Therapeutics Advances
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World J Orthop. Oct 18, 2013; 4(4): 167-174
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.167
Normal and abnormal spine and thoracic cage development
Federico Canavese, Alain Dimeglio
Federico Canavese, Pediatric Surgery, Pediatric Surgery Department, University Hospital Estaing, 63003 Clermont-Ferrand, France
Alain Dimeglio, Faculté de Médecine, Université de Montpellier, 34000 Montpellier, France
Author contributions: Canavese F and Dimeglio A contributed equally to this work, designed the aim of the editorial, generated the figures and wrote the manuscript.
Correspondence to: Federico Canavese, MD, PhD, Professor of Pediatric Surgery, Pediatric Surgery Department, University Hospital Estaing, 1, place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France. canavese_federico@yahoo.fr
Telephone: +33-4-73750293 Fax: +33-4-73750291
Received: March 5, 2013
Revised: June 7, 2013
Accepted: June 18, 2013
Published online: October 18, 2013
Processing time: 237 Days and 12.5 Hours
Abstract

Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive early-onset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension (cor pulmonale), which characterize thoracic insufficiency syndrome (TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations (e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases (e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth.

Keywords: Spine; Thorax; Thoracic cage; Growth; Early-onset spinal deformity; Children

Core tip: Development of the spine and thoracic cage is a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena follow a rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. Complex spinal deformities alter normal growth plate development and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time.