title: A review of the pathomechanism of forward slippage in pediatric spondylolysis: the Tokushima theory of growth plate slippage.
abstract: Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
authors: Department of Orthopedics, Tokushima University.
authors: Koichi
authors: K
authors: Sairyo
authors: Akihiro
authors: A
authors: Nagamachi
authors: Tetsuya
authors: T
authors: Matsuura
authors: Kosaku
authors: K
authors: Higashino
authors: Toshinori
authors: T
authors: Sakai
authors: Naoto
authors: N
authors: Suzue
authors: Daisuke
authors: D
authors: Hamada
authors: Yoichiro
authors: Y
authors: Takata
authors: Tomohiro
authors: T
authors: Goto
authors: Toshihiko
authors: T
authors: Nishisho
authors: Yuichiro
authors: Y
authors: Goda
authors: Takahiko
authors: T
authors: Tsutsui
authors: Ichiro
authors: I
authors: Tonogai
authors: Ryo
authors: R
authors: Miyagi
authors: Mitsunobu
authors: M
authors: Abe
authors: Masatoshi
authors: M
authors: Morimoto
authors: Kazuaki
authors: K
authors: Mineta
authors: Tetsuya
authors: T
authors: Kimura
authors: Akihiro
authors: A
authors: Nitta
authors: Tadahiro
authors: T
authors: Higuchi
authors: Shingo
authors: S
authors: Hama
authors: Subash C
authors: SC
authors: Jha
authors: Rui
authors: R
authors: Takahashi
authors: Shoji
authors: S
authors: Fukuta
mesh_terms: D000293:Adolescent; D000818:Animals; D001696:Biomechanical Phenomena; D002648:Child; D004195:Disease Models, Animal; D020342:Finite Element Analysis; D006132:Growth Plate / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology; D008954:Models, Biological; D051381:Rats; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D013169:Spondylolysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology