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Normal Growth of the Spine and Thorax

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Book cover The Growing Spine

Abstract

The growing spine is the product of more than 130 physes or growth plates. Growth holds the basics; it is a ratio between remaining and elapsed growth, and any surgical strategy should be adjusted according to remaining growth. As the spinal deformity progresses, not only spinal growth is affected but also the size and shape of the thorax are modified. There is a normal interaction between the organic components of the spine, the thoracic cage, and the lungs. Both early-onset spinal deformities and an early spinal arthrodesis alter spinal growth and affect thorax development by changing its shape and reducing its normal mobility. As a “domino effect,” the distortion of the thorax will eventually interfere with lung development and cardiac function, leading those children to develop thoracic insufficiency syndrome and cor pulmonale, which can be lethal in the most severe cases.

The growing spine can be approached by diametric measurements; sitting height is the most reliable parameter to assess trunk growth.

In normal children, the longitudinal growth of the thoracic spine is about 1.3 cm/year between birth and 5 years, about 0.7 cm/year between the ages of 5 and 10 years, and 1.1 cm/year during puberty. T1–T12 is the posterior pillar of the thoracic cage, and it is a strategic segment. A nearly arthrodesis of this segment can have repercussions on thoracic growth and lungs development. The ideal surgical treatment of early-onset scoliosis has not yet been identified. Surgery must be minimally invasive. Due to repetitive surgical procedures, however, the surgeon inadvertently fuses almost the whole spine and forgets that it is necessary to spare levels as well as spinal motion. It is important to remember that between T1 and S1, there are only 18 vertebrae. The child with severe early-onset spinal deformities must not become a full-time patient or a juxtaposition of surgical procedures. The ultimate goal of treatment is to improve the natural history of the patient’s spinal deformity as well as the quality of life and to have these children become independent adults.

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Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Montpellier, 2, Rue De L’Ecole de Medicine, 34000, Montpellier, France

    Alain Dimeglio PhD, MD & François Bonnel PhD, MD

  2. Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France

    Federico Canavese MD, PhD

Authors
  1. Alain Dimeglio PhD, MD
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  2. Federico Canavese MD, PhD
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  3. François Bonnel PhD, MD
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Corresponding author

Correspondence to Alain Dimeglio PhD, MD .

Editor information

Editors and Affiliations

  1. San Diego Center for Spinal Disorders Medical Group, Inc., La Jolla, California, USA

    Behrooz A. Akbarnia

  2. Hacettepe University Dept. Orthopedics & Traumatology, Sihhiye, Ankara, Turkey

    Muharrem Yazici

  3. Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA

    George H. Thompson

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Dimeglio, A., Canavese, F., Bonnel, F. (2016). Normal Growth of the Spine and Thorax. In: Akbarnia, B., Yazici, M., Thompson, G. (eds) The Growing Spine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48284-1_4

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  • DOI: https://doi.org/10.1007/978-3-662-48284-1_4

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