Glen Ginsburg, M.D. ∆ Richard M. Schwend, M.D. ∫ John Schmidt, PhD Φ

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Presentation transcript:

Glen Ginsburg, M.D. ∆ Richard M. Schwend, M.D. ∫ John Schmidt, PhD Φ Neurocentral Synchondrosis Behavior in Cadaveric Vertebra in the Skeletally Immature Glen Ginsburg, M.D. ∆ Richard M. Schwend, M.D. ∫ John Schmidt, PhD Φ ∆ Children's Hospital & Medical Center, Omaha, NE ∫ Children’s Mercy Hospital, Kansas City, MO Φ K2M, Leesburg, VA 4th International Congress on Early Onset Scoliosis and Growing Spine (ICEOS) Toronto, Canada – November 19-20, 2010

Disclosures Glen Ginsburg, MD K2M (a) Richard M. Schwend, MD K2M (a,b) John Schmidt, MD K2M (c) Grants/Research Support Consultant Stock/Shareholder Speakers’ Bureau Other Financial Support

Introduction Neurocentral synchondrosis (NCS) is the cartilaginous growth plate of the pedicle with the vertebral body Timing of closure of the NCS is controversial Most agree that the NCS are open until 4 years of age Subsequent closure remains unclear The mid- to lower thoracic spine is the last to close Interference with the NCS growth at this stage may be responsible for asymmetrical spinal growth

Methods Examined scalar measurements of cadaveric vertebrae from the Hamann-Todd Collection for neurocentral synchondrosis (NCS) during their developmental stages The cadavers from the Hamann-Todd collection: Are greater than 75 years since death Did not die of natural causes TB, Diphtheria, Stills Disease, Lues Demographics were known 13 specimens were examined. Age: 1 to 16 Years. Five vertebrae from each specimen were chosen for the study: (T1, T4, T7, T10 and L3)

Methods Each vertebra was inspected for NCS maturity The percentage of open growth plate was compared to the full NCS length. A six point scale of percent of NCS closure1,2 was used Stage 0: No Closure Stage 1: Less than 25% Closure Stage 2: 25-49% Closure Stage 3: 50-74% Closure Stage 4: 75-99% Closure Stage 5: 100% Closure Findings were compared to recent published data

1 Year Old Black Male (2075) T1: Stage 0 T4: Stage 0 T7: Stage 0 T10:

4 Year Old Black Female (2141) T1: Stage 0 T4: Stage 0 T7: Stage 0 L3: Stage 3 T10: Stage 0

8 Year Old Black Female (2074) T1: Stage 4 T4: Stage 2 T7: Stage 3 T10: Stage 4 L3: Stage 5

12 Year Old Caucasian Female (1240) T1: Stage 5 T7: Stage 2 T4: Stage 3 T1 - 5 T4 - 2 T10: Stage 3 L3: Stage 5

14 Year Old Black Female (2135) T1: Stage 5 T4: Stage 4 T7: Stage 4 T10: Stage 5 L3: Stage 5

16 Year Old Black Male (1232) T1: Stage 4 T4: Stage 2 T7: Stage 3 T10:

Results Vertebrae with a Chronological Age 3 or Less: No Evidence of NSC Closure (Stage 0) at Any Level Vertebrae with Chronological Age 4-8: Lumbar Vertebrae Showed 50-100% NCS Closure Other Vertebrae Showed an Average of <25% Closure Vertebrae with Chronological Age 9-12: Upper Thoracic Vertebra (T1) Showed 75-100% NCS Closure In the Middle Thoracic (T4, T7, T10), the NCS were All 50-74% Closed (Stage 3) In the Lumbar (L3), the NCS were Closed (Stage 5)

Results Vertebrae with Chronological Age >12: NCS in Upper Thoracic and Lumbar were Completely Closed (Stage 5) The NCS in the Middle Thoracic were 50-100% Closed (Stage 3-5) The NCS were Symmetrical from Left to Right in All Vertebrae

Conclusions The Results are in general agreement with recent MRI investigations into the characteristics of the NCS1, 2 There was no closure of the NCS in any vertebra <3 chronological years The lumbar vertebrae were starting to close the NCS in the 4-8 year age group, closely followed by the upper thoracic vertebrae In the 8-12 year age group, the middle thoracic vertebrae (T4, T7, T10), the NCS were still only 50-74% closed

Conclusion Results may support the theory that: If vertebral growth can be disturbed in the middle thoracic spine (at the age of maximal growth rate) this may contribute to adolescent idiopathic scoliosis.3,4

References Zhang H, Sucato DJ, Nurenberg P, McClung A. Morphometric Analysis of Neurocentral Synchondrosis Using Magnetic Resonance Imaging in the Normal Immature Spine. SPINE 2010; 35: 76-82 Rajwani T, Bhargava R, Mahood J, et al. MRI Characteristics of the Neurocentral Synchondrosis. Pediatr Radiol. 2002: 32: 811-6 Zhang H, Sucato DJ . Unilateral Pedicle Screw Epiphyseodesis of the Neurocentral Synchondrosis. Production of Idiopathic-like Scoliosis in an Immature Animal Model. J Bone Joint Surg Am. 2008 Nov; 90(11): 2460-9 Sanders JO, Browne RH, Cooney TE et al. Correlates of the Peak Height Velocity in Girls with Idiopathic Scoliosis. SPINE 2006: 31: 2289-95.

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