Spinal Hemiepiphysiodesis Decreases the Size of Vertebral Growth Plate Hypertrophic Zone and Cells

Byiski-Austrow, Donita I.; Wall, Eric J.; Glos, David L.; Ballard, Edgar T.; Montgomery, Andrea; Crawford, Alvin H.
March 2009
Journal of Bone & Joint Surgery, American Volume;Mar2009, Vol. 91-A Issue 3, p584
Academic Journal
Background: Hemiepiphysiodesis is a potential method to treat idiopathic juvenile scoliosis early. The purpose of the present study was to investigate a mechanism of curve creation in the pig thoracic model of spinal hemiepiphysiodesis by determining whether the structure of the vertebral growth plate varied with distance from the stapled, concave side of the spine. The hypotheses were that the heights of the hypertrophic zone, hypertrophic cells, and disc would be decreased on the treated side of the treated level as compared with both an unstapled control level and the side opposite the staple. Methods: Custom spine staples were implanted into six midthoracic vertebrae in each of five skeletally immature pigs. After eight weeks, the spines were harvested and histological sections were prepared. Hypertrophic zone height, hypertrophic cell height and width, and disc height were measured at discrete coronal plane locations at stapled and unstapled thoracic levels. Differences between stapled and unstapled levels and locations were compared with use of mixed linear modeling for repeated measures, followed by regression models to determine growth plate intercept and slope across the plane by thoracic level. Results: Zone height, cell height, and cell width were lowest on the stapled side of the stapled level, with significant differences in the overall statistical model (p < 0.02). Disc heights were significantly reduced (p < 0.0001) at the stapled levels across the coronal plane. Conclusions: Unilateral control of intervertebral joint motion decreased growth plate height, cell size, and disc height. Clinical Relevance: A method of spinal hemiepiphysiodesis with use of a clinically relevant procedure has been shown to create a gradient in growth plate structure. If a similar gradient can be produced in humans, mechanical growth modulation may prove capable of slowing or stopping the progression of early-stage spinal deformity.


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