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Spinal Hemiepiphysiodesis Decreases the Size of Vertebral Growth Plate Hypertrophic Zone and Cells
Donita I. Bylski-Austrow, PhD1; Eric J. Wall, MD1; David L. Glos, BSE1; Edgar T. Ballard, MD1; Andrea Montgomery, BS1; Alvin H. Crawford, MD1
1 Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. E-mail address for D.I. Bylski-Austrow: Donita.Bylski-Austrow@cchmc.org
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Ethicon Endo-Surgery and DePuy AcroMed (now DePuy Spine) and less than $10,000 from the University of Cincinnati Women in Science and Engineering Fellowship. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (DePuy Spine, Ethicon Endo-Surgery, and SpineForm) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Mar 01;91(3):584-593. doi: 10.2106/JBJS.G.01256
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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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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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