfactory, with no neurological sequalae described with excellent recovery. CONCLUSIONS Pediatric disc herniation is often caused by precipitating factors such as trauma. In the absence of resolution with conservative treatment, surgical options yield favorable short term clinical outcomes with minimal complications and no neurological sequalae.
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Affiliation(s)
- Elise Loubeyre
- Department of Neurosurgery, CHRU de Tours, Tours, France.
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Gabrielle Cognacq
- University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford, Oxfordshire, OX3 9DU, UK
| | - Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | | | - Thierry Odent
- Department of Pediatric Surgery, CHRU de Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France
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Jiang L, Du X, Pan Z, Yuan Y, Battié MC, Wang Y. Lumbar disc herniation in juveniles: A case-control study of MRI characteristics and etiological insights. J Orthop Res 2023; 41:2685-2693. [PMID: 37165707 DOI: 10.1002/jor.25598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/03/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2023]
Abstract
Lumbar disc herniation (LDH) is rare in juveniles. LDH occurring at age 20 years or younger is referred to as juvenile disc herniation (JDH). While adult LDH is regarded as an advanced stage of disc degeneration, it remains unclear why intervertebral discs rupture in youth. This study aimed to characterize magnetic resonance imaging (MRI) findings of JDH and investigate possible etiological factors. From 2013 to 2020, JDH patients and controls were identified and interviewed to assess demographics, general lifestyles, and family histories. MRIs were evaluated for disc degeneration, epiphyseal ring separation, Modic changes and endplate lesions. The relationships between JDH and suspected risk factors were examined. A total of 297 JDH patients (199 boys and 98 girls, age 17.3 ± 2.1 years) and 185 controls (age 17.1 ± 2.4 years) were studied. Age, body mass index, exposures to daily physical labor, regular exercise, and daily sitting time were similar between JDH cases and controls. A family medical history of serious back pain was more common in JDH patients than in controls (59.4% vs. 26.5%, p < 0.001), as well as family history of clinically established LDH (45.0% vs. 12.4%, p < 0.001). Epiphyseal ring separation was identified in 102 (29.2%) herniated discs in 91 (36.4%) JDH patients, while occurring in only 5 (1.4%) control participants (p < 0.001). Overall, severe disc degeneration was not a prominent finding in JDH patients. In conclusion, epiphyseal ring separation was a common magnetic resonance feature in JDH. Findings suggest a genetically mediated developmental model of JDH, rather than a model of premature disc degeneration.
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Affiliation(s)
- Lejian Jiang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotian Du
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zongyou Pan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Michele C Battié
- Department of Physical Therapy, Faculty of Health Sciences, Western University, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Back pain is common, in up to 30% of children, increasing with age. Eighty percent is benign, mechanical type, improving within 2 weeks of conservative care. Required for those not improving is in-depth evaluation, including MRI, laboratory, and peer consultations. Spondylolysis and spondylolisthesis comprise almost 10% of pediatric back pain, often caused by lumbar hyperextension activities and treated conservatively in most cases. Osteoid osteomas and osteoblastomas constitute the most common benign spinal tumors in childhood. Aggressive and malignant tumors of the spine are rare but when present require tertiary care referral and a comprehensive oncology team for optimal life-sustaining outcomes.
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Affiliation(s)
- Kevin P Murphy
- Department of Physical Medicine and Rehabilitation, Sanford Health Systems, Bismarck North Dakota and Northern Minnesota, Northland Pediatric Rehabilitation Medicine LLC, 4710 Matterhorn Circle #309, Duluth, MN 55811, USA.
| | - Cristina Sanders
- Pediatric Rehabilitation Medicine, Monument Health Department Neurology and Rehabilitation, Monument Health System, 677 Cathedral Drive, Suite 240, Rapid City, SD 57701, USA
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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El-Qadi M, Thabit MA, Eissa E, Aziz AAFA, Kamel R. Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients.
AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents.
PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period.
RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved.
CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.
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Yuan AL, Shen X, Chen B. Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study. J Pain Res 2022; 15:1719-1728. [PMID: 35734509 PMCID: PMC9208632 DOI: 10.2147/jpr.s357033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs. Methods The study included 104 patients who were divided into two groups. Group A comprised 50 patients with calcified lumbar disc herniation and group B comprised 54 patients with non-calcified lumbar disc herniation diagnosed by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy at our hospital from January 1, 2017, to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospectively reviewed. The treatment outcome was analyzed using the numerical rating scale (NRS) score, Oswestry Disability Index (ODI) score, and modified Macnab criteria. Results Patients in groups A and B showed significant improvement in both the NRS and ODI scores after the surgery and maintained relatively low ODI and NRS scores during subsequent follow-ups. According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy was 94% in group A and 92.6% in group B at the 3 month follow-up. In group A, one patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient’s condition improved. No similar complications occurred in group B. In both the groups, no patient reported any dural leak, infection, or other related complications. Conclusion The use of transforaminal remolding technology can significantly improve the symptoms and dysfunction of patients with calcified and non calcified lumbar disc herniation. There are few intraoperative and postoperative complications and have little impact on vertebral stability. It can provide a reference for the treatment of special types of lumbar disc herniation.
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Affiliation(s)
- Ao-Lin Yuan
- Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People's Republic of China
| | - Xin Shen
- Breast and Thyroid Surgical Oncology, Hebei Medical University Second Affiliated Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Bin Chen
- Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People's Republic of China
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Cordover JB, Fleisig GS, Raszewski JA, Dumont AS, Cordover AM. Return to sport after lumbar microdiscectomy in high school and college age athletes. World Neurosurg 2022; 163:e516-e521. [PMID: 35421588 DOI: 10.1016/j.wneu.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have reported return to play (RTP) rates for athletes after lumbar discectomy, but not specifically younger athletes. The purpose of this study was to evaluate RTP rate of young athletes after lumbar microdiscectomy. METHODS Medical records for a single spine surgeon were reviewed to identify lumbar microdiscectomy patients. Patients were included if they were 21 years old or younger at the time of surgery and were athletes. 38 patients (25 male, 13 female) were identified, with mean age at surgery of 19 years. Level of herniated nucleus pulposus, variant anatomy, degenerative change, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. Patients were contacted to determine when and if they RTP. RESULTS Most patients had degenerative changes at the time of surgery, with a mean Pfirrmann score of 2.2. The average time from onset of symptoms until surgery was 11 months. All patients were reached for follow-up at an average 51 months post-op. 71% returned to play at an average of 4.5 months. There were no statistical differences in Pfirrmann Grade and RTP rates between high school and collegiate athletes, between males and females, nor between patients with two-level and one-level discectomies. Pfirrmann Grade was not significantly different between patients who RTP and those who did not RTP. CONCLUSIONS The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. RTP rate and Pfirrmann Grade were not related to gender, sport level, or discectomy level.
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Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA.
| | | | - Aaron S Dumont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Cordover
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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Gadjradj PS, Harhangi BS. Percutaneous transforaminal endoscopic discectomy in a nine-year-old patient with sciatica: case report, technical note and overview of the literature. Childs Nerv Syst 2021; 37:2343-2346. [PMID: 33772354 PMCID: PMC8263397 DOI: 10.1007/s00381-021-05135-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 11/03/2022]
Abstract
Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative procedure to open microdiscectomy (OM) to treat sciatica caused by lumbar disk herniation. Even though robust evidence comparing PTED with OM is lacking, PTED is becoming increasingly popular to treat spinal disorders. In this technical report, the surgical technique and outcomes of PTED in a 9-year-old patient are described. Furthermore, an overview of the literature on full-endoscopic techniques to treat sciatica is given, showing that PTED is feasible, safe and effective to treat lumbar disk herniation in the pediatric population.
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Affiliation(s)
- P. S. Gadjradj
- Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, The Netherlands
| | - B. S. Harhangi
- grid.5645.2000000040459992XDepartment of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Rapid increase in intradiscal pressure in porcine cervical spine units negatively impacts annulus fibrosus strength. J Biomech 2020; 108:109888. [PMID: 32636001 DOI: 10.1016/j.jbiomech.2020.109888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/15/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
Abstract
Vertebral endplate fracture is generally accepted to occur as a result of excessive, typically rapid, pressure developed within the intervertebral disc. Clinical evidence of disc disorders later in life following endplate fracture suggests that the disc is also impacted by the fracture event. There is an abundance of evidence to indicate that loss of disc pressure at the time of fracture alters annulus fibrosus loading which could impact disc health long-term. However, little is known regarding the isolated impact of the rapid disc pressurization during the fracture event. This study sought to determine if rapid disc pressurization impacts mechanical properties of the annulus. Intervertebral discs of porcine cervical functional spine units (FSU) were pressurized via rapid injection of hydraulic fluid (standard motor oil). FSUs were subsequently grouped according to whether the pressurization resulted in endplate fracture ('fracture'; n = 9) or not ('non-fracture'; n = 13). Annular tensile properties and lamellar adhesion strength were quantified for both fractured and non-fractured samples. A third group was also examined in which FSUs did not undergo the pressurization protocol ('control'; n = 10). Annular tensile properties were not found to be statistically different between the three conditions (p > 0.05). Lamellar adhesion strength, in contrast, was found to be, on average, 53% lower in specimens which were pressurized compared to control, non-pressurized samples (p = 0.03). Further, no statistical differences in adhesion strength was found between fractured and non-fractured pressurized samples (p = 0.990) indicating that rapid pressurization , and not the presence of an endplate fracture, impacted the mechanical properties of the annulus. Decreased lamellar adhesion strength increases the potential of delamination, which can lead to disc disorders.
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Abstract
Fractures are common in children, although accurate diagnosis is confounded by mimics of fractures some of which are unique to the pediatric population. Such fracture mimics include developmental variations of the growth plates, normal anatomic structures that simulate fracture lines, and/or metabolic disorders that alter the pattern of ossification. Although subtle clues on plain radiographs may help to discriminate between a true fracture or injury and a fracture mimic, MR imaging may be helpful to eliminate uncertainty or expedite diagnosis.
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Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Main 2, 300 Longwood Avenue, Boston, MA 02115, USA.
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Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019; 185:105486. [DOI: 10.1016/j.clineuro.2019.105486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
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Gale NC, Zeigler SL, Towler C, Mondal S, Issen KA, Mesfin A, Michalek AJ, Kuxhaus L. Increased lumbar spinal column laxity due to low-angle, low-load cyclic flexion may predispose to acute injury. JOR Spine 2018; 1:e1038. [PMID: 31463453 PMCID: PMC6686791 DOI: 10.1002/jsp2.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 11/05/2022] Open
Abstract
Lumbar spinal column laxity contributes to instability, increasing the risk of low back injury and pain. Until the laxity increase due to the cyclic loads of daily living can be quantified, the associated injury risk cannot be predicted clinically. This work cyclically loaded 5-vertebra lumbar motion segments (7 skeletally-mature cervine specimens, 5 osteoporotic human cadaver specimens) for 20 000 cycles of low-load low-angle (15°) flexion. The normalized neutral zone lengths and slopes of the load-displacement hysteresis loops showed a similar increase in spinal column laxity across species. The intervertebral kinematics also changes with cyclic loading. Differences in the location and magnitude of surface strain on the vertebral bodies (0.34% ± 0.11% in the cervine specimens, and 3.13% ± 1.69% in the human cadaver specimens) are consistent with expected fracture modes in these populations. Together, these results provide biomechanical evidence of spinal column damage during high-cycle low-load low-angle loading.
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Affiliation(s)
- Nicole C. Gale
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | | | | | - Sumona Mondal
- Department of MathematicsClarkson UniversityPotsdamNew York
| | - Kathleen A. Issen
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | - Addisu Mesfin
- Departments of Orthopaedic Surgery and NeurosurgeryUniversity of RochesterRochesterNew York
| | - Arthur J. Michalek
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | - Laurel Kuxhaus
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
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Snow CR, Harvey-Burgess M, Laird B, Brown SHM, Gregory DE. Pressure-induced end-plate fracture in the porcine spine: Is the annulus fibrosus susceptible to damage? 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 2017; 27:1767-1774. [DOI: 10.1007/s00586-017-5428-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022]
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Corbiere NC, Zeigler SL, Issen KA, Michalek AJ, Kuxhaus L. Ring apophysis fractures induced by low-load low-angle repetitive flexion in an ex-vivo cervine model. J Biomech 2016; 49:1477-1481. [PMID: 27036072 DOI: 10.1016/j.jbiomech.2016.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/09/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Ring apophysis fractures of the spine occur in physically-active adolescents causing low back pain and the potential for chronic pain. Many of these fractures occur without memorable trauma, suggesting that the fractures occur during everyday movements and activities. The benign nature of this poorly understood potential mechanism of injury hampers appropriate diagnosis and early treatment. The purpose of this study was to establish an ex-vivo model of ring apophysis fracture and demonstrate that these fractures can be initiated by repetitive non-traumatic loading. Six 5-vertebra cervine lumbar (L1-L5) motion segments were cyclically loaded in low-angle low-load flexion (to 15° flexion, with peak load of 230±50N), a representative movement component of daily activities for both human and deer lumbar spines. Pinned end conditions replicated physiologically realistic loading. Ring apophysis fractures were created under low-load low-angle conditions in healthy vertebrae of similar bone mineral density and a similar degree of skeletal maturity to adolescent humans. All specimens developed ring apophysis fractures, some as early as 1400 cycles. The load-displacement data, and hysteresis loops during the cyclic loading, suggest that the fractures occurred gradually, i.e., without trauma. The ease at which these fractures were created suggests that ring apophysis fractures may be more prevalent than current diagnosis rates. Therefore, clinically, healthcare providers should include the potential for ring apophysis fracture in the differential diagnosis of all physically-active adolescents who present with back pain.
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Affiliation(s)
- Nicole C Corbiere
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Stacey L Zeigler
- Department of Physical Therapy, Clarkson University, Potsdam, NY, USA
| | - Kathleen A Issen
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Arthur J Michalek
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Laurel Kuxhaus
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
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