title: Posterior arthrodesis in the skeletally immature patient. Assessing the risk for crankshaft: is an open triradiate cartilage the answer?
abstract: METHODS
  Thirty-three skeletally immature patients younger than 12 years of age and having posterior arthrodesis and evidence of solid posterior fusion without "adding on" were retrospectively reviewed. All patients had a minimum of 5 years of follow-up.
  
  
  OBJECTIVE
  To ascertain factors associated with crankshaft and to determine how accurate a marker the triradiate cartilage was.
  
  
  METHODS
  All patients had Risser Stage 0 curves and all of the girls were premenarchal preoperatively. The average age was 9 years 3 months (range, 2 years-11 years 11 months). Preoperative diagnoses consisted of 14 idiopathic, 11 congenital, five dysplastic, and three neuromuscular etiologies.
  
  
  METHODS
  Preoperatively, within 3 months after surgery, and at 2-year, 5-year, and final postoperative follow-up, the following radiographic parameters were reviewed: coronal Cobb, apical vertebral rotation, apical vertebral translation, rib vertebral angle difference, and trunkshift.
  
  
  RESULTS
  The triradiate cartilage was open in 24 patients at the time of operation. Of those 24, only nine (37.5%) had documented proof of crankshaft. Patients with closed triradiate cartilage had no significant postoperative increase in radiographic parameters (0 of 9). The subgroup of patients with idiopathic scoliosis had an average age of 11 years 3 months (range, 9 years 2 months-11 years 11 months). Five of 14 patients had an open triradiate cartilage. All were followed up to skeletal maturity. None had significant progression in postoperative radiographic parameters.
  
  
  CONCLUSIONS
  This study did not find an open triradiate cartilage to be an absolute prognostic indicator for the occurrence of crankshaft. Additional refinement of markers of maturity are needed to determine who requires anterior arthrodesis.
authors.affiliation: St. Louis Children's Hospital, Missouri, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Hamill
authors.forename: K H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: L G
authors.initials: LG
authors.lastname: Lenke
authors.forename: M P
authors.initials: MP
authors.lastname: Chapman
authors.forename: C
authors.initials: C
authors.lastname: Baldus
authors.forename: K
authors.initials: K
authors.lastname: Blanke
mesh_terms: D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000254:growth & development; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion; D013131:Spine / Q000254:growth & development; D013997:Time Factors